Rural Health
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Research Alert: November 3, 2026

Availability of Hospital-Based Obstetric Services in the United States by County, 2010–2024: A State-by-State Report

This state-by-state report reveals continued declines in availability of hospital-based obstetric services in both rural and urban U.S. communities. Between 2010 and 2024, 301 of the 3,144 counties (9.6%) in the U.S. lost all hospital-based obstetric services. Between 2023 and 2024, 30 counties lost these services, 24 of which were rural. By 2024, 61% of rural counties and 39% of urban counties did not have hospital-based obstetric services. Availability of obstetric care is further limited in less populated rural counties. Among rural noncore counties (counties without a town population of ≥ 10,000), 160 counties (12%) lost all hospital-based obstetric services between 2010 and 2024 (13 of these losses occurred recently, between 2023 and 2024). As a result, only 23% of rural noncore counties had any hospital-based obstetric services by 2024.

Additionally, this report highlights variation across states in county-level hospital-based obstetric services availability. Between 2010 and 2024, there were 10 states where more than 10 counties lost all hospital-based obstetric services; in Iowa, 20 counties lost these services during this time. In the most recent year of data available (between 2023 and 2024), obstetric service losses at the county level were concentrated in several states. Arkansas and Georgia both lost services in two counties each (all of which were rural); Alabama and Ohio lost services in three counties each (two of which were rural in both states); and Indiana experienced recent losses in six counties (four of which were rural). There were no states that gained hospital-based obstetric services in 2024 in a county without those services in 2023.

Contact Information:

Kevan O'Hanlon, MPH
Rural Maternal Health Data Support and Analysis Program
Phone: 612.626.8401
ohanl018@umn.edu

Additional Resources of Interest: