Neonatal Care at Rural Hospitals: Describing Access, Closures and Levels of Childbirth-Related Care

Infant mortality increases with rurality. Most childbirth-related and infant deaths are preventable, and risks are elevated for people living in rural communities, where access to childbirth-related care is limited. Neonatal care access at birth is lifesaving for higher-risk infants, but there is no current research on access to and closures of neonatal units in rural communities, which are suffering the widespread loss of health care services.

Despite the interdependence of neonatal and obstetric services, a comprehensive examination of access to basic and/or specialty childbirth-related care is lacking. This project's goal was to describe access to childbirth-related care for families living in rural and urban communities; it documented access to neonatal care and the levels of that care, described rural counties that have lost access to neonatal care, and identified rural counties without access to either neonatal or obstetric services. This work informed clinical and policy efforts to ensure access to appropriate and necessary care at the time of childbirth, including maternal and infant transport policies and regional perinatal referral networks, as well as financial policies that support rural hospitals that provide these essential services.

Publications

• Availability of Higher-Level Neonatal Care in Rural and Urban U.S. Hospitals, 2010-2022
  Journal Article
  University of Minnesota Rural Health Research Center
  Date: 02/2026
  In this paper, researchers used mixed methods (survey data, administrative data, and primary sources) to identify childbirth services and higher-level neonatal care at hospitals in both rural and urban counties.
• Availability of Higher-Level Neonatal Care Services in Rural U.S. Counties, 2010-2022
  Policy Brief
  University of Minnesota Rural Health Research Center
  Date: 12/2025
  The purpose of this policy brief is to show the changes in the availability of higher-level neonatal care in rural U.S. counties from 2010 to 2022, and how this availability differs by rural county type (micropolitan vs. noncore).
• Local Availability of Neonatal Intensive Care at Rural Hospitals With Childbirth Services
  Journal Article
  University of Minnesota Rural Health Research Center
  Date: 11/2025
  In this paper, researchers used survey data to better understand county and hospital-level characteristics of rural U.S. hospitals based on distance to the nearest neonatal intensive care unit (NICU).