This study describes state variations in 1) the availability of hospital-based obstetric services, and 2) the scope of obstetric unit and hospital closures resulting in the loss of obstetric services in rural U.S. counties from 2004 to 2014. This is the second in a series of two policy briefs examining the closure of hospital obstetric services in rural areas; a companion policy brief takes a national perspective, whereas this brief documents state-level variability in access to hospital-based obstetric services in rural counties from 2004-2014.

Key Findings
With this study, we found that between 2004 and 2014:

• County-level access to hospital obstetric (OB) services varied considerably across states.
• More than two-thirds of rural counties in Florida (78%), Nevada (69%), and South Dakota (66%) had no in-county hospital OB services.
• Rural counties in South Carolina (25%), Washington (22%), and North Dakota (21%) experienced the greatest decline in hospital OB services.
• North Dakota (15%), Florida (17%), and Virginia (21%) had the lowest percentage of rural counties with continual hospital OB services owing to loss of hospital OB units in rural noncore areas of North Dakota and Virginia, and in micropolitan areas of Florida.