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
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.