Report: Access to Rural Obstetric Care is on the Decline

July 21, 2025

It’s clear that mothers benefit from obstetric care but hospital-based services, particularly in rural areas, are getting harder to find, according to a study from the University of Minnesota School of Public Health.

The 12-year study found widespread losses in hospital-based obstetric services and variability across states—with disproportionate impacts in rural communities. The new analysis examined the status of obstetric services in nearly 5,000 acute-care hospitals in all 50 states and the District of Columbia from 2010–2022.

"Access to hospital-based obstetric care is eroding in rural and urban communities across many U.S. states. This is occurring alongside a maternal health crisis and in a rapidly-evolving state health policy environment," said Katy Backes Kozhimannil, lead author and co-director of the school’s Rural Health Research Center.

Here are a few key takeaways:

Devastating Impact:  Seven states saw at least 25 percent of all hospitals close their obstetric units. By 2022, eight states had more than two-thirds of rural hospitals without obstetric services.

Rural Hospitals Hit Harder:  Rural and urban obstetric service losses differed across states. From 2010–2022, more than 40 percent of rural hospitals lost obstetrics in Pennsylvania. Declines in access disproportionately affected rural hospitals in highly rural states.

Quotable:  "Obstetric unit closures can increase distance to care and put pregnant patients and newborns at risk. Our analysis revealed wide variability across states in obstetric care losses, and highlighted the growing access challenges faced by people living in rural communities and highly rural states," Backes Kozhimannil.

Read the report online.

In January, HAP released an action plan to improve maternal health outcomes, increase access to care, and eliminate disparities. Developed by HAP’s Task Force on Maternal and Child Health, the report provides recommendations for what Pennsylvania hospitals and policymakers can do to advance high quality and equitable care, expand access, and strengthen and diversify the maternal health workforce.

HAP’s recommendations focus on expanding proven, evidence-based strategies for improving maternal health outcomes and equity, as well as public policies to address barriers such as workforce shortages, the commonwealth’s medical liability climate, and the long-term sustainability of labor and delivery services.

Learn more about HAP’s work to improve maternal health access online.