Rural Maternity Care at Risk

November 21, 2025

Since 2020, having a baby in rural America has become more and more challenging as hospitals close, access to services declines, and travel time to service providers increases, according to a report from the Center for Healthcare Quality & Payment Reform.

The report states that 117 rural hospitals in the U.S. have stopped delivering babies or announced they will stop before the end of 2025, which is an 11 percent reduction in rural labor and delivery units. In Pennsylvania, four labor and delivery units have closed since 2020, 17 percent of which were at rural hospitals, according to the report.

Here are a few key takeaways: 

Pennsylvania’s picture:  Today, Pennsylvania has only 20 rural hospitals providing labor and delivery services, with at least one at risk of closure, according to the report. Across the state, 32 rural hospitals have ceased labor and delivery services, which has resulted in a median travel time of 38 minutes for maternity care, the report states.

Why it matters:  When mothers have to travel greater distances for care, it can increase the chances of complications. In urban areas, the travel times to a hospital with labor and delivery services is typically under 20 minutes; but in rural areas, it may be 50 minutes or greater. Patients are also less likely to receive postpartum care if they do not have local maternity services, the report states.

Financial losses:  Since rural hospitals lack the economies of scale of urban hospitals for other services, it’s harder for them to offset financials losses on maternity care. Rural communities are at risk of losing maternity care because payments from private insurance plans and Medicaid programs do not reflect the true cost of delivering maternity care in rural areas.

Contributing factors:  The national health care workforce shortage has added to the challenging picture facing rural hospitals. Recruiting providers to rural areas comes with unique challenges.  

HAP continues to highlight the need to support Pennsylvania’s rural hospitals. Earlier this year, HAP shared an action plan for how Pennsylvania hospitals and policymakers can support maternal health access, including aligning reimbursement with the cost of care and addressing the commonwealth’s medical liability climate.

Read the report online.