Over the past four years, more than 80 rural hospitals across the country have stopped delivering babies, contributing to the growing majority of rural hospitals that lack labor and delivery services.
This finding comes from the Center for Healthcare Quality and Payment Reform. Its February report details the number of rural hospitals by state that lack maternity care services, those that do offer such services, the financial losses incurred from maternity care and the travel time to the nearest hospital providing OB services.
In most cities, reaching a hospital with labor and delivery services takes less than 20 minutes. However, in rural areas, travel times are typically 30 minutes or longer, often exceeding 50 minutes. The absence of local maternity care services increases the risk of complications and death for both mothers and babies.
"Over 80% of pregnancy-related deaths are preventable with appropriate prenatal, labor & delivery, and post-partum care," the CHQPR report notes. "Although improvements in maternity care are needed in all parts of the country to reduce mortality rates, one of the greatest challenges is in rural areas, because most rural hospitals are no longer providing maternity care at all."
Of the 960 rural hospitals that still offer labor and delivery services, 34% reported financial losses on patient services overall in the past year, putting their ability to continue delivering maternity care at risk.
Medicaid currently covers about 40% of all births in the United States, providing a critical safety net for low-income and rural families. Proposed changes to Medicaid funding could further destabilize maternity care, compounding an already fragile situation.
Below are the 20 states with the highest percentages of rural hospitals lacking OB or maternity care. Ties among states result in 30 states holding 20 rankings for the greatest proportion of hospitals without OB care.
Readers can find CHQPR's report on maternity care deserts among rural hospitals in full here.
1. Florida
Total rural hospitals: 22
Number without OB services: 20
Percentage without OB services: 91%
2. North Dakota
Total rural hospitals: 39
Number without OB services: 31
Percentage without OB services: 79%
3. West Virginia
Total rural hospitals: 33
Number without OB services: 25
Percentage without OB services: 76%
4. Louisiana
Total rural hospitals: 56
Number without OB services: 42
Percentage without OB services: 75%
Illinois
Total rural hospitals: 75
Number without OB services: 56
Percentage without OB services: 75%
5. Nevada
Total rural hospitals: 14
Number without OB services: 10
Percentage without OB services: 71%
Alabama
Total rural hospitals: 51
Number without OB services: 36
Percentage without OB services: 71%
6. Virginia
Total rural hospitals: 30
Number without OB services: 21
Percentage without OB services: 70%
7. Oklahoma
Total rural hospitals: 81
Number without OB services: 56
Percentage without OB services: 69%
8. Mississippi
Total rural hospitals: 73
Number without OB services: 50
Percentage without OB services: 68%
9. Arkansas
Total rural hospitals: 50
Number without OB services: 33
Percentage without OB services: 66%
10. South Dakota
Total rural hospitals: 49
Number without OB services: 32
Percentage without OB services: 65%
Pennsylvania
Total rural hospitals: 43
Number without OB services: 28
Percentage without OB services: 65%
11. Georgia
Total rural hospitals: 72
Number without OB services: 46
Percentage without OB services: 64%
Montana
Total rural hospitals: 55
Number without OB services: 35
Percentage without OB services: 64%
12. Kansas
Total rural hospitals: 100
Number without OB services: 63
Percentage without OB services: 63%
13. Iowa
Total rural hospitals: 93
Number without OB services: 57
Percentage without OB services: 61%
14. California
Total rural hospitals: 58
Number without OB services: 34
Percentage without OB services: 59%
15. Texas
Total rural hospitals: 163
Number without OB services: 95
Percentage without OB services: 58%
Colorado
Total rural hospitals: 43
Number without OB services: 25
Percentage without OB services: 58%
16. Kentucky
Total rural hospitals: 72
Number without OB services: 41
Percentage without OB services: 57%
17. Missouri
Total rural hospitals: 59
Number without OB services: 33
Percentage without OB services: 56%
Tennessee
Total rural hospitals: 54
Number without OB services: 30
Percentage without OB services: 56%
Washington
Total rural hospitals: 45
Number without OB services: 25
Percentage without OB services: 56%
18. Hawaii
Total rural hospitals: 13
Number without OB services: 7
Percentage without OB services: 54%
Michigan
Total rural hospitals: 65
Number without OB services: 35
Percentage without OB services: 54%
New York
Total rural hospitals: 52
Number without OB services: 28
Percentage without OB services: 54%
Ohio
Total rural hospitals: 71
Number without OB services: 38
Percentage without OB services: 54%
19. New Hampshire
Total rural hospitals: 17
Number without OB services: 9
Percentage without OB services: 53%
20. Indiana
Total rural hospitals: 54
Number without OB services: 28
Percentage without OB services: 52%