By 2023, 60% of rural counties and 38% of urban counties did not have any hospital-based obstetric services, according to the University of Minnesota’s Rural Health Research Center report.
The “Availability of Hospital-Based Obstetric Services in the United States by County, 2010–2023: A State-by-State Report” used data from 2010 through 2023 from the American Hospital Association Annual Surveys, CMS provider of services file, and reviewed hospital websites. The data, collected through October, analyzed hospital-based obstetric services available in aggregate at the county level. Short-term acute care hospitals, obstetrics and gynecology specialty hospitals, or children’s short-term acute care hospitals that provide OB services at any point during the study period were included.
Here are seven key findings:
1. Between 2010 and 2023, 8.6% of the U.S. lost all hospital-based obstetric services, with most of those losses happening between 2022 and 2023.
2. Between 2022 and 2023, obstetric service losses at the county level were concentrated in California, Idaho, Indiana, Minnesota, and Nebraska, all of which lost services in two counties each. Illinois and Kansas lost services in three counties and Ohio lost services in four counties.
3. Iowa had the most counties lose services between 2010 and 2023, at 20 counties.
4. Over 50% of all counties lacked hospital-based obstetric services in 23 states, with the highest number being in North Dakota (79%), Kentucky (68%) and South Dakota (68%).
5. Over 75% of rural counties lacked hospital-based obstetric services in Florida, North Dakota, Virginia and West Virginia.
6. Florida, Georgia, Illinois, Louisiana, North Dakota, Oklahoma and Tennessee all had over 90% of rural noncore counties — non-metropolitan counties without a town of 10,000 or more — without hospital-based obstetric services.
7. North Dakota was the only state to gain hospital-based obstetric services in 2023 in a county without those services. This gain was in a rural noncore county.
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