Why It Matters
The closure of obstetric units at rural hospitals is narrowing access to childbirth services for low-income pregnant women across America. In 14 states, the loss of a nearby maternity facility would force Medicaid patients to drive an hour or more to reach alternative care, raising risks during pregnancy emergencies and complicating access to prenatal and delivery services in economically fragile regions.
What Happened
Between 2010 and 2022, rural hospitals across the United States eliminated 238 obstetric units while opening only 26 new ones, according to federal data. By 2023, nearly half of all rural counties had no hospital offering inpatient maternity services at all. The trend reflects a widening gap in birth-related care between rural and urban America, with Medicaid-dependent populations facing the steepest barriers to timely medical attention during labor and delivery.
Fourteen states have seen their rural obstetric networks shrink so severely that closure of the nearest facility would force pregnant women on Medicaid to travel more than one hour to find alternative hospital maternity care. Alaska, Nevada, and North Dakota face the longest potential driving times, while Arizona, Colorado, Florida, Hawaii, Massachusetts, Montana, New Hampshire, New Mexico, Vermont, Virginia, and Wyoming all have median travel distances of one hour or more. By contrast, New Jersey, Louisiana, and Ohio maintain relatively short average drive times to rural maternity services.
The disparity between rural and urban access is stark. Medicaid patients in rural areas face a median drive time of 43 minutes between the nearest two hospitals offering inpatient maternity care, compared to just 13 minutes for those in urban settings. Low Medicaid reimbursement rates have emerged as a primary culprit; a 2022 Government Accountability Office report cited inadequate payment levels and difficulty recruiting and retaining obstetric providers as the chief reasons rural hospitals have shuttered their maternity units.
By the Numbers
14 — states where closure of the nearest rural obstetric facility would force Medicaid patients to drive one hour or longer
238 — rural hospital obstetric units closed nationwide between 2010 and 2022
26 — new rural hospital obstetric units opened during the same period
43 minutes — median drive time between rural hospitals with inpatient maternity care and the closest in-state alternative for Medicaid patients
13 minutes — median drive time between urban hospitals with inpatient maternity care and the closest in-state alternative for Medicaid patients
Almost 50% — rural counties without any hospital offering obstetrics services as of 2023
17.9 per 100,000 live births — U.S. maternal mortality rate in 2024
Zoom Out
Rural hospital maternity closures reflect a broader crisis in rural healthcare infrastructure nationwide. Rural hospitals have faced mounting financial pressure from declining patient volume, aging populations, and inadequate insurance reimbursement. The obstetrics specialty has proven particularly vulnerable because delivering babies requires 24/7 staffing, specialized training, and malpractice insurance costs that rural facilities often cannot sustain on Medicaid rates.
Recent data on maternal outcomes underscore the stakes. A survey of Medicaid patients who gave birth in 2023 and 2024 found they experienced more complications than women with private insurance—a disparity that extended travel times and delayed care access could exacerbate. The Trump administration’s tax and spending law is expected to further tighten hospital finances by reducing certain Medicare and Medicaid payments while cutting Medicaid enrollment through work requirements, potentially accelerating closures.
What’s Next
As more rural obstetric units close, policymakers face pressure to stabilize rural maternity services through targeted payment reforms and workforce development initiatives. Brittni Frederiksen of the Kaiser Family Foundation told Penn Capital-Star that “there are likely going to be rural hospitals that close their obstetric units or have to close the entire hospital, and so people will have greater distances to travel to safely deliver a baby.” Without intervention, the gap in maternal healthcare access between rural and urban communities will likely widen, leaving low-income pregnant women in underserved regions with fewer options for safe, timely delivery care, as first reported by the Pennsylvania Capital-Star.