• Posted December 5, 2024

America's Rural Hospitals Are Shutting Down Maternity Wards

Hospitals across America are shuttering their obstetric units, and the issue is most acute for women served by rural hospitals, a new study finds.

By 2022, a majority (52%) of rural U.S. hospitals no longer had any maternity ward, compared to 36% of urban hospitals, according to a study from the University of Minnesota.

Study lead author Katy Kozhimannil believes these closures will only increase the vulnerability of new moms and their babies.

“Rural hospitals not only started with fewer obstetric services but also experienced more severe losses over time, leaving rural residents with fewer options and longer distances to travel -- often at times when patients are in urgent need of timely care," said Kozhimannil, a professor of health policy and management at the university.

The United States already has maternal mortality rates that are higher than other affluent countries, and without more investment in obstetric care, "this public health crisis will only get worse," she said in a university news release.

The research was published Dec. 4 in the Journal of the American Medical Association.

Her team looked at U.S. hospital data from the American Hospital Association and the U.S. Centers for Medicare & Medicaid Services. The data spanned the years 2010 through 2022 and included 2,982 city hospitals nationwide and 1,982 rural hospitals.

During that time, the share of hospitals reporting no obstetric services rose from 35% to 46%, the study found, with relative declines in rural areas outpacing those observed in cities.

In total, 537 hospitals discontinued their obstetric care -- 299 in urban areas and 238 in rural locales. But urban centers were also more likely to add a maternity unit, helping make up for those losses.

Between 2010 and 2022, "138 U.S. hospitals added obstetric care, with most gains occurring in urban areas -- 112 urban hospitals and 26 rural," the researchers said.

Why are Americans losing their maternity wards? The researchers believe that it comes down to money: Obstetric services tend to be less profitable for hospitals.

Speaking to the New York Times, Kozhimannil explained that 40% of U.S. births are now covered by Medicaid, which typically pays significantly less than private insurance does.

“It is rare for an obstetric unit to operate in the black,” Kozhimannil told the Times. “It is a service line that tends to be subsidized by other more lucrative service lines.”

Childbirth is costly, because moms-to-be often require round-the-clock monitoring and specialists on call, in case emergency care (such as a C-section) is needed.

Medicaid also has a flat-rate payment system for deliveries, no matter how complicated an individual delivery might have been.

Put together, this means that services on other wards are often more profitable on a per-bed basis.

“When you’re a small hospital looking at the alternatives of what you could turn a bed into, it might be more advantageous to have a general-ward bed or not even have to staff the bed at all,” Dr. Scott Lorch, chief of neonatology at the Children’s Hospital of Philadelphia, who has studied maternity ward closures, told the Times.

All these ward closures may prove dangerous for the health of women and their babies, Kozhimannil.

“Maternal mortality is a tragedy for too many families, and the consequences reverberate for generations," she said in the news release. "Closure of obstetric units and further limiting access to quality health care is only going to make the problem worse."

More information

There's more on obstetric care at the American College of Gynecologists.

SOURCE: University of Minnesota, news release, Dec. 4, 2024; New York Times