In some cases the loss of obstetric services stems from entire rural hospitals closing, and in other cases cash-strapped hospitals are forced to cut services such as obstetrics in order to stay open. Obstetrician-gynecologists face the highest malpractice insurance rates of any specialty, which makes it an expensive proposition for hospitals. Low numbers of births also factor into hospitals feeling that obstetrical services are expendable. And obstetricians might not want to relocate to rural areas.
The study's findings underscore the health and accessibility disparities between rural and urban women. Rural women "are more likely to report having fair or poor health, be obese, smoke cigarettes, commit suicide and have cervical cancer than their urban counterparts," Johnson reports. "But the recent trend could exacerbate disparities in reproductive health, too. One recent study found that rural areas had made far fewer gains in improving infant mortality compared with the rest of the country."
A federal program, the National Health Service Corps, may help address the problem of rural obstetric access. Through the program, medical students can have their schooling paid for if they practice in an underserved community for a set period of time. Megan Evans, an OB-GYN at Tufts Medical Center in Boston, has been working with the American Congress of Obstetricians and Gynecologists to define underserved communities according to areas of need--including lack of obstetrical care. A bill to identify areas that need maternity care has passed the House and has been introduced in the Senate.