Closing rural labor and delivery units poses problems for women, babies and rural population growth

Addie Comegys travels 45 minutes for her prenatal visits. 
(Photo by Tony Leys, KFF Health News)

As rural women have fewer babies, hospitals that once served more remote locations have closed their labor and delivery units, which leaves rural pregnant women facing maternity care deserts, reports Tony Leys of KFF Health News. In many areas, women leaving or not wanting to relocate to smaller towns with limited obstetric care has contributed to rural population loss.

Rural areas surrounding Oskaloosa, Iowa, population 11,558, illustrate how obstetric care has become long-distance care for some pregnant women. "At least 41 Iowa hospitals have shuttered their labor and delivery units since 2000," Leys writes. "Those facilities, representing about a third of Iowa hospitals, are located mostly in rural areas where birth numbers have plummeted."

Addie Comegys, who lives in southern Iowa and is expecting a baby in August, has spent part of her summer driving "45 minutes each way for prenatal checkups at Oskaloosa's hospital," Leys writes. "Oskaloosa's hospital has kept its labor and delivery unit open, partly by pulling in patients from 14 other counties." Not every smaller hospital has that geographical benefit.

For women who don't have reliable transportation or flexible work schedules, longer travel to see an obstetric provider becomes a barrier to care. Declining births have accelerated the problem. "Katy Kozhimannil, a University of Minnesota health policy professor who studies rural issues, said declining birth numbers and obstetric unit closures can create a vicious cycle," Leys reports. "Fewer babies being born in a region can lead a birthing unit to shutter. Then the loss of such a unit can discourage young people from moving to the area, driving birth numbers even lower."

Despite delivering far fewer babies, some rural hospitals have kept their units open, but that choice has posed care challenges. "A study published in JAMA in 2023 found that women were more likely to suffer serious complications if they gave birth in rural hospitals that handled 110 or fewer births a year," Leys writes. "The authors said they didn't support closing low-volume units because that could lead more women to have complications related to traveling for care. Instead, they recommended improving training and coordination among rural health providers."