Connecting state and local government leaders

Rural Access to Obstetric Services Continues to Decline

Minot, North Dakota

Minot, North Dakota Michael Grass / Route Fifty


Connecting state and local government leaders

MAP: As many as 2.4 million women of reproductive age live in counties that completely lack these services.

Twenty-eight million women of reproductive age live in rural America. New research has found that the number of those women that live in counties without any hospital obstetric services is high and continues to rise.

Researchers from the University of Minnesota School of Public Health examined five sources of data from the period between 2004 and 2014 with a focus on 1,249 hospitals in 1,086 rural counties.

They found that in that decade in question, 9 percent of rural counties experienced a total loss of hospital obstetric services—a finding that adds an additional warning to an already dire situation. Forty-five percent of all rural U.S. counties already lacked hospital obstetric services during that same period of time. The additional closures during that decade left more than half of all rural counties—home to 2.4 million women of reproductive age—completely devoid of these services.

The research suggests might that these rural counties have a few things in common.

According to the study’s authors, counties were more likely to lack hospital obstetric services if they had a higher percentage of non-Hispanic black women of reproductive age, lower median household incomes and a higher percentage of residents in poverty. Likewise, counties were more likely to lack these services if they are located in states with more restrictive Medicaid income eligibility thresholds for pregnant women. In some states in 2017 a pregnant woman may only be eligible for Medicaid coverage if her income is lower than 380 percent of the federal poverty level.

A few states were hit particularly hard by the decline in hospital obstetric services. Twenty percent of rural counties in North Dakota and South Carolina completely lost these services over the past 10 years.

Hospital obstetric services by U.S. counties, 2004-14 (via Project HOPE)

This research also comes at a time when public health officials across the United States are sounding an alarm on rising maternal mortality rates in the United States. More women are dying of pregnancy-related complications here than in any other developed country.

This problem is demonstrably more serious in rural parts of the country than in cities.

Rural hospitals report higher rates of postpartum hemorrhage and of blood transfusion during delivery than in urban settings and maternal and infant mortality rates in rural parts of the country are higher in rural areas than in metropolitan areas.

Quinn Libson is a Staff Correspondent for Government Executive’s Route Fifty and is based in Washington, D.C.

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