A comprehensive new study reveals a troubling trend in American healthcare - more than 500 hospitals have shuttered their labor and delivery departments since 2010, creating vast gaps in access to maternity care across both rural and urban areas.
The research, published in JAMA, shows that while approximately 130 new maternity units opened during this period, the overall decline has left most rural hospitals and over one-third of urban facilities without obstetric services. This reduction in care options coincides with persistently high maternal mortality rates in the United States.
The closures stem from multiple factors, with financial pressures playing a central role. Maternity units typically operate at a loss since Medicaid, which covers over 40% of U.S. births, provides lower reimbursement rates compared to private insurance. Hospitals must maintain round-the-clock specialist coverage for emergencies while receiving fixed payments per delivery regardless of complications.
Staffing shortages have further strained remaining facilities. An estimated 100,000 nurses left healthcare during the COVID-19 pandemic, making it increasingly difficult for hospitals to maintain adequate staffing for maternity services.
The impact is felt across both rural and urban communities. In rural areas, closures force expectant mothers to travel long distances for care, sometimes resulting in emergency room deliveries. Urban areas saw 299 maternity unit closures between 2010-2022, creating challenges for patients with limited transportation options.
Dr. Katy Kozhimannil, the study's lead author from the University of Minnesota, notes that this decline in access has persisted throughout America's ongoing maternal health crisis. The situation may worsen, as the study's data predates additional challenges following recent abortion restrictions in multiple states.
Some facilities are exploring alternative solutions. After closing its maternity ward in 2022, Plumas District Hospital in rural California is working to establish a midwife-staffed birth center. However, such stopgap measures may not fully address the growing gaps in maternal healthcare access across America.
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