Rural US counties continue to lose obstetric services
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Rural counties in the United States — especially the least-populated, most remote counties — continue to lose basic obstetric services, according to a study published in JAMA.
A steady decline over the course of a decade left 54% of rural U.S. counties without hospital-based obstetric services in 2014, according to Katy B. Kozhimannil, PhD, MPA, Julia D. Interrante, MPH, and colleagues from the University of Minnesota. In the new study, the researchers reported that about 53% (n = 1,045) of hospitals in rural U.S. counties never had obstetric services during a 5-year period from 2014 through 2018, and that nearly 3% of them lost these services during those years.
“Loss of hospital-based obstetric services in rural communities is accompanied by increases in emergency department births, which have important clinical implications as emergency departments are often not staffed and equipped to handle such situations,” Kozhimannil and Interrante told Healio. “Loss of obstetric services can also lead to higher rates of preterm birth in the most remote rural counties.”
The study included data from 6,233 hospitals in all 3,145 U.S. counties — 1,976 rural and 1,169 urban counties — that were available from the American Hospital Association annual survey and other files.
From 2014 to 2018, 2.7% (n = 53) of rural counties lost hospital-based obstetric services, the researchers reported. The losses were most frequent in rural counties with no towns of more than 10,000 people, where 3.5% of hospitals lost services. Obstetric services were already rare in these counties — 68.7% never had them during the study period, according to the report. Among these counties, three experienced hospital closure and 52 had hospitals that closed their obstetric units.
Losses were even worse — 4.3% — when the county was rural, had no large towns and also was not adjacent to an urban area. Losses of at least 1% also occurred in rural areas with larger towns that were adjacent to urban areas.
“Parents and clinicians should be aware of the risk of loss of hospital-based obstetric services as many rural hospitals have faced increased financial strain, especially given the additional financial pressure due to the COVID-19 pandemic,” Kozhimannil and Interrante said.
The authors said policymakers should support rural communities to ensure that hospitals without obstetric services — and those that lost them — will be prepared for emergency births and possible transfers.
“Policymakers should also ensure that Medicaid reimbursement rates for births in rural areas are adequate to support the maintenance of rural obstetric services and should ensure that state scope of practice laws help increase access to a variety of providers, including nurse practitioners and midwives, to support the health care needs of pregnant rural residents and families,” they said.
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