Access to hospital-based obstetric care declining in rural, urban communities
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Key takeaways:
- The percentage of hospitals that offer no obstetric care grew from 35.2% to 42.4% from 2010 to 2022.
- Hospitals in rural counties experienced the largest losses in obstetric care.
Access to obstetric care at rural and urban short-term acute care hospitals across the U.S. steadily declined from 2010 to 2022, with the greatest impact seen among hospitals in rural counties, researchers reported in JAMA.
“We are more than a decade into a national maternal health crisis, yet fewer U.S. hospitals provide obstetrics every year, with rural hospitals experiencing the greatest losses,” Katy Backes Kozhimannil, PhD, professor at the University of Minnesota School of Public Health, told Healio. “After every closure, pregnant people must travel farther for care; as distance increases, so do maternal and infant risks. When a hospital decides that the risks are too much, and they close the obstetrics unit, that risk does not disappear. The risks transfer to the pregnant people and families in that community, and this is happening in both rural and urban settings.”
In a retrospective study, researchers assessed the availability of hospital-based obstetric services annually for 4,964 U.S. short-term acute care or obstetrics/gynecology specialty hospitals, using American Hospital Association annual surveys and CMS Provider of Services files from 2010 to 2022.
Researchers defined obstetric status using four American Hospital Association variables (reported provision of obstetric services; at least level 1 obstetric care; at least one dedicated obstetric bed; and at least 10 births per year) and at least Provider of Services-indicated obstetric clinician. Hospital rurality was classified using Office of Management and Budget definitions; researchers identified 1,982 hospitals in rural counties and 2,982 hospitals in urban counties.
Among rural and urban hospitals, researchers analyzed losses and gains of obstetric services from 2010 to 2022, calculating the percentage of hospitals without obstetrics among hospitals open during the indicated year.
In 2010, 43.1% of rural hospitals and 29.7% of urban hospitals did not offer obstetric care.
Each subsequent year, researchers observed a net loss of obstetric services at U.S. hospitals. Between 2010 and 2022, 537 hospitals lost obstetrics, including 238 rural hospitals and 299 urban hospitals. During the same period, 138 hospitals gained obstetric services, though they were disproportionately located in urban areas (n = 112) vs. rural areas (n = 26).
In 2022, 52.4% of rural hospitals and 35.7% of urban hospitals did not offer obstetric care.
From 2010 to 2022, the percentage of all hospitals without obstetrics rose from 35.2% to 42.4%, with a higher percentage among rural vs. urban hospitals during each year, according to the researchers.
The researchers noted that the data did not include births outside hospital settings, which make up less than 2% of U.S. births. Additionally, descriptive hospital-level data did not contain patient-level information, so researchers were unable to assess how any obstetric status changes affected patient outcomes.
“It will be important for future research to focus both on the causes of closures in the current and changing policy environment, as well as the consequences for rural and urban communities that lose access to hospital-based obstetric care,” Kozhimannil told Healio.
For more information:
Katy Backes Kozhimannil, PhD, can be reached at kbk@umn.edu.