Year(s) Funded: 2019-2020
Topic(s): Emergency Medical Services and Trauma, Health Disparities and Health Equity, Healthcare Access, Maternal Health, Women
Project Lead: Katy Kozhimannil
Increasingly, rural hospitals are closing obstetric units, and local families have to travel far from home to give birth. Compared to urban residents, rural residents have less access to services, more frequently live in areas with healthcare workforce shortages, and travel longer distances to receive maternity care.
By 2014, more than half of rural counties had no hospital that provided care for childbirth; 179 rural counties lost obstetric services from 2004-2014, and at that time, fewer than half of rural counties had a hospital that provided obstetric care. Our research has documented the potential health risk of losing hospital-based obstetric services, including increases in preterm delivery, out-of-hospital births, and emergency room births.
Prior studies on emergency obstetric care access in rural America date back 25 years, and substantial hospital and obstetric unit closures have occurred since then, alongside changes in technology and practice patterns, as well as maternal health outcomes. Data on emergency childbirth care in the rapidly changing rural U.S. context is urgently needed to support state and federal policy efforts aimed at improving rural maternity care access and supporting the viability of rural healthcare delivery systems for meeting the needs of rural residents. Limited information is available about local preparedness and capacity to support emergency obstetric services in rural communities with no hospital that provides this care or those that close this service line. This project aimed to provide these data.
Using the 2018 American Hospital Association Annual Survey, we identified rural hospitals that do not provide obstetric services, distinguishing Critical Access Hospitals and Prospective Payment System hospitals. We then described the characteristics of these rural hospitals in terms of hospital size, location, and service lines. We conducted a survey among a sample of rural hospitals that do not provide obstetric services, across all U.S. census regions, to ascertain local emergency obstetric capacity. We also conducted a site visit to guide interpretation and write-up of study findings.
Related Publications
- Emergency Obstetric Training Needed in Rural Hospitals without Obstetric Units, November 19th, 2020
- Obstetric Emergencies in Rural Hospitals: Challenges and Opportunities, September 10th, 2020