Loss of obstetric services at hospitals in rural counties puts mothers at a higher risk of preterm birth and birth outside of a hospital or in a hospital without an obstetric unit.
The issue: People who live in rural areas often experience worse health outcomes, due in part to issues of access to care. One area of health care that in recent years has suffered dramatic losses in rural areas is obstetric services. Less than half of rural counties have hospital-based obstetric services now. As hospitals lose these services, rural mothers face challenging decisions about where and how they will receive their care.
Researchers at the University of Minnesota and Yale theorized that changes in access to care could have effects on preterm birth rates, which are linked to increased risk of infant mortality. The scholars analyzed data to discover the outcomes of these changes on a variety of measures associated with maternal and infant health.
An academic study worth reading: “Association Between Loss of Hospital-Based Obstetric Services and Birth Outcomes in Rural Counties in the United States,” published in JAMA, 2018.
About the study: Researchers looked at data collected between 2004 and 2014 on births occurring in 1,086 rural counties in the United States. This encompassed almost 5 million births. The scholars compared the rates of out-of-hospital births, births in hospitals without obstetric units and preterm deliveries for counties that had in-hospital obstetric services and those that did not.
Key findings:
- Over the 10 years studied, 179 counties lost in-hospital obstetric services.
- Loss of obstetric services in rural counties not adjacent to urban areas was linked to a 0.7 percentage point increase in out-of-hospital births, a 3 percentage point increase in births in a hospital without an obstetric unit, and a 0.7 percentage point increase in preterm births in the year following the closure compared to counties where women continued to have access to in-hospital obstetric services.
- Loss of obstetric services in rural counties that were adjacent to urban areas was linked to a 1.8 percentage point increase in births in a hospital without an obstetric unit.
- Pregnant women went for prenatal visits less often in rural counties that lost obstetric services.
Other resources:
- The U.S. Health Resources and Services Administration’s Maternal and Child Health Bureau collects relevant data and research.
- The U.S. Centers for Disease Control and Prevention’s Division of Reproductive Health describes initiatives aimed at reducing infant mortality They also offer statistics on infant mortality by state.
- The University of Minnesota Rural Health Research Center produced a report in 2017 on access to obstetric services in rural U.S. counties.
- ProPublica’s Lost Mothers series looks at maternal care in the U.S. and preventable deaths.
Related research:
- A study published in 2017 in Health Affairs, “Access to Obstetric Services in Rural Counties Still Declining, with 9 Percent Losing Services, 2004-14,” found that in the study period, 45 percent of rural U.S. counties did not have obstetric services.
- A study published in the Journal of Rural Health in 2016, “The Rising Rate of Rural Hospital Closures,” takes a wider look at recent declines in rural health care.
- A study published in the Canadian Medical Association Journalin 2016, “Maternal Morbidity and Perinatal Outcomes Among Women in Rural Versus Urban Areas,” found higher rates of severe maternal and neonatal morbidity in rural areas.
- We’ve covered research on the relationship between maternal education and infant mortality.
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