WASHINGTON, DC — Fewer than half of rural hospitals in the United States still deliver babies, and 139 of them have stopped offering labor and delivery services since 2020. The loss is being felt far beyond maternity wards, because each closure can add distance for expectant mothers while also pushing physicians, jobs and young families out of the communities they served.
More than one-third of U.S. counties, 35.1% in the most recent national count, are now considered maternity care deserts. Those are places with no hospital or birth center offering obstetric care and no obstetric clinicians at all, a shortage that makes childbirth harder to access in much of rural America.
What The Numbers Show
The piece points to several examples of how quickly the problem can spread. When Bonner General Health in Sandpoint, Idaho, ended labor and delivery services in 2023, the hospital said declining birth volume, fewer pediatricians and a legal climate that had driven physicians to leave the state all played a role. Residents were left with at least a 46-mile drive to the nearest labor and delivery unit.
Idaho has since lost roughly one-third of its OB-GYNs statewide, making it harder for other hospitals to keep their own maternity units open. Missouri has also seen 11 hospital obstetric units disappear since 2009, and administrators there say they often use money from other departments to keep maternity care going because Medicaid reimbursement does not cover the full cost.
Economic Ripple Effects
The reporting also lays out the broader economic stakes. Researchers do not all agree on how much a rural hospital closure changes county income, but some studies have found lower employment, a smaller labor force and population decline after a closure. One study found that a rural hospital closure was linked to an 8.3% drop in primary care physicians and a 4.8% drop in OB-GYNs practicing in the county afterward.
Those losses matter because hospitals are often major employers and anchors for local commerce. When a labor and delivery unit closes, the community can lose not only clinical access but also the workers and families whose spending helps support stores, schools and housing demand.
What Comes Next
The article argues that the federal response is mixed. A 2025 budget law reduced projected Medicaid spending by an estimated $911 billion over 10 years and also created a $50 billion Rural Health Transformation Program. States are now using that money for workforce and telehealth efforts, but advocates have warned it may not make up for coverage losses in places that expanded Medicaid.
The piece says the most useful responses would include higher Medicaid obstetric reimbursement, a national version of the value-based payment model CMS is piloting in 15 states, and clearer tracking of obstetric unit closures as their own category. It also points to the continuing maternal mortality gap, noting that Black mothers still die at more than three times the rate of white mothers.
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