Research Snapshot: Why are obstetric units in rural hospitals closing their doors?

New research from the University of Minnesota School of Public Health shows obstetric units in rural hospitals are closing their doors, due to difficulty in staffing, low birth volume, and financial burdens. As the annual birth volume decreases, additional rural hospitals will be vulnerable to obstetric unit closure in the future.

The study findings were published in the Health Services Research. Doctoral student and lead author, Peiyin Hung M.S.P.H., and her colleagues gathered hospital discharge data as well as conducted interviews to identify factors associated with unit closures between 2010 and 2014. The analysis found 7.2 percent of rural hospitals in the study closed their obstetric units. These units were typically small in size and located in communities with fewer resources including lower family income, fewer obstetricians and fewer family physicians.

“The decline of obstetric units interferes with the goals set by the Patient Protection and Affordable Care Act concerning timely access to quality care for women,” said Hung. “Rural women in these communities need to travel an average of 29 miles, with a range from 9 to 65 miles, for intrapartum care,” said Hung.

Those located in low supply of obstetric providers, such as family physicians and obstetricians, and those in low income communities are more likely to terminate their obstetric services.

“The continued decreases in number of family physicians being trained and choosing to provide obstetric care may put obstetric services in rural communities in danger,” said Hung. “Appropriate regionalization of maternity care need to be implemented, particularly in rural communities with greater risk of obstetric service discontinuation.”

Hung says future policy changes could help rural hospitals keep their obstetric units.

“Currently, the Improving Access to Maternity Care Act is under revision. This Act aims to identify maternity care workforce shortage areas and it may help monitoring and preparing for potential obstetric unit closures based on local perinatal needs,” said Hung.

Furthermore, over half of rural pregnant women are currently covered by Medicaid. Meaning, these Medicaid programs play a vital role in ensuring availability and accessibility of obstetric services for rural women as well as offer payment and coverage arrangements to reduce financial barriers for small rural hospitals.
“Future studies should examine the effects of obstetric unit closures on local women’s maternity care accessibility, childbirth costs, and maternal/neonatal outcomes, especially among women in rural areas where obstetric resources are very limited” said Hung.

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