Rural hospitals shutter labor, delivery units

Editor's Note

Rural hospitals throughout the country are struggling to maintain labor and delivery units amid dwindling numbers of births, KFF Health News reported July 15, noting that more than half lack these services entirely.

Nationwide, annual births have fallen from 4.3 million in 1957 to below 3.7 million by 2022, despite the U.S. population nearly doubling. Many Americans now choose smaller families or no children, a trend exacerbated in rural areas by young adults moving away, KFF reports.

Although 13 states, including Arizona, California, and Florida, have seen birth increases due to attracting newcomers, rural areas in these states have also experienced obstetric unit closures. According to the article, hospitals often cite declining births and staffing challenges when closing obstetrics units, impacting pregnant women who need to travel further for care.

The article focuses specifically on Iowa, where at least 41 hospitals—representing a third of the state total—have shuttered labor and delivery units since 2000. Citing federal records, KFF reports annual births have dropped 75% in some of this state’s counties since the height of the baby boom in the 1950s and ’60s, when many rural hospitals were built or expanded. The full report details the experience of Oskaloosa’s Mahaska Health, which has seen annual deliveries increase from 160 to 250 after not only keeping the labor and delivery unit open, but also expanding services.

Overall, experts argue that maintaining high-quality care is more crucial than keeping all obstetrics units open, suggesting consolidations and improved training for rural health providers, KFF reports. The decline in rural births often leads to a cycle of further unit closures and discourages young families from settling in these areas, driving birth rates even lower.