The loss of hospital-based obstetric services threatens maternal and reproductive healthcare access for millions of Americans. Between 2010 and 2022, 537 U.S. hospitals discontinued obstetric services through unit or hospital closure. As of 2022, 52% of rural hospitals and 36% of urban hospitals lacked obstetric services, resulting in barriers to prenatal care, reduced delivery options, and increased travel time to obtain care.
Seeking insight into the causes of this trend, researchers at the University of Minnesota School of Public Health recently examined the hospital-level factors associated with obstetric services loss. The results of their study were published in JAMA.
Research Focus and Findings
The researchers conducted a retrospective cohort study of all U.S. hospitals that provided obstetric services in 2010, using data from the American Hospital Association Annual Surveys, the Centers for Medicare and Medicaid Services’ Provider of Services Files, hospital websites, and news articles. Among 1,126 rural hospitals with obstetric units open in 2010, 239 (21.2%) had closed their obstetric units and 42 (3.7%) had closed entirely by 2023. Among 1,982 urban hospitals open in 2010, 250 (12.6%) had closed their obstetric units and 92 (4.6%) had closed entirely by 2023.
Factors associated with obstetric unit closure included low birth volume and unprofitability, i.e., negative operating margins. Rural hospitals with the lowest birth volume (fewer than 150 births) had a 36.4% predicted probability of unit closure, compared to only a 5.2% predicted probability of unit closure for rural hospitals with the highest birth volume (more than 500 births). Rural hospitals classified as unprofitable, meaning they had negative operating margins, had a 30% predicted probability of unit closure, compared to a 17.8% predicted probability of unit closure for rural hospitals with profitable operations. In rural areas, for-profit hospitals had a 33.7% predicted probability of unit closure, compared to a 19.7% predicted probability of unit closure for government-owned hospitals. Notably, even among the hospitals maintaining obstetric services in 2023, 41% exhibited characteristics associated with vulnerability to future service closure.
Insights for Arkansas
According to an October 2026 report by the Center for Healthcare Quality and Payment Reform, rural Arkansas faces a critical maternal health crisis. Since 2020, 27% of labor and delivery units at rural Arkansas hospitals have closed, and among the remaining units, 38% are at risk of closing.
Currently, only 30 hospitals in Arkansas provide labor and delivery services, meaning women in only 24 of Arkansas’s 75 counties can access obstetrical care within their home counties. Recent obstetric unit closures at Ouachita County Medical Center and Baptist Health-Fort Smith exemplify this trend.
The insights from the JAMA study can be used to help predict which hospitals are at risk of losing their obstetric units. Additionally, these metrics can be used to help set targets to avoid closure. For example, the probability of obstetric unit closure drops by at least 14.9 percentage points if a hospital exceeds 150 births annually.
