Noteworthy News

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These figures reflect the dismal state of rural-health-care infrastructure, which is particularly acute in maternity care. Since 2005, 109 rural hospitals have closed outright. Of those that remain, many have been closing down their labor-and-delivery units. Most rural hospitals no longer offer labor-and-delivery services, and in the past five years, an average of more than two rural hospitals a month have closed these units. As of 2023, 60 percent of rural counties had no hospital-based obstetric care. With few options available, rural women are less likely than urban women to receive prenatal care; this in turn makes them and their babies more susceptible to preventable complications.

Several related factors have contributed to these closures. Labor-and-delivery units have high fixed costs (physician and nurse salaries, birthing beds, fetal warmers), making them a financial liability if they are not operating at or near capacity. As fertility has declined, more units have gone into the red because they have too many empty beds. But even a steady flow of patients is not always enough: A rural hospital’s labor-and-delivery unit can struggle economically despite full beds because pregnant rural women are less likely than pregnant urban women to be enrolled in the commercial insurance plans that have high reimbursement rates. Instead, rural women are more likely to be enrolled in Medicaid, which has lower reimbursement rates, or to have no insurance at all.

Further, only 4 percent of the country’s ob-gyns practice in rural areas, which is where 10 percent of women ages 15 to 49 live. And that proportion is likely to fall even more because many new entrants to the field are not willing to do a residency or start a practice in states that restrict abortion, many of which are more rural.

Rural family doctors can and do still deliver babies in the absence of ob-gyns. But the proportion of generalist doctors willing and trained to do so has been declining for decades. Many family physicians I met while touring rural areas as part of a Brookings and American Enterprise Institute commission on rural life cited liability risks as the motivator of their retreat from maternity care. Adverse birth outcomes are among the most common claims against physicians in medical-malpractice lawsuits, and awarded judgments can be very high, which inflates the liability-insurance premiums that doctors must pay. In addition, in places with few ob-gyns, a generalist is more likely to have to handle high-risk cases without expert help.

https://www.theatlantic.com/ideas/2026/0...ty/688091/