More and more, people giving birth can’t count on their closest hospital having the specialized health care they need.

Researchers tallied losses and gains of labor and delivery units at close to 5,000 U.S. hospitals from 2010 to 2022. The losses prevailed. More than half of rural hospitals and more than one-third of urban hospitals did not offer obstetric services in 2022, researchers report December 4 in the Journal of the American Medical Association. That’s worse than in 2010, when 43 percent of rural hospitals and 30 percent of urban hospitals lacked these services.

The cost of maintaining obstetric services, shortages of labor and delivery clinicians and nurses and safety are among the reasons that hospitals shut the units down, says Katy Kozhimannil, a health policy researcher at the University of Minnesota School of Public Health in Minneapolis. But when a hospital decides that the risks of keeping an obstetric unit are too high, she says, those risks don’t go away, but stay with the people giving birth (SN: 3/16/23). “People are still going to have babies and the place where they can deliver just gets further and further away.”

The absence of labor and delivery services can harm infant and maternal health, studies have found. Kozhimannil and colleagues compared rural counties that lost hospital-based obstetric services with rural counties that had these services. More remote rural counties — those not next to urban counties — without hospital-based obstetric services saw an increased risk of preterm birth, the team reported in the Journal of the American Medical Association in 2018. Preterm birth is a leading cause of infant mortality.

Women living in maternity-care deserts in Louisiana had a higher risk of pregnancy-related deaths compared with women who had more access to this care, a different group reported in Women’s Health Issues in 2020. Maternity-care deserts describe counties that have no hospitals offering obstetric services or only one and no or very few obstetric providers.

When a hospital in a rural area closes its obstetric unit, lactation and breastfeeding support, childbirth education classes, perinatal mental health services and postpartum support groups are less likely to be available too, Kozhimannil says. “Half of all maternal mortality occurs in the postpartum year,” she says. “Making sure that communities are well-equipped to support people is essential.”