Characteristics of US Rural Hospitals by Obstetric Service Availability, 2017

Abstract

Objectives. To describe characteristics of rural hospitals in the United States by whether they provide labor and delivery (obstetric) care for pregnant patients. Methods. We used the 2017 American Hospital Association Annual Survey to identify rural hospitals and describe their characteristics based on the lack or provision of obstetric services. Results. Among the 2019 rural hospitals in the United States, 51% (n = 1032) of rural hospitals did not provide obstetric care. These hospitals were more often located in rural noncore counties (counties with no town of more than 10 000 residents). Rural hospitals without obstetrics also had lower average daily censuses, were more likely to be government owned or for profit compared with nonprofit ownership, and were more likely to not have an emergency department compared with hospitals providing obstetric care (P for all comparisons < .001). Conclusions. Rural US hospitals that do not provide obstetric care are located in more sparsely populated rural locations and are smaller than hospitals providing obstetric care. Public Health Implications. Understanding the characteristics of rural hospitals by lack or provision of obstetric services is important to clinical and policy efforts to ensure safe maternity care for rural residents. (Am J Public Health. Published online ahead of print July 16, 2020: e1–e3. doi:10.2105/AJPH.2020.305695)

Birth Volume and Geographic Distribution of US Hospitals With Obstetric Services From 2010 to 2018

“…For hospitals with discrepancies in these criteria, inclusion was determined after validation of the AHA criteria against the POS data. Manual verification was performed for any remaining discrepancies or uncertainties . Obstetric hospitals were identified annually (hospital-year) to include those that gained or lost obstetric services during the study period …”

“…Manual verification was performed for any remaining discrepancies or uncertainties. 27,28 Obstetric hospitals were identified annually (hospital-year) to include those that gained or lost obstetric services during the study period. 4…”

Disparities in early prenatal care and barriers to access among American Indian and white women in North Dakota

“…In addition to under‐resourced IHS and tribal health care facilities, other rural care providers that could bridge these gaps in care have limited capacity to provide OB care. A study using the American Hospital Association Annual Survey (2017) found that roughly 51% (n = 1,032) of rural hospitals did not provide obstetric care 27 . The effect of historic and continuing systemic discriminatory policy may be manifest in the higher prevalence of structural (ie, transportation) and economic (ie, too busy and no childcare) barriers reported by AI/AN women than women of other racial groups in ND.…”

Reimagining and reinvesting in rural hospital markets

“…12 Similarly, obstetric unit closures have disproportionately affected rural communities with a higher proportion of Black residents, those in more remote areas, and in states with less generous state Medicaid programs. 13,14 Promoting access to care in areas with low population density is inherently challenging. Even with recent closure trends, rural hospitals have more unoccupied beds than urban hospitals, suggesting little strain on aggregate availability.…”

“…Since 2010, rural counties with hospital closures have had above‐median shares of racialized residents, including Black and Hispanic people 12 . Similarly, obstetric unit closures have disproportionately affected rural communities with a higher proportion of Black residents, those in more remote areas, and in states with less generous state Medicaid programs 13,14 …”