Why Are Obstetric Units in Rural Hospitals Closing Their Doors?

Peiyin Hung, Katy B. Kozhimannil, Michelle M. Casey, Ira S. Moscovice

Research output: Contribution to journalArticlepeer-review

74 Scopus citations


Objectives: To understand hospital- and county-level factors for rural obstetric unit closures, using mixed methods. Data Sources: Hospital discharge data from Healthcare Cost and Utilization Project's Statewide Inpatient Databases, American Hospital Association Annual Survey, and Area Resource File for 2010, as well as 2013-2014 telephone interviews of all 306 rural hospitals in nine states with at least 10 births in 2010. Via interview, we ascertained obstetric unit status, reasons for closures, and postclosure community capacity for prenatal care. Study Design: Multivariate logistic regression and qualitative analysis were used to identify factors associated with unit closures between 2010 and 2014. Principal Findings: Exactly 7.2 percent of rural hospitals in the study closed their obstetric units. These units were smaller in size, more likely to be privately owned, and located in communities with lower family income, fewer obstetricians, and fewer family physicians. Prenatal care was still available in 17 of 19 communities, but local women would need to travel an average of 29 additional miles to access intrapartum care. Conclusions: Rural obstetric unit closures are more common in smaller hospitals and communities with a limited obstetric workforce. Concerns about continuity of rural maternity care arise for women with local prenatal care but distant intrapartum care.

Original languageEnglish (US)
Pages (from-to)1546-1560
Number of pages15
JournalHealth Services Research
Issue number4
StatePublished - Aug 1 2016

Bibliographical note

Funding Information:
Joint Acknowledgment/Disclosure Statement: This research was supported by the Rural Health Research Center Grant Program Cooperative Agreement from the Federal Office of Rural Health Policy, Health Resources and Services Administration (U1CRH03717-09-00). This work was also supported by the Building Interdisciplinary Research Careers in Women's Health Grant (K12HD055887) from the National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Health Resources and Services Administration. The authors are grateful for helpful input provided by Shailendra Prasad, MD, MPH; the rural hospital survey respondents; and the Office of Measurement Services at the University of Minnesota for fielding the survey. All authors declare no conflicts of interest with regard to the financial or policy interest in the subject matter discussed in the manuscript. Disclosures: None. Disclaimers: None.

Publisher Copyright:
© Health Research and Educational Trust


  • birth volume
  • closures
  • obstetric units
  • obstetric workforce
  • Rural hospitals

PubMed: MeSH publication types

  • Journal Article


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