Maternal care is disappearing from America’s rural counties

Maternity care is disappearing from America's rural counties, and for the 28 million women of reproductive age living in those areas, pregnancy and childbirth are becoming more complicated—and more dangerous. That's the upshot of a new report from the Rural Health Research Center at the University of Minnesota that examined obstetric services in the nation's 1,984 rural counties over a 10-year period. In 2004, 45 percent of rural counties had no hospitals with obstetric services; by 2014, that figure had jumped to 54 percent. The decline was greatest in heavily black counties and in states with the strictest eligibility rules for Medicaid. The decrease in services has enormous implications for women and families, says Katy B. Kozhimannil, an associate professor in health policy who directs the Minnesota center's research efforts. Rural areas have higher rates of chronic conditions that make pregnancy more challenging, higher rates of childbirth-related hemorrhages—and higher rates of maternal and infant deaths. And because rural counties tend to be poorer, any efforts to revamp or slash Medicaid could hit rural mothers especially hard. ProPublica spoke with Kozhimannil about the new study and the implications for maternal care.