More than half of rural counties don't have a hospital where women can give birth

A new study in the journal Health Affairs quantifies the trend. In 2004, 45 percent of rural counties lacked a hospital with obstetrics services. About one in 10 rural counties lost those services over the next decade, and by 2014, 54 percent of communities lacked those services. That leaves 2.4 million women of child-bearing age living in counties without hospitals that deliver babies.There are already a slew of well-known health disparities between rural women and those who live in urban settings. Women from rural areas are more likely to report having fair or poor health, be obese, smoke cigarettes, commit suicide and have cervical cancer than their urban counterparts. But the recent trend could exacerbate disparities in reproductive health, too. One recent study found that rural areas had made far fewer gains in improving infant mortality compared with the rest of the country.“A lot of discussion has been focusing on the closures of rural hospitals entirely,” said Peiyin Hung, a postdoctoral associate at Yale School of Public Health, who led the study. “We found that even among surviving hospitals in rural communities, a lot of obstetric services in these ares are disappearing.”What troubled Hung was that the most geographically isolated communities were more likely not to have had obstetrics services to begin with — and were more likely to lose them over the decade they studied. There were also patterns of inequality: rural counties that had lower median incomes and higher percentages of African American women of reproductive age were also more likely to not have hospitals with maternity wards.