Over 100 U.S. hospitals have closed their OB units since 2022, forcing rural pregnant women to drive 45+ extra minutes while in labor to reach a delivery hospital

Between 2011 and 2021, 267 rural hospitals closed their obstetric services — 25% of all rural OB units in the country. Since 2022, more than 100 additional hospitals have shuttered OB units, meaning 1 in 25 obstetric units in America has disappeared in just two years. By 2022, a majority (52%) of rural U.S. hospitals no longer had any maternity ward at all. Over two million women now live in 'maternity care deserts' where there is no hospital with obstetric services, no birth center, and no OB-GYN or certified nurse-midwife within their county. The consequences are not abstract. In the 200+ rural communities that lost OB services between 2011 and 2021, pregnant women must spend an additional 15 to 45 minutes traveling to reach delivery care. For a woman in active labor with a complication — placental abruption, cord prolapse, severe preeclampsia — 45 minutes is the difference between a living mother and a dead one. Studies show a doubling of infant mortality rates in counties that have lost OB services. These are not subtle statistical effects; these are babies and mothers dying because the nearest delivery room is an hour away and the ambulance cannot get there in time. The closures are driven by a vicious cycle that no individual hospital can break. Rural OB units operate at low volume, which makes them financially unsustainable — the fixed costs of maintaining 24/7 anesthesia coverage, nursing staff, and surgical readiness cannot be spread across enough deliveries. Only 7% of OB providers work in rural areas, even though 20% of the population lives there. Malpractice insurance costs for low-volume OB are high relative to revenue. And increasingly, the Dobbs ruling is accelerating provider exodus: OB-GYNs are leaving states with restrictive abortion laws, and medical residents are choosing to train and practice elsewhere. The states with the worst maternity care deserts are disproportionately the same states that have restricted abortion access, creating a compounding crisis where the places that need OB care the most are the places least able to attract providers.