Maternity Wards Are Disappearing From Rural America

As rural hospitals struggle to keep their doors open, the high cost of ob-gyn wards makes them one of the first things cut.
by | December 2017
Kearny County Hospital is one of a shrinking number of rural hospitals that still offers birthing services. (AP Photo/Orlin Wagner)

Located as it is in rural southwest Kansas, you’d expect the Kearny County Hospital to be a relatively sleepy operation. The county’s population is just under 4,000, and the closest metropolitan area, Wichita, is four hours away. But the hospital’s birthing suites are busy: They’re now averaging almost one birth every day, nearly twice as many as a few years ago.

There’s no mystery as to why the number of babies being born annually at the county-run hospital in Lakin jumped from 189 to 360 in a four-year period. Other hospitals across the region have closed their expensive ob-gyn wards, reflecting a trend across rural America. A study published in September in the journal Health Affairs found that 1 in 10 rural counties had lost their ob-gyn wards in the past 10 years.

It used to be unimaginable for any hospital to shutter its obstetrics ward, says Benjamin Anderson, the Kearny County Hospital’s CEO. But for hospitals struggling to stay open at all, there aren’t a lot of units to close other than the maternity ward. “It requires so many fixed costs,” Anderson says. “You have to have birthing suites, anesthesia, medical staff with C-section capabilities.”

Yet even getting out of the birthing business hasn’t enabled some rural hospitals to survive. Since 2010, 82 of them have closed their doors, the result of factors ranging from the costs of health-care reform to declining populations to aging local workforces that make staffing a particular challenge.

The Affordable Care Act forced hospitals to modernize their operations and change existing structures of health-care delivery. Rural hospitals often lacked the resources to comply, but this was especially true in states such as Kansas that didn’t expand Medicaid under the federal law.

Maternal health in rural America is made more complicated by the fact that rural areas routinely rank higher than urban areas in rates of noncommunicable diseases and preventable deaths. Birth outcomes are poorer, too. And with fewer and fewer ob-gyns available, there will likely be more high-risk pregnancies, unhealthy births and resulting long-term health issues. “What happens during pregnancy sets the tone 20 or 30 years down the road,” says Lisette Jacobson, an assistant professor of preventive medicine and public health at the University of Kansas.

Meanwhile, costs and maternity ward closures are likely to continue to mount. Anderson says that by offering obstetric services, his hospital is operating at a six-figure annual loss, even after receiving funding through a public-private partnership to expand its maternity offerings. Women are coming in from two hours away to give birth, and the hospital is quickly running out of birthing space, he says.

There’s no funding solution in sight. While states might try to pick up some of the slack, there’s a consensus among most health-care experts that a federal partner is needed. Even a reform as simple as mandating a minimum distance between delivery sites -- along with the funding to make that work -- would benefit not only new mothers but their families as well, Anderson says. “Mothers make about 80 percent of the health-care decisions in a family, so if mom is healthy, that’s one of the most significant factors to making sure the whole family is healthy. We have to get this right.”