Women who live in rural areas have limited options when it comes to labor and delivery

Across the U.S., people are having fewer kids. That’s no surprise, with costs constantly rising, wages stagnating, and birth control generally pretty accessible (for now). But as birth rates have steadily declined since the baby booms of the mid 1900s, it’s given way to a problematic result: Hospitals across the U.S., especially those in rural areas, are closing their labor and delivery wards due to unprofitability and low demand.

This is a big problem for the women who do give birth in those areas—especially if they’re low income and unable to travel to get to hospitals with the facilities they need to access prenatal care and safe places to give birth. A shocking NPR report shows that more than half of rural U.S. hospitals have now stopped offering labor and delivery services.

The baby boom in the U.S. peaked in 1957, and that coincided with a period of huge investment in building rural hospitals. But as of 2022, the birth rate has declined nearly 14% nationwide, with rural areas seeing much larger declines (as high as 62% in West Virginia, where the steepest drop has occurred). At the same time, public funding for rural hospitals is nearly nonexistent compared to when federal programs offered ample funding decades ago.

People accessing care in rural places are more likely to be low-income, which means a larger percentage of patients on Medicaid, which pays about half as much as private insurance for the same medical services.

All these factors have combined to cause hospitals to struggle to staff and maintain obstetrics and labor and delivery units.

Amid this crisis, the Biden administration has announced the first-ever federal maternal health and safety requirements for hospitals, which would require the medical industry to invest billions of dollars into improving maternal care.

The Centers for Medicare and Medicaid Services (CMS) announced the two new programs earlier this week, which will cover about 40% of U.S. patients:

• Hospitals will be required to keep basic resuscitation equipment available in labor and delivery rooms, document maternal health training for staff, and have written policies for transferring patients to other facilities.
• All hospitals that offer emergency services will be required to have protocols and supplies for emergency deliveries — even if they don’t have an obstetrics unit.

In a post-Roe America, states with restrictive abortion bans are shuttering more obstetrics wards for even more reasons. In Idaho, for example, OB-GYNs have repeatedly spoken out about fleeing the state (and hospitals have reported being unable to recruit replacements) due to fears of being prosecuted simply for providing necessary, life-saving care to women under the Republican government’s anti-abortion laws.

The trend in labor and delivery care reflects a larger trend in women’s healthcare overall.

“It’s not even just for delivery, but we need access just to women’s health care in general,” OB-GYN Dr. Taylar Swartz told NPR. “I would love to see women’s health care be at the forefront of our government’s mind.”