More rural hospitals have closed or are planning to close their labor and delivery units in 2025 than in 2024, bringing the total number of closures since the end of 2020 to 116, according to the Center for Healthcare Quality and Payment Reform (CHQPR).
In a November report, the policy center outlined 27 completed or planned closures this year. That’s beyond the 21 of 2024 and the second-highest single-year total within the past five years behind 2023’s 34 closures.
“Rural maternity care is in a state of crisis, and more women and babies in rural communities will die unnecessarily until the crisis is resolved,” the CHQPR wrote in its report (PDF) while calling out the U.S.’ substantially worse maternal and infant mortality rates compared to other high-income countries.
There are now 950 rural hospitals still offering labor and delivery services, which is 41% of the country’s 2,396 hospitals with rural classifications. Twelve states, including several in the South, had less than a third of their rural hospitals still offering labor and delivery services.
Of the 950 providing these services, there are another 127 rural hospitals (13%) with labor and delivery units that are at risk of closing—a designation given by the CHQPR to hospitals that had a negative total margin and a loss on all patient services for the past two years. For nine states, a quarter or more rural hospitals faced these financial strains.
Without a local hospital offering labor and delivery services, the CHQPR warned that a pregnant woman may face a long trip to an alternative hospital that increases the risk of complications. For those living in a rural community, the trip from a hospital not offering these services to the nearest that does would take more than 30 minutes for about 70% of hospitals and more than 50 minutes for about 20%. In urban areas, most would only need 20 minutes or less to reach an alternative hospital.
The November report’s account of recent closures builds on a shutdown trend across rural and urban hospitals alike that dates back to at least 2010, other analyses have shown. These shutdowns varied greatly from state to state and often leave rural areas in particular with few hospital-based obstetrics providers.
The CHQPR’s proposed fixes focus on strengthening the rural maternity care workforce and boosting rural hospitals’ financial security.
On the former, the policy group called for a national-level solution to prevent limited clinicians from being claimed by hospitals and communities with greater resources. Such a response would involve recruitment and training specifically focused on rural care delivery, increased access to remote specialty support and a new staffing model that could serve as an alternative to the “long hours of on-call coverage” fewer and fewer clinicians are willing to deal with.
Payments tied to volumes are also an issue for rural facilities. Here, the CHQPR proposed a two-part payment strategy for both private and Medicaid payments comprised of standby capacity payments, which would pay for fixed expenses as long as services remain staffed and “extra” delivery fees when services are provided to cover variable time and costs associated with individual births.
“Federal and state government officials and private employers must take immediate action to ensure that all health insurance plans are paying adequately to support high-quality maternity care in every community,” the group wrote.