A new analysis is renewing warnings about how fast rural America is losing places to give birth. Since the end of 2020, 146 rural hospitals have stopped delivering babies or announced they will stop before the end of 2026, according to the Center for Healthcare Quality and Payment Reform, a roughly 14% reduction in rural labor and delivery units. Only 40% of U.S. rural hospitals still offer labor and delivery services at all, and in 12 states, fewer than a third do.
The reporting, based on the CHQPR’s latest maternity care report and covered by Stateline and KFF Health News in late August and early September, ties the closures to a familiar financial problem: insurance, including Medicaid, generally pays rural hospitals less than it costs them to run a maternity ward. But the effect of a closed labor and delivery unit isn’t evenly distributed. It depends heavily on who you are and where you live.
Medicaid-covered patients
Medicaid pays for about four in ten U.S. births, and covers an even higher share in rural areas. When a nearby rural hospital’s maternity unit closes, the median added drive time to the next hospital with labor and delivery services is 43 minutes for Medicaid patients, more than three times the 13-minute median in urban areas. Medicaid patients also enter pregnancy with higher rates of complications like high blood pressure and gestational diabetes than privately insured patients, according to KFF research, meaning the group facing the longest new drives is also the group with less room for delay if something goes wrong.
Residents of the hardest-hit states
The CHQPR analysis found 14 states where losing the nearest rural hospital’s maternity unit would force patients onto drives of an hour or more. States including Alaska, Nevada, North Dakota, Arizona, Montana, Wyoming and New Mexico face the longest potential travel times, while patients in states like New Jersey, Louisiana and Ohio face comparatively short ones. That means the risk of this trend isn’t just rural versus urban, it’s concentrated in specific states where the next closest option was already far away before any additional closures.
Rural hospital staff and local economies
A hospital that stops delivering babies often doesn’t stop there. Labor and delivery units are frequently the first service cut as hospitals try to stay open, since obstetrics tends to lose money on its own even before accounting for the round-the-clock staffing it requires. Nurses, obstetric techs and on-call physicians either relocate, shift to other departments, or leave the community altogether, which thins out the broader emergency and surgical staffing a small hospital needs to keep functioning at all.
Mothers and infants facing health risks
The stakes of longer drives aren’t abstract. KFF researcher Brittni Frederiksen has noted that increasing the distance to delivery raises the likelihood of poor outcomes, and the U.S. maternal mortality rate, 17.9 deaths per 100,000 live births as of 2024, already runs double to triple the rate in other high-income countries. Between 2010 and 2022, 238 rural hospitals closed their obstetrics units nationwide while only 26 opened new ones, and by 2023 nearly half of rural counties had no hospital-based obstetric services at all, a gap that keeps widening rather than closing.
What’s driving the closures
Researchers point to a straightforward financial mismatch: Medicaid reimbursement for deliveries typically falls well below what it costs a small rural hospital to staff and run a maternity ward, and most private insurance plans pay less than the true cost too. A federal tax and spending law passed in summer 2025 layered on additional Medicaid cuts tied to new work requirements, adding further financial pressure on hospitals that were already running maternity units at a loss.
Sources: KUNC / Stateline · Jefferson City News-Tribune · Center for Healthcare Quality and Payment Reform · Healthcare Dive
