Exploring Opportunities for Innovation in Rural Maternal Care

Every pregnant woman deserves access to high-quality maternal care — from conception through postpartum. Yet in parts of the country, some of that care is disappearing.

Rural communities are bearing the brunt of maternity service losses. Between 2022 and 2025, over 80 rural hospitals closed their labor and delivery units. A 2022 study estimated that half of all rural counties lack obstetric units. More than 2.3 million  women between the ages of 15 and 44 live in counties with neither an obstetrician nor labor and delivery services.

Amidst these challenges, there are emerging trends of concern about women’s access to care in rural areas: fewer prenatal visits, longer drives to reach a provider and higher risks when emergencies arise.

The Toll on Mothers and Babies

Pregnancy outcomes for rural women are significantly worse than for their urban counterparts.

• Pregnancy-related mortality is highest in rural populations — 37.9 deaths per 100,000 live births, compared to 23.1 in metropolitan areas.
• Rural women face increased risk of severe maternal morbidity such as sepsis, pulmonary edema and acute renal failure.
• Rates of infant mortality, premature birth and low birth weight are also higher in rural communities.

Retractions in Rural Maternal Care 

The decision to reduce labor and delivery services is complex and one not taken lightly. Hospitals and health systems report these decisions are largely driven by three interconnected factors.

1. Workforce shortages. Recruiting and retaining skilled maternity care providers is increasingly difficult and costly.
2. Payment challenges. Reimbursement rates often fail to cover the true costs of care, with more than one-third of rural hospitals operating obstetric units at a loss.
3. Lower patient volumes. Rural hospitals have lower patient volumes, which affects their ability to attract and retain clinical staff and provide enough services for them to maintain skills and competence. Fewer deliveries can also make it financially difficult to sustain services.

Introducing: Opportunities for Innovation in Rural Maternal Care

Although there are no easy solutions, there is hope. Many rural hospitals are steadfast in their commitment to labor and delivery services in their communities. They are developing innovative strategies to meet the needs of expectant and new mothers, from creative staffing models to community partnerships that expand access.

With support from the Commonwealth Fund, the American Hospital Association is launching the Opportunities for Innovation in Rural Maternal Care project. This effort will explore how rural hospitals leverage assets in their hospital and community to maintain, or even expand, access to care for pregnant women. Our goal is to uncover the common elements of effective strategies and translate them into a menu of options that other rural hospitals can adopt to help sustain local maternal care — now and into the future.

As we embark on this work, we want to hear from you. If your rural hospital has developed a strategy to sustain or expand maternal care, please reach out to our team using this form. Your experience can help shape solutions that ensure every woman — no matter where she lives — has access to the safe, high-quality pregnancy care she and her baby deserve.