Loss of Obstetric Care in Rural and Urban Hospitals in the US
Dec 4, 2024
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Katy Kozhimannil, a researcher specializing in rural maternity care, joins Linda Brubaker to discuss the troubling decline of obstetric services in U.S. hospitals. They reveal alarming statistics on the drop in maternity care between 2010-2022, particularly in rural areas, leading to increased maternal mortality. The conversation highlights the lack of transparency in service availability and the urgent need for policy reforms to improve access. Kozhimannil sheds light on how hospital mergers complicate data tracking, exacerbating these challenges for patients.
The decline in obstetric services at hospitals, particularly in rural areas, significantly impacts maternal health access and outcomes.
Grassroots awareness of dwindling maternal care in communities spurred a broader investigation into national trends in obstetric service availability.
Deep dives
Obstetric Care Accessibility Trends
A significant portion of hospitals in the United States lack obstetric services, with 52.4% of rural hospitals and 35.7% of urban hospitals not offering such care in 2022. This statistic highlights a concerning trend in maternal health access, particularly in rural areas where closures of obstetric units have been more pronounced. Patients and clinicians alike may be shocked by these figures, as it underscores the fact that many hospitals are not prepared to support labor and delivery, which is often unexpected. This discrepancy plays a crucial role in the ongoing maternal health crisis and raises alarms regarding the implications for communities that are already underserved.
Research Origins and Community Impact
The research into obstetric care accessibility was prompted by concerns from a group of grandmothers in Alabama who observed that their community's access to maternal care was dwindling as local hospitals closed. This grassroots effort led to a broader investigation into whether the challenges faced by this predominantly Black community were indicative of a national trend. The findings revealed that rural communities often struggle the most, losing hospital-based obstetric care, which can lead to increased travel distances for expectant mothers. Such changes not only affect immediate access to care but also have long-term implications for maternal and child health outcomes.
Methodology and Data Challenges
The study utilized a comprehensive approach, merging data from the American Hospital Association and Centers for Medicare and Medicaid Services to assess the availability of obstetric services over a 12-year period. Challenges included tracking hospital mergers and acquisitions, which complicated the identification of whether hospitals offered obstetric care. The research team also faced the issue of limited data availability, which made it difficult to provide a clear picture of accessibility trends. By employing a meticulous validation process, the researchers aimed to ensure accuracy in their findings, shedding light on a critical gap in maternal health service delivery.
Access to obstetric care in US hospitals has been declining, while maternal mortality is on the rise. A new research letter published in JAMA quantifies losses and gains of obstetric care at rural and urban short-term acute care hospitals in the US between 2010-2022. Author Katy Kozhimannil, PhD, MPA, discusses this and more with JAMA Deputy Editor Linda Brubaker, MD, MS. Related Content: