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Results

This study included 4964 short-term acute care hospitals (1982 in rural counties and 2982 in urban counties). In 2010, 43.1% (843/1955) of rural hospitals and 29.7% (836/2813) of urban hospitals did not offer obstetric care (Table). Each subsequent year, there was a net loss of obstetric services at US hospitals. Between 2010 and 2022, there were 537 hospitals that lost obstetrics, split between rural hospitals (238) and urban hospitals (299). During this time, 138 hospitals gained obstetrics, concentrated heavily among urban hospitals (112) vs rural hospitals (26). In 2022, 52.4% of rural hospitals and 35.7% of urban hospitals did not offer obstetric care.

There was a steady rise in the percentage of hospitals without obstetrics in 2010-2022, increasing from 35.2% to 42.4% of all hospitals (Figure). The percentage of hospitals without obstetrics was higher among rural hospitals compared with urban hospitals in each year.