A recent study from KFF, a healthcare research organization, paints a troubling picture for pregnant women in rural America. Proposed Medicaid cuts and the shuttering of rural hospitals could mean many women might have to drive long distances for inpatient maternity care. This is especially concerning in 14 states like Alaska, Nevada, and North Dakota where losing the nearest rural hospital or its obstetric unit would drastically increase travel times for Medicaid patients needing maternity services.
The study shows a clear divide between rural and urban healthcare access. The median drive time between rural hospitals with maternity care and their nearest alternative is 43 minutes, while it's just 13 minutes for urban hospitals. And this gap is expected to grow. Changes from a law signed by President Donald Trump last summer, which includes hospital payment reductions and Medicaid enrollment cuts due to new work requirements, could speed up the closure of rural obstetrics units.
Between 2010 and 2022, 238 rural hospitals closed their obstetrics units, with only 26 new ones opening. By 2023, nearly half of rural counties were without a hospital offering obstetrics services. The Government Accountability Office points to low Medicaid reimbursement rates and challenges in hiring and keeping healthcare providers as key reasons for this trend.
Brittni Frederiksen, who led the KFF report, stressed the financial instability of rural hospitals. These facilities often have slim profit margins, and more cuts might force them to shut down obstetric units or close entirely. "There are likely going to be rural hospitals that close their obstetric units or have to close the entire hospital, and so people will have greater distances to travel to safely deliver a baby, " Frederiksen said.
States facing the longest potential drives for maternity care include Alaska, Nevada, and North Dakota. In other states like Arizona, Colorado, Florida, Hawaii, Massachusetts, Montana, New Hampshire, New Mexico, Vermont, Virginia, and Wyoming, the median trip would exceed an hour. Conversely, New Jersey, Louisiana, and Ohio have the shortest drive times.
A lack of maternity care access can lead to severe consequences, including higher maternal mortality, low birthweight, and premature births. The U. S. has one of the highest maternal mortality rates among high-income countries, standing at 17.9 deaths per 100,000 live births, according to a philanthropic and research group. This rate is two or three times higher than most other high-income nations.
Women relying on Medicaid, the government insurance program for those with low incomes, often face even worse outcomes. A recent survey of Medicaid patients who gave birth in 2023 and 2024 showed higher complication rates, such as high blood pressure and gestational diabetes, compared to those with private insurance.
