Infant mortality increases with rurality. Most childbirth-related and infant deaths are preventable, and risks are elevated for people living in rural communities, where access to childbirth-related care is limited. Neonatal care access at birth is lifesaving for higher-risk infants, but there is no current research on access to and closures of neonatal units in rural communities, which are suffering the widespread loss of health care services.

Despite the interdependence of neonatal and obstetric services, a comprehensive examination of access to basic and/or specialty childbirth-related care is lacking. This project's goal is to describe access to childbirth-related care for families living in rural and urban communities; it will document access to neonatal care and the levels of that care, describe rural counties that have lost access to neonatal care, and identify rural counties without access to either neonatal or obstetric services. This work will inform clinical and policy efforts to ensure access to appropriate and necessary care at the time of childbirth, including maternal and infant transport policies and regional perinatal referral networks, as well as financial policies that support rural hospitals that provide these essential services.