Access to obstetric services continues to decline in rural communities in the United States, with only 44% of rural counties having access to hospital-based obstetric care in 2018. Moreover, some rural communities are particularly vulnerable – including remote rural communities, lower income communities, and rural areas with a high proportion of Black and Indigenous residents.

Accurate, up-to-date, and publicly available data on access to hospital-based obstetric care are urgently needed; yet, the process of timely and accurate identification of obstetric unit closure is highly complex. While several organizations have attempted to report on maternity care access, their use of simplified access measures has led to the reporting of inaccurate and inconsistent data on obstetric care. Commonly cited measures are created by well-intentioned and well-regarded organizations but have limitations that disproportionately affect the accuracy of measurement in rural communities.

The goal of this project is to build a public health database to support access to care for pregnant rural residents. Specifically, our team will create a database of obstetric unit closures, by state and county; and link the closure database with additional data useful for research, public health, clinical care, and policy, including hospital- and county-level financial and characteristic data, hospital merger and system affiliation, private equity acquisition, and patterns of patient transport and seasonal drive times. In addition, we will ensure the data infrastructure is scalable to allow for future ongoing, annual updates to measure obstetric unit closures and inform research, policy, and public health decisions on rural maternity care access and rural maternal health.