The health of rural mothers and infants is a growing concern across the U.S. Access to care during pregnancy and childbirth is declining for rural residents, and both maternal and infant morbidity and mortality are higher for rural families compared to urban families. Both limited care access and poor outcomes among rural residents are cause for concern in the broad national context of rising rates of maternal morbidity and mortality and maternity care quality. This project aimed to address the nexus of these challenges: minimum standards for safe maternity care in rural communities.

Prior research and stakeholder input indicate that the main challenges rural hospitals face in providing services during pregnancy and childbirth can be categorized into four groups: local context, clinical safety, workforce, and financial. This project surveyed rural hospitals and systematically assessed minimum criteria present when providing obstetric services in these categories. It also explored potential policy options to ensure that financial and workforce constraints do not impede rural obstetric care access and that clinical safety is supported through policies and resources.

Publications

• Characteristics of Rural and Urban U.S. Hospitals Based on Obstetric Services
  University of Minnesota Rural Health Research Center
  Date: 04/2021
  This infographic provides an overview of characteristics of rural and urban hospitals in the United States that provide obstetric services, as well as rural hospitals that recently closed their obstetric units.
• A Comparison of Evidence-Based Supports for Maternal and Infant Health in 133 Rural U.S. Counties With and Without Hospital-Based Obstetric Care
  University of Minnesota Rural Health Research Center
  Date: 12/2022
  This infographic offers a comparative look at evidence-based supports available for maternal and infant health in rural counties with recently closed obstetric units (within the past 10 years) and those with hospital-based obstetric care at the time of the survey, in 2021.
• An Enhanced Method for Identifying Hospital-Based Obstetric Unit Status
  University of Minnesota Rural Health Research Center
  Date: 01/2022
  The purpose of this methodology brief is to describe an enhanced method for identifying hospital-based obstetric unit status and for identifying closures of obstetric units.
• Rural and Urban Hospital Characteristics by Obstetric Service Provision Status, 2010-2018
  Policy Brief
  University of Minnesota Rural Health Research Center
  Date: 04/2021
  The purpose of this policy brief is to illustrate the differences between urban and rural hospitals that provide obstetric services by their size, capacity, location, and community characteristics, as well as to compare these factors between rural hospitals with obstetric services and those that recently closed their obstetric units.
• Rural Hospital Administrators' Beliefs About Safety, Financial Viability, and Community Need for Offering Obstetric Care
  Journal Article
  University of Minnesota Rural Health Research Center
  Date: 03/2022
  This study offers results from a national survey of a sample of 292 rural hospitals that provided obstetric services in 2021. Obstetric unit administrators shared about their experiences, the challenges they face, and the decisions that factor into providing labor and birth care for their rural communities.
• State and Regional Differences in Access to Hospital-Based Obstetric Services for Rural Residents, 2018
  Policy Brief
  University of Minnesota Rural Health Research Center
  Date: 08/2021
  This policy brief measures state and regional differences in the availability of hospital-based obstetric services among rural hospitals in the U.S. in 2018.