This study aimed to analyze the scope of obstetric unit and hospital closures resulting in loss of obstetric services in rural U.S. counties from 2004 to 2014. This is the first in a series of two policy briefs examining the closure of hospital obstetric services in rural areas; this policy brief takes a national perspective, whereas a companion policy brief documents state-level variability in access to hospital-based obstetric services in rural counties from 2004-2014.

Key Findings
We found that between 2004 and 2014:

• The percent of all rural counties in the U.S. that lacked hospital obstetric services increased from 45% to 54%, due to hospital and obstetric-unit closures.
• 179 rural counties (9% of all rural counties) lost access to in-county hospital obstetric services.
• Women living in rural noncore counties (areas with less than 10,000 residents) were disproportionately affected by the loss of hospital obstetric services.
• Only 30.2% of rural noncore counties had continual hospital obstetric services compared to 77.9% of micropolitan counties.