Some key highlights of rural counties in the US in 2010:
- 12.5% without a primary care provider
- 58.8% without an OB/GYN
- 56.1% without a pediatrician
- 20.5% without a hospital
- 56.1% without a hospital that offered obstetric services
- 94.4% without a community mental health facility
Recent work by the University of Minnesota further examined the availability of obstetric service in rural areas, showing similar results. This work further examined the availability by state, demonstrating great variability; specifically, 25 states had half or more of their counties with a unit. Those with the largest proportion of countries without services included North Dakota, Florida, Virginia, Arkansas, Nevada, and South Dakota.
These closures affect, not surprisingly, the smaller counties across the US.
Why are these units closing? In short, due to money. Rural hospitals are, by default, low volume facilities. Many rural OB usnits see few patients (relatively speaking) per year, many with less than 100 births per year. This is due in part to the small local population, as well as patients skipping their local hospital to one further away.
The reasons for closure are fairly straightforward: low volumes means the facility loses money on each birth due to the high fixed costs of delivery care (e.g. malpractice, training, equipment, and the like). OB units that do close are smaller, privately owned, and in areas with lower socioeconomic status as well. It is difficult to blame these hospitals for their closures; their overall margins are so low (and often negative) that losses in one unit are very difficult to subsidize with other services.
These women are now forced to travel further away for care, on average 29 additional miles. The further these women need to travel to seek care, the higher the mortality and NICU rates are--clearly indicating a relationship between the two.
Why is there not more alarm for this? Where are the pro-life groups rallying to support these women and rural facilities, so they can care for these pregnant women and children? Searching some of the major pro-life groups yields nothing on this topic--why is that? Why is there so much concern about contraception, abortion, and planned parenthood, and so little on caring for those vulnerabel in our community?
