title: Why Are Obstetric Units in Rural Hospitals Closing Their Doors?
abstract: To understand hospital- and county-level factors for rural obstetric unit closures, using mixed methods.
  
  
  
  Hospital discharge data from Healthcare Cost and Utilization Project's Statewide Inpatient Databases, American Hospital Association Annual Survey, and Area Resource File for 2010, as well as 2013-2014 telephone interviews of all 306 rural hospitals in nine states with at least 10 births in 2010. Via interview, we ascertained obstetric unit status, reasons for closures, and postclosure community capacity for prenatal care.
  
  
  
  Multivariate logistic regression and qualitative analysis were used to identify factors associated with unit closures between 2010 and 2014.
  
  
  
  Exactly 7.2 percent of rural hospitals in the study closed their obstetric units. These units were smaller in size, more likely to be privately owned, and located in communities with lower family income, fewer obstetricians, and fewer family physicians. Prenatal care was still available in 17 of 19 communities, but local women would need to travel an average of 29 additional miles to access intrapartum care.
  
  
  
  Rural obstetric unit closures are more common in smaller hospitals and communities with a limited obstetric workforce. Concerns about continuity of rural maternity care arise for women with local prenatal care but distant intrapartum care.
authors.affiliation: Division of Health Policy and Management, University of Minnesota School of Public Health, University of Minnesota, Minneapolis, MN.
authors.forename: Peiyin
authors.initials: P
authors.lastname: Hung
authors.affiliation: Division of Health Policy and Management, University of Minnesota School of Public Health, University of Minnesota, Minneapolis, MN.
authors.forename: Katy B
authors.initials: KB
authors.lastname: Kozhimannil
authors.affiliation: Division of Health Policy and Management, University of Minnesota School of Public Health, University of Minnesota, Minneapolis, MN.
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Casey
authors.affiliation: Division of Health Policy and Management, University of Minnesota School of Public Health, University of Minnesota, Minneapolis, MN.
authors.forename: Ira S
authors.initials: IS
authors.lastname: Moscovice
mesh_terms: D000328:Adult; D005260:Female; D006271:Health Facility Closure / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000639:trends; D006780:Hospitals, Rural; D006801:Humans; D008427:Maternal Health Services / Q000600:supply & distribution / Q000639:trends; D008507:Medically Underserved Area; D009775:Obstetrics and Gynecology Department, Hospital / Q000706:statistics & numerical data* / Q000600:supply & distribution; D011247:Pregnancy; D012424:Rural Population; D014481:United States
keywords: Rural hospitals; birth volume; closures; obstetric units; obstetric workforce