Most rural hospitals in the United States no longer offer labor and delivery services, leaving pregnant women in many rural communities with increasingly limited access to maternity care, according to a new report from the Center for Healthcare Quality and Payment Reform (CHQPR).

The October 2026 report, Stopping the Loss of Rural Maternity Care, found that just 40% of U.S. rural hospitals still provide labor and delivery services. In 12 states, fewer than one-third of rural hospitals offer these services.

The decline has accelerated in recent years. Since the end of 2020, 144 rural hospitals have stopped delivering babies, representing a 14% reduction in rural labor and delivery units. Four additional hospitals have announced plans to discontinue services by early 2027. On average, more than two rural labor and delivery units have closed each month over the past six years.

The closures have significant implications for access to care. While travel times to a hospital offering maternity services are generally less than 20 minutes in urban areas, women in rural communities are likely to travel at least 30 minutes, with trips of 50 minutes or longer common, according to the report.

The report identifies workforce shortages and inadequate reimbursement as two major factors contributing to the loss of rural maternity services. Providing safe, high-quality maternity care requires round-the-clock availability of physicians capable of performing cesarean sections, physicians or midwives to perform vaginal deliveries, nurses trained in obstetric and newborn care, and anesthesia professionals. Recruitment and retention can be particularly difficult for small rural hospitals.

Financial pressures further threaten the sustainability of remaining services. Reimbursement from private insurers and Medicaid often fails to cover the costs of providing maternity care, particularly in hospitals with relatively low delivery volumes. Unlike larger facilities, small rural hospitals may not have other profitable service lines to offset maternity care losses.

The report identified 90 rural hospitals that continue to provide labor and delivery services but lost money overall in each of the two most recent years for which data were available. These hospitals could be forced to discontinue maternity services to remain financially viable.

To address the crisis, CHQPR recommends a combination of workforce development and payment reforms. Proposed strategies include recruiting and training clinicians specifically for rural maternity care, expanding remote specialty support, developing alternative staffing models for physician on-call coverage, and requiring public and private health plans to reimburse hospitals adequately for the cost of care.

The report also proposes a two-part payment model that would compensate hospitals and clinicians for maintaining the staffing and readiness needed to provide round-the-clock maternity services, in addition to paying a delivery fee when care is provided. This approach would help rural hospitals cover fixed staffing costs regardless of how many births occur.

The report warns that the loss of local maternity services can affect more than the delivery itself. Women may be less likely to receive adequate prenatal and postpartum care when those services are not available in their communities, while longer travel distances can increase risks for mothers and babies. Mortality rates for infants and mothers in the U.S. are currently among the highest in the world.