More U.S. hospitals are closing their obstetrics (OB) units. Between 2004 and 2014, 179 rural hospital systems closed OB units, affecting access to care for more than 28 million women of reproductive age living in rural America. And there's no sign of this trend slowing down, with 21% of all rural hospitals in the United States currently at risk of closing unless financial situations improve.
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In 2016, we wrote about how to decide whether "To close or not to close your OB unit," based on key program challenge solvability, market demand, and downstream ramifications. In addition to these factors, health systems weighing or implementing closure must consider two additional impacts and how to address them.
Fewer than half of all rural counties have a practicing OB-GYN, meaning the majority of rural women do not have access to prenatal care and labor and delivery services. These access gaps can have serious implications for women's health.
A lack of prenatal care contributes to higher rates of infant mortality, and increases the likelihood that women will die a pregnancy-related death by three to four times. Further, data shows that women who need to travel farther from home for care have more adverse outcomes. Finally, longer patient travel for care means that patients may instead go to a nearby ED that is often times not equipped to handle deliveries.
Potential solutions:
OB unit closure often, and understandably, results in a strong emotional response from the community and impacts staff morale. Therefore, it's essential that health systems weighing OB unit closure consider ways to mitigate community backlash and the impact on staff.
Potential solutions:
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