Over half of rural hospitals in the U.S. no longer have units for childbirth, according to a University of Minnesota study published this month in Health Affairs.

The study shows the percent of hospitals with obstetric units fell from 54 percent in 2004 to about 45 percent in 2014. This limited accessibility disproportionately impacts low-income communities and women of color, putting childbearing-aged women and their babies at risk of complications, researchers say. 

“This is really concerning to us because those are groups of women who are already disadvantaged,” said University research associate Carrie Henning-Smith, the study’s co-author and co-investigator. 

More than half of women in affected rural areas are at least 30 minutes away from a hospital with an obstetric unit, according to the study. Out of the 28 million reproductive-age women who live in rural counties, about 500,000 give birth in hospitals in rural areas, according to the research.

The study took many factors into account, including proportions of reproductive-age women, race and ethnicity in the counties.

The Federal Office of Rural Health Policy  —  which funded the University study — and the National Rural Health Association both took an interest in the issue after hearing concerns from individual members of Congress about diminishing access to obstetric care in rural areas.

University researcher Peiyin Hung, adviser and author of the study, realized inaccessibility of obstetric units is a national problem and began studying the impacts on rural and urban communities specifically. 

“Rural women’s access to obstetric care services is an issue of clinical, community and personal relevance,” Hung said. 

The Ely Bloomenson Community Hospital in Ely, Minnesota, is one of many hospitals that shut down its obstetric unit.

A low volume of births led to the hospital shutting down its unit, as there were regularly fewer than 20 births per year at the hospital, said hospital Administrator John Fossum. Plus, Ely is predominantly an older community, he said.

“This is the time to start thinking about potential interventions, such as telemedicine technologies,” Hung said. “Such technologies and interventions may give low-volume rural hospitals ready access to referral, consultation and outreach education from larger regional hospitals so that skills and patient safety can be maintained locally.”