Rural hospital closures and the shuttering of obstetrics units across the nation threaten to leave pregnant women in Idaho and other states facing hour-long or longer drives to reach maternity care, according to new analysis from the Kaiser Family Foundation. The research highlights a growing public health concern as financial pressures and workforce challenges force rural facilities to abandon childbirth services, potentially compromising outcomes during pregnancy and delivery.
The KFF analysis found that in 14 states—including Montana, Wyoming, and other rural-heavy regions—closure of a pregnant woman’s nearest rural hospital or obstetrics unit would force many Medicaid-enrolled patients to drive one hour or more to reach alternative inpatient maternity care. Across rural hospitals nationally, the median drive time to the closest in-state alternative maternity facility stood at 43 minutes for Medicaid beneficiaries, compared to just 13 minutes for those served by urban hospitals.
A Troubling Trend in Rural Healthcare Access
The trend reflects a decade-long erosion of obstetric services in rural America. Between 2010 and 2022, 238 rural hospitals closed their obstetrics units. While 26 new obstetrics units opened during that same period, the net loss left rural communities increasingly without in-hospital delivery options. By 2023, nearly half of all rural counties lacked a hospital offering obstetrics services—a milestone that underscores the scale of the access crisis.
Brittni Frederiksen, an associate director at KFF, told the outlet that deteriorating conditions threaten rural childbirth access. “There are likely going to be rural hospitals that close their obstetric units or have to close the entire hospital, and so people will have greater distances to travel to safely deliver a baby,” Frederiksen said, as reported by the Idaho Capital Sun. She added that increased travel distance to delivery sites raises the risk of worse health outcomes.
Financial and Workforce Pressures Driving Closures
A 2022 Government Accountability Office report identified low Medicaid reimbursement rates and difficulties recruiting and retaining obstetric providers as the primary drivers of rural obstetrics closures. Many rural hospitals operate on thin margins and cannot sustain obstetric services when reimbursement fails to cover staffing, equipment, and liability costs.
The fiscal outlook worsened after President Donald Trump signed a tax and spending measure last summer that reduces hospital payments and cuts Medicaid enrollment through work requirements. Those policy changes are expected to further strain rural hospital finances and could accelerate the pace of obstetrics unit closures in coming years.
States facing the most severe access challenges include Alaska, Nevada, North Dakota, Arizona, Colorado, Florida, Hawaii, Massachusetts, Montana, New Hampshire, New Mexico, Vermont, Virginia, and Wyoming. States with the shortest median drive times to obstetric care include New Jersey, Louisiana, and Ohio, where hospital density and Medicaid reimbursement structures better support rural obstetrics services.
Rising Maternal Mortality and Idaho’s Position
The loss of accessible maternity care occurs against a backdrop of elevated maternal mortality nationally. The U.S. maternal mortality rate reached 17.9 deaths per 100,000 live births in 2024, a reflection of systemic barriers to timely, quality prenatal and delivery care.
Idaho shares characteristics with other rural states affected by obstetric access loss. Pregnant Medicaid patients in Idaho’s more remote counties face real risks if local hospital obstetrics units close, forcing families to travel extended distances during labor or pregnancy complications. Such delays can prove critical when emergency medical intervention is needed during delivery.
What Comes Next
Rural hospital leaders and state policymakers face mounting pressure to stabilize obstetric services. Solutions under discussion include adjusted Medicaid reimbursement rates, loan forgiveness programs for rural obstetric providers, and regional care coordination models that allow smaller hospitals to support births while maintaining safety protocols. However, without legislative or policy intervention at the state and federal level, the trend of rural obstetrics closures is expected to continue.
For pregnant women in rural Kootenai County, North Idaho, and across the Panhandle, the question of local obstetric access carries immediate weight. As rural hospitals nationwide reassess the viability of childbirth services, Idaho residents and their elected representatives will need to weigh the cost and complexity of sustaining maternity care in smaller communities against the real human cost of forcing pregnant women to travel during critical medical moments.