BOSTON — March 2026 — Fewer people in the United States can reach hospital-based obstetric care within a reasonable drive than a decade ago, according to a new national study led by the Harvard Pilgrim Health Care Institute. The study found that from 2010 to 2021, access to obstetric care declined across the country as hospitals closed labor and delivery units, forcing many pregnant people to travel farther for care.
The study, “Obstetric Service Availability and Travel Time to Access Obstetric Services in the U.S., 2010–2021”, was published in the American Journal of Preventive Medicine .
Researchers found the biggest drop in access in counties that lost all hospital-based obstetric services during the study period. In these counties, the share of census tract-level reproductive-aged females living within a 30‑minute drive of obstetric care fell from more than 90% in 2010 to about 60% in 2021.
“Access to maternity care is critical for the health of both the birthing person and babies,” said lead author Brittany L. Ranchoff, a research fellow at Harvard Pilgrim Health Care Institute. “Our study shows that many birthing people would have to travel much farther for delivery, especially in counties that lost all hospital-based obstetric services.”
Rural communities hit hardest
The study analyzed travel times to hospital-based obstetric care for census tracts in more than 3,000 U.S. counties. Researchers compared counties that always had obstetric services, counties that never had them, and counties that lost all services between 2010 and 2021.
While travel times stayed mostly stable in counties that kept obstetric units open, access dropped sharply in areas where services disappeared. The decline was strongest in rural counties.
“In some rural areas, access dropped by more than 50%,” Ranchoff said. “These communities already face many health care challenges and longer travel times can add stress and increase risk during pregnancy, childbirth, and postpartum.”
Longer travel distances can make it harder for people to get prenatal care, respond to emergencies, and reach hospitals equipped to handle higher-risk deliveries.
Why the findings matter
Previous research has shown that hospital-based obstetric unit closures are linked to worse outcomes for pregnant people and newborns. This study adds new national data showing how these closures change travel time, and how uneven the impact is across the country.
The findings highlight the need for policies that support hospitals and clinicians in maintaining obstetric services, particularly in underserved and rural areas.
Journal reference
Ranchoff BL, Kofner A, Baker O, et al. Obstetric Service Availability and Travel Time to Access Obstetric Services in the U.S., 2010–2021. American Journal of Preventive Medicine. Published online February 13, 2026.
About the Harvard Pilgrim Health Care Institute’s Department of Population Medicine
The Harvard Pilgrim Health Care Institute's Department of Population Medicine is a unique collaboration between Harvard Pilgrim Health Care and Harvard Medical School. Created in 1992, it is the first appointing medical school department in the United States based in a health plan. The Institute focuses on improving health care delivery and population health through innovative research and education, in partnership with health plans, delivery systems, and public health agencies. Follow us on Bluesky , X , and LinkedIn .
American Journal of Preventive Medicine
Obstetric Service Availability and Travel Time to Access Obstetric Services in the U.S., 2010–2021
13-Feb-2026