Impact of Labor and Delivery Unit Closures
April 25th 2025
Over the past two decades, the United States has experienced a troubling trend: the closure of hundreds of labor and delivery units, including 11 in New Hampshire alone. These closures are primarily driven by fixed operating costs, low patient volume, lower Medicaid reimbursement and often follow hospital consolidations. However, the implications extend far beyond hospital budgets. These closures have measurable, negative impacts on maternal and infant health outcomes, particularly among rural populations, women of color, and Medicaid beneficiaries. In fact, according to 2023 data from the New Hampshire Department of Health and Human services, the areas of the state where there are the most closures are also the areas with the most Medicaid beneficiaries. The closures very likely contribute to the ever worsening maternal mortality disparities in the U.S. and in New Hampshire.
Research consistently shows that when a labor and delivery unit closes, maternal and infant outcomes suffer. Women in rural areas are forced to travel long distances to receive care—or forgo it altogether. This results in reduced access to prenatal and postnatal services, increased rates of preterm births and cesarean deliveries, and a higher likelihood of medically unnecessary interventions, such as inductions. The ripple effects of these closures place strain not only on families, but also on the broader healthcare system.
Contributing to the challenge is the difficulty rural hospitals face in recruiting and retaining OB/GYNs and other maternity care providers. Factors such as lower patient volume, limited professional development opportunities, lower compensation, and more frequent on-call requirements deter many clinicians from practicing in rural settings. Additionally, when women in rural areas with greater financial or social mobility choose to deliver in non-rural hospitals, the remaining patient base becomes smaller and more resource-constrained—further undermining the viability of local services.
Targeted policy interventions to address these trends are available to states. Evidence-based solutions could include:
- Supporting the development of free-standing birth centers, which reduce overhead costs while maintaining high-quality care;
- Ensuring reimbursement for services provided by Certified Nurse Midwives (CNMs), Certified Midwives (CMs), and doulas across all care settings and payers;
- Expanding and diversifying the perinatal workforce, particularly through investment in rural training pipelines and workforce retention incentives;
- Implementing regionally coordinated maternity care systems that integrate care across levels of risk and geography, ensuring every woman has access to appropriate care regardless of location.
- Stabilizing and strengthening rural maternity care infrastructure is a worthy public policy goal. Without this, maternal health disparities will increase, and safe, accessible childbirth will remain out of reach for many Americans.
- Alison Mehlman
Blog Post Archive
Impacts of Labor and Delivery Unit Closures
April 25th 2025
Labor and delivery units are closing all over the United States. Read about what is causing these closures, how they are effecting maternal care, and what can be done about it.
Tariffs, Cuts, and Consequences: Unpacking the Latest Healthcare Policy Shifts
April 17th 2025
Alison Mehlman breaks down how new tariffs could drive up drug prices, disrupt access, and reshape the future of healthcare in the United States, starting with pharmaceuticals.
The Brass Tacks on the Pink Tax
April 10th 2025
Women are consistently charged more for everyday essentials, a phenomenon know as the “pink tax.” This hidden cost of being a woman extends into healthcare, where out-of-pocket expenses can soar simply due to gender. Read Kimberly Persson's analysis on this issue and more, below.
UNH Healthcare Vitals: Medical Debt and the Rise of Rx Drug Costs
April 1st 2025
The cost of prescription medication costs are rising. See how this is effecting New Hampshire residents and what policymakers are doing about it.
Rising Trends in Behavioral Health: Chronic Conditions, and Pregnancy: A Seven Year Analysis
March 13th 2025
The prevalence of certain health conditions in New Hampshire are on the rise, to find out which ones, why, and the implications, read Bethany Swanson's summary here.
Out-of-Pocket Healthcare Costs Are Rising - Pregnancy Tops the List.
March 10th 2025
According to recent medical claims data, Pregnancy with delivery has the highest out-of-pocket costs. Read about other findings and implications here.
Understanding New Hampshire's Most Costly Health Conditions
February 27th 2025
Bethany Swanson explores the financial impact of the most costly conditions in New Hampshire based on a recent analysis of medical claims data from Medicaid, Medicare, and commercial insurers.
Hospital Cost Containment through Tax Legislation?
February 21th 2025
Kimberly Persson details how hospital prices have been dramatically increasing, and how legislation to tax hospitals on excessive prices could be part of the solution.
Strengthening Support for Youth: How New Hampshire is Expanding Awareness and Access to the 988 Suicide and Crisis Lifeline
February 18th 2025
In efforts to better market the 988 Suicide and Crisis Lifeline, New Hampshire plans use results from a recent survey conducted by IHPP on college and high school student's awareness and perceptions of the 988 Suicide and Crisis Lifeline. The findings of the survey, future recommendations, and more, are detailed and analyzed by Tess Pueschel and Susy Peoples.
Unaffordable Employer Sponsored Insurance - Could ICHRA Be the Solution Employers Need?
February 14th 2025
Increases in employer-sponsored insurance have left employees unable to afford premiums and out-of-pocket expenses. Individual Coverage Health Reimbursement Arrangements (ICHRAs) offered by employers are changing the benefits game; Kimberly Persson details how.
What is Old is New Again: Medicaid Work Requirements and Changing the Federal Share of Medicaid Spending
February 10th 2025
Deb Fournier details how Medicaid financing and work requirements are changing, and what that might mean for Americans depending on this program.
Understanding Pharmaceutical Utilization and Costs in New Hampshire: Key Insights from 2022
February 7th 2025
An analysis of New Hampshire pharmacy claims from major insurance payers presents interesting findings, read Bethany Swanson's take on the implications of the complex relationship between drug utilization and costs in NH.
Health Policy for New Hampshire and Country
February 3rd 2025
Read a list of what Deborah Fournier and the rest of the Health Law and Policy Team are reading in the health policy space this February:
Measuring Total Healthcare Expenditures
January 23rd 2025
Healthcare costs are rising, and we don't know how much we spend on healthcare, or what we're spending it on. Read Lucy Hodder's analysis of current healthcare expenditures and what we're doing about it in New Hampshire.
The Disparate Data on Opioid Overdose Deaths: A Call to Close the Gap
January 13th 2025
The United States is seeing a decrease in opioid overdose deaths for the first time since 2018, but not for all demographics. Susy Peoples shows that it is time to develop community-specific response strategies across the United States. Additionally, take a look at an analysis of New Hampshire's response to this epidemic.
US Continues to Receive Bad Marks in Healthcare
December 12th 2024
See an analysis of this year's Mirror, Mirror report from the Commonwealth Fund and continued reports of healthcare facilities struggling with inadequate staffing.
Four New Hampshire Hospitals Earn “A” on the Fall 2024 Leapfrog Hospital Safety Grade
November 15th 2024
On November 15th, The Leapfrog Group, a national nonprofit representing hundreds of the nation’s most influential employers and purchasers of health care, announced the Fall 2024 Leapfrog Hospital Safety Grades.
How Hospitals Use a Low-Cost Drug Program to Profit on Patient Care
November 2024
Have you ever heard of 340B? No? Well, it’s coming. Policy pundits across the country predict that 340B will be a prime topic of conversation for employers in the coming year because it is costing them a lot of money and contributing to the unsustainable growth in healthcare expenditures.
Continuing the quest for affordable and equitable healthcare
October 17th 2024
On October 17, IHPP held its annual symposium, this year entitled, “Continuing the quest for affordable and equitable healthcare.” Attendees discussed the wicked problem of healthcare costs and affordability in New Hampshire. The day’s dialogue included the current trends in healthcare prices and the affordability crisis in healthcare, affordability as a component of access and equity, primary care’s role in improving costs and outcomes, equity beyond affordability, and available state policy solutions to address cost and affordability, such as cost growth benchmarks with Rachel Block of Milbank Memorial Fund and prohibiting anti-competitive contracting with Maureen Hensley-Quinn at NASHP.
On October 25, the New Hampshire Insurance Department held its annual hearing on its report on NH healthcare premium rates and claims. Public comment is being accepted on the report through November 15, 2024. NHID also held a robust discussion of using a total healthcare expenditure model to learn more about New Hampshire’s drivers of healthcare costs – neatly echoing the cost growth benchmark discussion that was held the week prior at the symposium. Panelists included Rhode Island’s Health Insurance Commissioner, Cory King and President of the Milbank Memorial Funds, Chris Koller.
Meanwhile, the Attorney General’s office held a public hearing about the proposal for HCA to purchase Catholic Medical Center on October 23, 2024. Public comments are being accepted through November 1, 2024.
Last in this post, but certainly not least, Medicare Open Enrollment began on October 15 and Marketplace Open Enrollment begins November 1.
