Why GAO did this study. Access to obstetric care is a growing concern in rural U.S. communities, given recent closures of hospitals in rural areas. The loss of hospital-based obstetric services in rural areas is associated with increases in out-of-hospital births and pre-term births, which may contribute to poor maternal and infant outcomes. These have been more prevalent in rural areas and non-White racial and ethnic groups. House Report 116-450 directed GAO to report on ways to improve access to obstetrics care in rural areas. This report is focused on the hospitals and clinicians that provide delivery services, and describes (1) the availability of hospital-based obstetric services in rural areas, (2) stakeholder perspectives on factors that affect such availability, and (3) stakeholder perspectives on efforts federal agencies, states, and others could take to increase such availability. GAO reviewed literature published from 2011 through 2022, interviewed researchers and provider associations, and conducted semi-structured interviews with 19 selected stakeholders to obtain their perspectives on factors that affect the availability of care and efforts to address such factors. Stakeholders, comprised of provider associations, patient advocacy groups, researchers, and federal agencies, were selected to represent diverse perspectives, including various obstetric clinicians and organizations representing different racial and ethnic groups. GAO provided a draft of this report to HHS. HHS provided technical comments, which GAO incorporated as appropriate.
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