A Cross-Sectional Analysis of Expanding Maternity Care Deserts in Rural Kansas Counties, 2016-2023.

Introduction: Rural Kansas accounts for one-quarter of the state's population and births. Living in rural areas is associated with delayed prenatal care, adverse birth outcomes, and higher infant mortality. Limited access to obstetric services, particularly in maternity care deserts (MCDs), defined as counties without hospitals or clinicians offering obstetric care, contributes to these disparities. Authors of this study assessed obstetric care availability in rural Kansas and compared findings with 2016 data. Methods: In this cross-sectional study, rural hospitals were defined as those located in counties with <39.9 people per square mile using Kansas Department of Health and Environment (KDHE) data. Ninety-three hospitals were contacted by phone between August and October 2023. A survey, replicated from a 2016 study, assessed obstetric clinicians' availability, attrition, and anticipated retirements. Data were analyzed using descriptive statistics and Wilcoxon signed-rank tests. Results: Of 93 hospitals, 66 (71.0%) responded. Among these, 38 (57.6%) reported no obstetric services and 28 (42.4%) offered services. Nine hospitals (32.1%) anticipated losing clinicians within five years, including one (3.5%) expecting complete loss. Among 28 hospitals with data from both years, 50.0% lost ≥1 provider and 21.4% lost all. Median provider counts declined from 5 (IQR 3-6.5) to 4 (IQR 2-5; p = 0.038). MCDs have continued to expand. Conclusions: Obstetric care access in rural Kansas has declined, with expanding MCDs. These trends threaten maternal and neonatal outcomes and underscore the need for targeted strategies to sustain rural obstetric services.