Seven labour and delivery units have closed in western Wisconsin in five years. Dr Cara Syth, an obstetrician who worked in the region, recalls them with a count: River Falls, Barron, Menomonie, Rice Lake, Cumberland, then a large healthcare organisation pulling out of Eau Claire and Chippewa Falls. The family birth centre in Menomonie – a university town of 16,000 – shut its doors in January 2023, giving patients four months’ notice. Women who had driven thirty minutes to deliver their babies suddenly faced hours of travel. One pregnant with twins, unsure whether she was in labour, drove four hours in total after Syth told her she could not wait and see. She was not in labour. If a closer unit had existed, she could have stayed home longer.
The collapse of rural maternity care in the US
The closures in western Wisconsin are part of a longer national trend. Since 2004, the number of rural hospitals providing obstetric services has fallen; by 2018 more than half of rural counties in the US lacked such services. The closures are concentrated in sparsely populated, low-income counties and in those with a majority Black or African American population.
Syth says the decisions to shut units generally come down to three forces: business calculations by healthcare organisations that decide birth units are not worth the cost; political decisions, such as the Supreme Court’s Dobbs v. Jackson Women’s Health Organization ruling; and the chronic underfunding of rural obstetric care. Medicaid covered 41 per cent of US births in 2022, but its reimbursement rates have never been enough to make rural obstetrics financially viable on its own. In 2018, Medicaid covered an estimated 51 per cent of rural births, yet the payments still fell short of the actual cost of running a unit.
Those financial pressures have been compounded by the One Big Beautiful Bill Act, signed into law by President Donald Trump on 4 July 2025. The legislation cuts $911 billion (£672 billion) from Medicaid and the Children’s Health Insurance Programme over the next decade. Although the coverage losses do not take effect until January 2027, hospitals running on thin reimbursements are already closing. The cuts are projected to result in a $50.4 billion reduction in federal Medicaid spending on rural hospitals over ten years, potentially leading to 1.8 million people in rural communities losing coverage by 2034. A $50 billion Rural Health Transformation Fund created by the bill is intended for innovative solutions, but critics argue it is insufficient to prop up struggling hospitals.
Carrie Cochran-McClain, chief policy officer at the National Rural Health Association, says she has “a lot of concern that we’ll continue to see labour and delivery units close in rural hospitals and potentially even at an accelerated rate, as hospitals feel greater strain.” Leslie Dach, chair of the advocacy group Protect Our Care, says the cuts have “set off a chain reaction pushing over 800 hospitals, clinics, and nursing homes to the brink of collapse, forcing mothers, seniors and children to scramble for care that no longer exists.” Nearly 30 maternity wards have shut since the bill passed, according to Dach.
Workforce shortages add another layer of difficulty. Recruiting and retaining maternal health providers – physicians, nurses, anaesthesiologists – is a persistent challenge in rural areas, where they must compete with urban centres for a limited pool of professionals. The new administrative requirements in the OBBBA, including work requirements for Medicaid eligibility, could make it harder for young adults and other vulnerable groups to maintain coverage, further reducing the patient base that keeps rural units open.
Political decisions and the aftermath of Dobbs
The Dobbs ruling in June 2022 overturned the 1973 Roe v. Wade decision and devolved authority over abortion to the states. In Wisconsin, abortion services halted entirely for fifteen months as courts fought over whether an 1849 law banning the procedure was enforceable. Doctors described patients who could not comprehend being forced to carry nonviable pregnancies. In July 2025, the Wisconsin Supreme Court ruled that the 1849 law had been implicitly repealed by subsequent legislation and was therefore unenforceable, effectively legalising abortion up to 20 weeks. Yet the OBBBA still threatens access: Planned Parenthood of Wisconsin paused abortion services for nearly a month in late 2025 because of federal restrictions on Medicaid coverage for such services.
Syth names Dobbs as one of the forces driving doctors out of states like Wisconsin – fewer clinicians are willing to practise where the law criminalises their medical judgment, and fewer units can stay open with the staff they have. Across the country, a survey found that 40 per cent of medical professionals in states with abortion bans felt constrained in treating patients for miscarriages or other pregnancy-related emergencies.
In West Virginia, a survey of more than twenty mothers – conducted by the West Virginia Centre on Budget and Policy and shared exclusively with The Independent – documented the consequences. One woman woke in the night with contractions a minute apart, her husband driving fast to a hospital that was not ready for them. Another went into early labour from the stress and had to schedule an induction to avoid travelling over an hour and a half. A third drove two hours for a vaginal birth after a caesarean, waited three hours on arrival, was told there were no beds, and checked into a hotel for two nights. A fourth described struggling alone to pay for petrol to get to appointments.
The US maternal mortality rate stood at 22.3 deaths per 100,000 live births in 2022 – more than 55 per cent higher than the rate in Chile, the next highest among high-income nations studied by the Commonwealth Fund. Provisional data for 2024 shows a rate of 17.9. For Black women, the rate was 50.3 deaths per 100,000 live births in 2023, more than three times the rate for white women (14.5) and significantly higher than for Hispanic (12.4) and Asian (10.7) women. Black women covered by Medicaid are 50 per cent more likely to experience severe maternal morbidity and have lower access to preventive care than white women with private insurance.
Global repercussions of aid withdrawal
The United States is simultaneously cutting maternity care at home and withdrawing the funding that kept services alive in some of the world’s most under-resourced settings. On International Day of the Midwife, marked each 5 May, the World Health Organisation and the International Confederation of Midwives estimated the world is short of at least 900,000 midwives – a figure that could rise to one million by 2035. The UN Population Fund says the world needs one million more midwives by 2035, a move that would save more than four million lives every year. Africa accounts for nearly half the global deficit. Every dollar invested in midwifery yields up to $16 in social and economic returns, and universal access to midwife-delivered care could prevent two-thirds of maternal and newborn deaths and stillbirths, saving an estimated 4.3 million lives annually by 2035.
In South Sudan, the world’s youngest nation, one state has just five midwives. One of them, speaking anonymously to The Independent, described her ward: six patients – one in labour, one recovering from a miscarriage, one with sepsis because she came too late after delivering at home without gloves or sterile equipment. Two midwives cover the delivery room, the neonatal ward and the postnatal side. One surgeon and one doctor cover the entire hospital – childbirth, malaria, broken bones.
Trump’s decision to effectively close the United States Agency for International Development (USAID) as a distinct entity and slash American aid spending at the start of his second term has hit South Sudan hard. The midwife says: “USAID cuts have impacted us in a very bad way. From January to now we have had five maternal deaths. That is so alarming.” One woman died of sepsis after arriving ten days after giving birth, going into shock within thirty minutes of walking through the hospital gates. A functioning blood bank – the kind that consistent funding makes possible – operates around the clock. Without it, staff must go into the community to find donors. Sometimes they come; sometimes they do not and it is too late. Last month a woman died of haemorrhage after a caesarean section for that reason. Staff have not been paid in seven months, but they come anyway and often work without eating.
South Sudan saw USAID spending cuts exceeding 40 per cent in 2025, with commitments to future spending falling by more than 60 per cent. A 2026 study modelling the impact of USAID withdrawal across six vulnerable countries in west and central Africa projected that maternal deaths could increase by 45 per cent on average among populations in need. The Guttmacher Institute estimates that if 11.7 million women and girls are denied access to contraceptive care in 2025 because of the USAID freeze, around 8,340 maternal deaths could result from pregnancy and childbirth complications.
“We are a growing country,” the midwife says. “We are trying hard. Our mothers need a lot of support.”
Back in Menomonie, Syth thinks about the women she can no longer reach. People moved there for the university, the industries, a place to raise children. “When you move to a university town you don’t expect that you’re not going to be able to deliver your baby there,” she says. After the Menomonie closure she drove to a neighbouring county for three years to keep delivering babies, until the distance became unsustainable. She found another rural hospital willing to put community before profit and calls herself lucky for it, but knows what was lost. “There is no reason that we shouldn’t be able to take care of our women.”