Over the past decade, a growing number of California hospitals have stopped providing maternity care, increasing the distance to the closest hospital offering these services for some women of childbearing age. This is part of a national trend driven by a range of factors, including lower birth rates, hospital consolidation, and financial considerations of providing maternity services. While there is no established travel standard, concerns about the impact of these closures are particularly acute for rural areas that have far fewer health care resources overall.

Nationwide, women giving birth travel about 15 minutes to the nearest hospital maternity services; in more rural areas the distances can be much longer. Travel times and distances are shorter in California, where fewer people live in rural areas compared to other states.

In 2019, about 6.9 million (85%) of California women of reproductive age (15 to 44) lived within 15 minutes of a hospital offering maternity care (without accounting for traffic). Due to hospitals closing or discontinuing maternity services, that number dropped to about 6.5 million (79%) by 2024.

Statewide, about 15% of reproductive-age women (1.2 million) experienced an increase in the distance to the nearest hospital that offered maternity services over the last five years. For nearly half (47%) the increase was less than five minutes more driving time; about three-quarters of these women live in four large urban counties (Los Angeles, Orange, San Diego, and San Francisco). However, one in ten had at least a fifteen minute increase to the nearest hospital-based maternity care.

The risk associated with traveling farther varies, depending on the health and chance of complications for mothers and infants. Some recent national studies have found compelling evidence that hospital closures may actually improve some maternal outcomes (e.g., lower C-section rates) and have no impact on infant outcomes, because although women are travelling farther, they are accessing better equipped hospitals with more services. But research focused specifically on rural hospital closures has found negative impacts including reductions in prenatal care and an increase in pre-term births, though these effects varied by level of rurality or how rural the area was.

Our analysis indicates about 37% of women needing to travel farther for hospital-based maternity services in 2024 gained access to a hospital with a neonatal intensive care unit (NICU). For the 10% with at least a ten-mile increase, more than 60% gained access to a NICU.

Finally, access to hospital maternity care varies widely across the state. Several counties in the Far North, Eastern Sierra and Central Valley regions have median travel times of more than 30 minutes to the nearest hospital with maternity services. Most of these counties are largely rural and only about 80,000, or 1%, of reproductive-age women live there. Certain areas have been more impacted by recent reductions in maternity care; for example, some women in Mendocino, Madera, Kern, and Mono Counties have seen travel times to hospital maternity care increase by more than 20 minutes over the past five years.

The state legislature has been focusing on concerns about the loss of hospital maternity services. Governor Newsom recently vetoed a bill that would have required hospitals to inform the Department of Health Care Access and Information (HCAI) if they are considering cuts, so that HCAI could analyze potential community impacts. California lawmakers are again looking to address reductions in hospital maternity services in the current legislative session. More in-depth analyses could inform these efforts by providing a clearer understanding of the women most impacted—and where cuts may have negative repercussions on infant and maternal health.