Kozhimannil KB, Interrante JD, Tuttle MKS, et al. - In 2014, there were no hospital-based obstetric services in 54% of rural US counties, following a steady decline over the prior decade. Adverse maternal and infant health outcomes are observed in correlation with loss of rural maternity care. Higher rates of emergency department births were noted for rural counties that have lost hospital-based obstetric services, and there were increases in preterm birth in rural counties not adjacent to urban areas, which is a leading cause of infant mortality.