Healthcare providers in Arkansas are sounding the alarm over an issue many believe has reached crisis level — access to birthing hospitals.
Since 2019, 10 Arkansas hospitals have closed their obstetrics units, leaving the state with just 30 general acute care hospitals out of 122 equipped to deliver babies, data from the Arkansas Center for Health Improvement shows. In some rural areas of Arkansas, expectant mothers are more than 45 minutes away from the nearest birthing hospital.
Yet even today, when one thinks of a hospital, the first thing that comes to mind, oftentimes, is the maternity ward.
Arkansas hospitals are not closing their labor and delivery units due to a declining birth rate, though both the state and national fertility rates are falling. In 2024, the last year for which data is available, Arkansas’ fertility rate was 58.8 births per 1,000 women aged 15 to 44, according to the U.S. Centers for Disease Control and Prevention, down from 59.2 the previous year. The national average was in the low 50s.
Almost half of Arkansas counties qualify as maternity-care deserts, above the national rate of 35 percent, according to a recent report from March of Dimes. The report also found that expectant mothers travel 22 minutes to reach the closest hospital with labor and delivery services. Women in maternity care deserts travel 2.3 times longer to reach a hospital that provides maternity care, the report revealed, while 91,000 Arkansas women live more than 30 minutes from such a hospital.
Dr. Nirvana Manning, chair of the department of obstetrics and gynecology at the University of Arkansas for Medical Sciences in Little Rock, said the problem is twofold — financial and staffing. Many hospitals, especially in rural areas, are struggling to stay open as it is, and the healthcare professionals needed to deliver obstetric services — OB-GYNs, maternity nurses and anesthesiologists among them — do not come cheap.
Dr. Nirvana Manning, UAMS
“I believe we are already at a critical point in many areas of Arkansas. Nearly half of Arkansas counties no longer have labor and delivery services, and many communities have become maternity care deserts,” Manning said. “If additional hospitals stop delivering babies, we will continue to see increasing travel distances, greater strain on regional hospitals, delayed emergency care, and growing disparities in maternal and infant outcomes. We also risk losing the healthcare workforce needed to support women’s health in rural communities because obstetric providers, nurses and anesthesia professionals often leave when delivery services disappear.
“This is not simply about where babies are born. It is about preserving access to comprehensive women’s healthcare across the lifespan.”
It is not just rural hospitals that are leaving the maternity game. CHI St. Vincent in Little Rock stopped offering maternity services roughly 20 years ago, but “big name” hospitals in larger Arkansas cities joined the trend as recently as July. In the spring, Baptist Health announced it would no longer offer the services at its Fort Smith hospital, formerly Sparks Regional Medical Center, and National Park Medical Center in Hot Springs followed suit. Freeman Health System’s Springdale Medical Center, formerly Northwest Medical Center, no longer operates an obstetrics unit, though its sister hospital just up the road in Bentonville does.
National Park Medical Center is one of the latest Arkansas hospitals to close its maternity ward. (Photos provided)
The lack of easy access to care runs much deeper than simple inconvenience, Manning said.
“Labor and delivery closures represent far more than the loss of a hospital service; they represent the loss of an entire maternity care ecosystem for a community,” she said. “When obstetric units close, women often lose access not only to delivery services but also to local prenatal care, postpartum care, lactation support and providers experienced in caring for pregnant patients. For many Arkansas families, particularly in rural communities, this means traveling an hour or more for routine prenatal visits and even farther when emergencies arise. Those additional barriers often translate into delayed prenatal care, missed appointments and delayed recognition of pregnancy complications.”
Arkansas continues to see maternal and infant mortality rates among the highest in the nation. Its maternal mortality rate as of 2022, the latest year for which data was available, was 38 deaths for every 100,000 live births, ACHI states. Arkansas’ infant mortality rate of 8.2 deaths for every 1,000 live births ranks second in the country.
“We know that the vast majority of pregnancy-related deaths are preventable,” said Manning, a member of the Arkansas Maternal Mortality Review Committee. “Improving timely access to care throughout pregnancy and especially during the postpartum period is one of the most important opportunities we have to improve outcomes. Every additional closure widens existing disparities and places more women and infants at risk.”
Dr. Donya Watson, associate professor of the UAMS Department of Family and Preventive Medicine and program director of the UAMS Family Medicine Rural Track Residency Program, said the impact of the closures runs deeper than most might realize.
Dr. Donya Watson, UAMS
“Closures are having a tremendous impact on access to prenatal care and delivery services for women all across Arkansas,” she said. “Drive times for prenatal care, delivery and access to emergency services often needed for women in labor are greatly increased. This is leading to fewer women able to find transportation and afford the time off work or the gas needed to travel to access prenatal care at all. Despite local emergency rooms remaining open, most rural emergency departments are not equipped to provide emergency care for pregnant women. These resource limitations will further increase the neonatal and maternal morbidity and mortality Arkansans already face.”
The Arkansas shortage extends to doctors specializing in obstetrics and gynecology, especially in rural areas. Along the Interstate 40 corridor through the River Valley, there are two full-time OB-GYNs, four family practice-obstetrics physicians (FP-OB) and one certified nurse midwife providing obstetrical care — a total of seven obstetrical providers and four hospitals that still operate maternity wards between Fort Smith and Conway.
Dr. Shannon Case, the only full time OB-GYN at Johnson Regional Medical Center in her hometown of Clarksville, said the shortage is causing a strain on those remaining labor-and-delivery units.
Dr. Shannon Case, Johnson Regional Medical Center
“Every time we hear of another unit closing, we feel a sense of panic, especially since our unit is a similar size,” she said.
The closure of the Baptist Health unit in Fort Smith is particularly alarming, she added, since that unit saw similar numbers to Johnson Regional. Add in the loss of several Russellville providers, who left for larger facilities, and Johnson Regional is left with a significant increase in volume with no increase in staff.
The Clarksville hospital has averaged between 250 and 300 deliveries each of the past three years but is on track to see 400 this year.
Case said she is cautiously optimistic that things will improve but challenges remain. One of the most significant involves how FP-OB and OB-GYN residents are trained. Current training uses a laborist model (the OB equivalent to the hospitalist model), which allows doctors to share workload in 12- or 24-hour shifts with no other responsibilities during that shift.
The laborist models are an updated diversion from older, traditional call models and provide much needed work relief to obstetrical providers, Case said.
Financial and staffing limitations make it difficult for rural labor and delivery units to adopt the laborist model, however.
“Rural hospitals struggle to recruit new providers to our facilities in part because we cannot currently provide new providers with the work-life balance that can be found at larger facilities,” Case said. “Given these recruiting struggles, existing rural providers have seen an increase workload that feels unsustainable.”
The closing of the Baptist maternity ward may be just the beginning in Fort Smith as Baptist Health is considering the future of the hospital itself. The Fort Smith hospital and surrounding facilities such as Baptist Health Van Buren lost roughly $25 million in 2025 and had lost $7 million in the first quarter of 2026, said Doug Weeks, Baptist Health executive vice president, chief strategy and innovation officer, who reported the numbers to a local civic group this past spring.
He attributed the losses to poor payor mix and underinvestment in the hospital from the previous owners.
Most maternity ward closures, however, boil down to a lack of human resources. Generational issues play a major role, Case said. Doctors — and especially specialists — are wary of launching a practice in rural areas, where the hours are longer and the amenities lacking.
“This generation seems to be a little different,” she said. “They’re more focused on time and lifestyle and are not as motivated by money. We need to increase the amount of training available in rural settings so they can see it’s not as scary as they think it is.”
In the meantime, Case and her smaller market colleagues continue to “work their butts off.” Asked if she would choose medicine as a career again, she said she did not know.
“I’m not sure I would choose it again in today’s environment,” she said.
Interests both public and private are working to address the issue. One of the reasons why the Arkansas Colleges of Health Education in Fort Smith launched in 2017 was to address the need for more healthcare providers in rural Arkansas. ACHE’s Arkansas College of Osteopathic Medicine trains osteopathic doctors and providers to help fill the void. It has graduated more than 600 doctors since it opened, the majority of whom remain local.
“One of ACHE’s founding commitments is addressing the healthcare workforce needs of Arkansas and the surrounding region, particularly in rural and underserved communities,” said Jo Alice Blondin, ACHE interim president. “We know that where physicians train often influences where they choose to practice. By providing exceptional medical education, meaningful clinical experiences and strong partnerships with healthcare systems throughout the state, ACHE is helping prepare physicians who are equipped — and inspired — to serve the communities that need them most.”
Jo Alice Blondin, ACHE
Blondin added that ACHE’s mission extends to improving health outcomes and expanding access to care.
“We are proud of the role ACHE plays in developing the next generation of physicians and healthcare leaders who will make a lasting impact in rural and underserved areas,” she said.
The UAMS Department of Family and Preventive Medicine launched the rural track residency program in El Dorado to recruit, train and retain family physicians who can provide prenatal and postnatal care, Watson said.
“While their local hospital may not provide delivery services, we hope to develop a hub-and-spoke model of prenatal care and communication between physicians and hospitals to at least allow women to be seen, evaluated and stabilized in the event of an emergency to facilitate transfer to the regional delivering hospital,” she said. “Women could be seen for prenatal visits close to home and either transfer care to the delivering physicians in the third trimester or be seen virtually as delivery time approaches to best provide for seamless transfer of care to the delivering hospital and its physicians. This training model could be further developed and duplicated across the state to provide basic, essential services to women of childbearing age across rural Arkansas.”
Manning said UAMS is “uniquely positioned to help redesign how maternity care is delivered across our state.” In addition to the rural residency program, the UAMS Arkansas Center for Women & Infants’ Health is developing innovative models to strengthen postpartum care, improve care coordination and expand access for women in rural areas that do not have birthing hospitals.
“By combining workforce development, regional partnerships and new models of care, UAMS can help ensure that where a woman lives does not determine the quality of maternity care she receives,” she said.
UAMS Medical Center in Little Rock
That lack of access boils down to something of a perfect storm — rural hospitals facing financial pressures, declining birth rates and the difficulty in attracting specialists to rural areas.
“Even when a hospital wants to maintain obstetric services, it may simply not have the workforce necessary to safely provide 24-hour coverage,” Manning said. “Addressing this challenge will require sustainable reimbursement, workforce development, regional collaboration and innovative care models rather than expecting every hospital to solve the problem independently.”
She stressed that improving overall maternal health in Arkansas will require more than just preserving the existing system.
“We need to redesign maternity care for a rural state by investing in regional networks, telemedicine, mobile care, postpartum outreach, transportation solutions and sustainable reimbursement models,” she said. “The goal should not simply be maintaining access — it should be ensuring that every Arkansas mother receives the right care at the right time regardless of where she lives.”
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