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Examining the Ratio of Obstetric Beds to Births, 2000–2019


The number of U.S. births has been declining. There is also concern about rural obstetric units closing. To better understand the relationship between births and obstetric beds during 2000–2019, we examined changes over time in births, birth hospital distributions (i.e., hospital birth volume, ownership, and urban–rural designation), and the ratio of births to obstetric beds. We analyzed American Hospital Association Annual Survey data from 2000 to 2019. We included U.S. hospitals with at least 25 reported births during the year and at least 1 reported obstetric bed. We categorized birth volume to identify and describe hospitals with maternity services using seven categories. We calculated ratios of number of births to number of obstetric beds overall, by annual birth volume category, by three categories of hospital ownership, and by six urban–rural categories. The ratio of births to obstetric beds, which may represent need for maternity services, has stayed relatively consistent at 65 over the past two decades, despite the decline in births and changes in birth hospital distributions. The ratios were smallest in hospitals with < 250 annual births and largest in hospitals with ≥ 7000 annual births. The largest ratios of births to obstetric beds were in large metro areas and the smallest ratios were in noncore areas. At a societal level, the reduction in obstetric beds corresponds with the drop in the U.S. birth rate. However, consistency in the overall ratio can mask important differences that we could not discern, such as the impact of closures on distances to closest maternity care.

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Data Availability

American Hospital Association Annual Survey data are available for purchase from:

Code Availability

SAS code for this analysis is available from the first author by request.


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Authors and Affiliations



DAG conceptualized and planned the analysis. MDB led data acquisition and data cleaning. CLD led the data analysis and writing of the first draft. MKM and ED provided expert guidance on the analysis and writing. All authors critically reviewed and revised the manuscript.

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Correspondence to Carla L. DeSisto.

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DeSisto, C.L., Goodman, D.A., Brantley, M.D. et al. Examining the Ratio of Obstetric Beds to Births, 2000–2019. J Community Health (2022).

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  • Hospitals
  • Obstetric beds
  • Births
  • Birth volume