By the end of 2022, two-thirds of rural hospitals in eight states were without obstetric services. In Pennsylvania, South Carolina, West Virginia, and Florida, more than 40% of rural hospitals lost obstetrics services. Declines in care disproportionately affected rural hospitals in highly rural states (those where more than 30% of the population lives in rural areas). But a Medicaid policy like Medicaid expansion, which focuses on the low-income childless adult population, was not targeted enough to specifically affect the financing for rural maternity care. But in terms of maternity care, the problem is that midwives are often going to be located where they can do births in a hospital.