FILE - Infant birthing unit hospital

Rural Iowa continues to lose facilities in which expectant mothers can deliver their babies, with the most recent being the Unity Point Hospital's obstetrics unit in Marshalltown.

The closure is part of a 20-year string of birthing unit closures, The Iowa Department of Public Health reports such 34 units at the state’s 118 community hospitals have closed over two decades.

Eight closures in 2018 were the most in a single year.

Stephen Hunter, vice chairman of obstetrics at the University of Iowa Hospitals & Clinics, told The Associated Press that Iowa's aging population and shrinking rural numbers are among key reasons for the closures.

Hunter added that the state does not have enough OB/GYNs and family doctors who practice obstetrics to perform deliveries in rural areas. Low Medicaid reimbursements have it made difficult for hospitals to keep their obstetrics units open, he said.

Rural hospitals are also losing out to their well-financed, well-staffed counterparts in Iowa’s larger cities. UnityPoint Health President Jenni Friedly said that “there are enough women becoming pregnant, but they are going elsewhere to deliver.”

The University of Minnesota conducted a study two years ago in which it determined the shuttering of labor and delivery units in smaller, more remote counties gave way to a decrease in prenatal care and increase in out-of-hospital and preterm births.

In an interview with Iowa Public Radio, Hansen Family Hospital CEO Doug Morse said that increasing costs prompted the closure of the birthing unit at the Iowa Falls facility.

IPR further reported that Iowa ranks 49th for the number of practicing OB/GYNs with only 1.49 doctors per 10,000 women, per the American College of Obstetricians and Gynecologists.

Meanwhile, Compass Memorial Hospital in Marengo appears to be bucking the trend as it is close to completing the construction of its new labor and delivery unit.