Rural U.S. hospitals welcome around half a million babies into the world each year. The growing challenge is keeping the doors open to the setting in which they’re optimally received—labor and delivery units.

According to a study published in the January edition of Health Services Research, 7.2 percent of 306 hospitals serving women residing far from urban care centers closed their obstetrics departments between 2010 and 2014.

What’s more, the units that closed were located in communities with relatively low family income, along with relatively few obstetricians and family physicians.

Kaiser Health News looked at the study Jan. 23 after speaking with experts concerned that the closings are not a glitch but a trend.

“A labor and delivery unit is functionally no different than an intensive care unit,” says Neel Shah, MD, of Harvard, referring to the heavy investment in nursing staff and bedside equipment needed despite the fact that a small rural hospital may deliver fewer than 100 babies a year.

One of the study’s co-authors, Katy Kozhimannil, PhD, University of Minnesota, adds that insurance payments are often low and, in rural areas, many patients are covered by Medicaid, which only pays about half as much as private insurance for childbirth.

Considering potential solutions, the Kaiser article points to a legislative effort underway to encourage medical professionals to move to rural areas, as well as rising rates in the use of midwives and cost-effective birthing centers.

Still, Kaiser notes, more than 98 percent of the 4 million babies born in 2014 arrived at a hospital.

“Finding strength in numbers, small rural hospitals are increasingly banding together to share resources, says Kozhimannil, adding that she sees opportunity in the ongoing national dialogue about health reform—but more must be done, as so much research has focused on urban care settings.

“[I]t’s crucial to have rural people at the table,” she says.

“You can deal with lower volume,” adds Shah, “and still be sustainable.”