The reasons are numerous, but the result is the same: A crisis in rural health care.
That's the inescapable conclusion from two pieces of related news last week.
The first is the report of a study by the University of Minnesota that rural mothers face a 9% greater risk of life-threatening complications or deaths from childbirth, compared with mothers in urban area.
The second was the announcement by Mayo Clinic that it plans to close its hospital and emergency room in Springfield, in southwestern Minnesota, effective March 1.
Mayo officials have talked for a few years now about the difficulty of maintaining sufficient staff at some of its facilities in smaller communities. That was one of the reasons for the reduction of services at the hospital in Albert Lea.
In a statement about the Springfield closure, Mayo said the hospital there "has experienced several challenges, including an inability to recruit and retain physicians, declining hospital admissions and extremely low use of the emergency department."
Across the Midwest, rural communities are struggling to maintain hospitals and clinics for similar reasons.
Is there a correlation between reduced care options and statistics such as those in the U of M study about childbirth risks in rural areas?
It's difficult for the average person not to draw that conclusion. In the past decade at least a dozen hospitals in smaller Minnesota communities have stopped scheduling baby deliveries. Those communities can also face a shortage of prenatal care.
In some cases, hospitals have or are considering closing their obstetrics departments due to the risks involved in dangerous deliveries.
All of this is part of the complicated state of America's health care system -- a system that clearly does not offer all citizens an equal level of care. "Geography affects maternal health risks," one of the U researchers said.
If rural hospitals and clinics continue to be closed, those risks will get greater.
Is rural health care heading toward a crisis? It would appear the crisis is already at the doorstep.