Changing Spatial Access to Obstetric Care in Germany from 2014 to 2024

BackgroundTimely access to healthcare is vital especially during childbirth, as it affects unplanned out-of-hospital births, survival and morbidity outcomes. In Germany, the number of maternity wards decreased since 2014, potentially increasing travel times for pregnant women. We examined changes in the travel times after maternity ward closures from 2014 to 2024 and addressed spatial disparities, providing essential information to ensure maternal and newborn care accessibility. MethodsMaternity ward closures in Germany from 2014 to 2024 were identified, and travel time to the nearest ward was calculated for women of reproductive age (15 to 49 years) using the Open Source Routing Machine. Critical driving time was defined as 40 minutes or longer. ResultsSince 2014, the number of maternity wards in Germany decreased by 172 (-23.1%), leaving 573 in 2024. Consequently, the number of women facing critical travel times increased by 112%, from 47,770 (0.27% of all women at risk) to 101,163 (0.60%). 27 closures were responsible for 90% of the increase in critical travel times, with seven accounting for over 50%. Northern and eastern parts of Germany were affected most which was reflected in an increasing Gini coefficient measuring the inequalities in travel times across Germany. ConclusionMost maternity ward closures had minimal effect, but a few substantially increased travel time, especially in regions without nearby alternatives. These closures exacerbated regional disparities and potentially increased the risks of unplanned out-of-hospital births and other adverse birth outcomes. Key MessagesO_ST_ABSWhat is already known on this topicC_ST_ABSLong travel time to the nearest maternity ward is associated with unplanned out-of-hospital births and negative maternal, fetal and neonatal birth outcomes. What this study addsFrom 2014 to 2024, the number of maternity wards in Germany decreased by 23.1%. As a result the number of women between 15 and 49 facing travel times of 40 minutes or more increased by 112%, reaching 101,163 in 2024. Regional disparities in critical travel times were exacerbated. How this study might affect research, practice or policyThis study underscores that further decisions on maternity ward closures should assess the impact on travel times and policy responses should create accessible accommodation options in areas where travel distance cannot be otherwise reduced. Further studies are needed to monitor the impact on increased travel time to obstetric care in Germany.