Three labor and delivery units closed last month in Alabama, including one in downtown Birmingham, one in suburban Shelby County and another in rural Monroe County.

These are just the latest in a string of closures going back decades that have hit rural areas especially hard. Rural hospitals often face financial pressure, and keeping enough staff on hand for labor and delivery can become expensive, especially when the number of births declines.

The number of rural counties in Alabama with labor and delivery units has fallen from 45 to 15 since 1980, according to the Alabama Department of Public Health. But it’s not just a rural problem. The recent closures also leave Shelby County without a hospital that delivers babies, making it the largest county in Alabama without those services.

Alabama already struggles with high infant and maternal mortality rates compared to the rest of the country. A study of outcomes following the reopening of a labor and delivery unit in rural Alabama showed that having those services available can improve the health of moms and newborns. But questions remain about how to fund and recruit doctors for those departments.

Watch this video for more information about the factors driving labor and delivery closures and how they affect mothers and babies.