Healthcare Accessibility in Germany: Analyzing the Closure of Maternity wards

Maternity ward closures have become a growing issue in Germany, with nearly 10% of wards shutting down since 2018—reaching over 50% in some states. These closures affects accessibility for expectant mothers, particularly in rural areas where alternative facilities are scarce.

Hospitals often cite staff shortages and economic challenges as the main reasons for closures. Obstetric care is particularly costly, and maternity wards typically only become financially viable with at least 800 to 1,000 births per year (Deutsche Welle, 2018). As a result, closures disproportionately affect rural areas, where residents may now face travel times of over 45 minutes to reach the nearest facility.

Maternity ward closures may also be affected by the ongoing political debate on hospital reform, highlighting the need for data-driven insights to support informed policy decisions. Using GOAT and data from the Mother Hood association, we analyze how these closures impact accessibility, focusing on Saarland, where over 30% of maternity wards have closed since 2014.

The case of Saarland

In Saarland, there were nine maternity wards until 2014, when the first closure occurred in Püttlingen, a city of 18,243 residents. In 2023, the Merzig maternity ward, serving a population of 29,609 and recording 579 births in 2020, also shut down. The most recent closure in 2024 affected St. Wendel, a town of 25,337 people, which had 534 births in 2020.

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Car Accessibility Analysis

Using GOAT, we analyzed the impact of maternity ward closures on accessibility in the Saarland state. Using the Catchment Area tool, we measured the population's access to maternity wards within 10, 20, 30, 40, 50, and 60 minutes of travel time. Our analysis included not only maternity wards within Saarland but also those near the state border that could serve as alternative options for residents.

The following map and graph illustrate the catchment areas along with the population reached. It reveals that over 200,000 people—more than 20% of Saarland’s population—now face travel times exceeding 30 minutes to reach a maternity ward by car.

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What happens with public transport?

While most women in labor are transported by car, many newborns require extended hospital stays, meaning parents must frequently travel back and forth. In these cases, daily car journeys of 30 to 40 minutes can quickly become exhausting. The situation is even more challenging for those relying on public transport, where travel times can exceed 60 minutes. We analysed the Saarland state with the Catchment Area Tool but this time using public transport as the routing type. In this case the results show that over 650,000 people—more than 65% of Saarland’s population—now face travel times exceeding 40 minutes to reach a maternity ward by public transport, something that if it is done on a daily bus, can become exhausting.

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The Broader Implications of Maternity Ward Closures

The closure of maternity wards in Saarland—and across Germany—has significantly impacted accessibility and may have important implications for public health, particularly in rural areas where travel times have increased. This analysis provides valuable insights and highlights how data-driven approaches can support healthcare planning. However, several limitations must be acknowledged.

First, this study primarily focuses on spatial accessibility, while other crucial factors—such as hospital capacity, birth rates, and the quality of care at remaining facilities—are not directly addressed. Additionally, the economic drivers behind these closures, especially amid rising healthcare costs and economic stagnation, add another layer of complexity that requires further investigation.

By assessing accessibility impacts, tools like GOAT, can help policymakers make informed decisions and ensure that maternity care remains available where it is most needed.

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📌 For more information about Maternity Ward closures, visit the Mother Hood website.

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