A small hospital more than four hours north of the Twin Cities is the latest reminder of a big issue facing Minnesotans in rural areas.

Essentia Health announced it will no longer schedule baby deliveries at its Fosston, Minn. location. The next closest location is in Detroit Lakes, about an hour away.

In a statement, an Essentia spokesperson says decreasing birth volumes, growth in high-risk pregnancies and challenges recruiting providers led to the closure. The statement went on to say the location will still provide prenatal and postpartum services.

“This is common and increasing,” said Katy Backes Kozhimannil, University of Minnesota public health researcher.

She says labor and delivery units are often first cut at rural hospitals because they are not as profitable, which leads to an increase in emergency room deliveries. She has studied data from these types of rural ER births and says there can be risks.

“More than a third of the ERs that had a delivery reported an adverse event… and more than 80% reported they needed more training,” she said.

Over the past decade, similar closures have happened across greater Minnesota, from Ely to Grand Marias to Albert Lea.