The quantity of expectant women who gave birth in Caithness last year was at its lowest level since the maternity services there were downgraded.
Eight women gave birth at the midwife-led Caithness General unit in Wick, while 202 women gave birth in Inverness, more than 100 miles away.
Over 160 mothers gave birth locally in 2015, when there was still a unit run by consultants.
The local unit could completely shut down, according to campaigners.
Local births are an option for women with low-risk pregnancies, according to NHS Highland.
The Raigmore Hospital in Inverness is where women with medical or pregnancy complications are sent when they need expert obstetric and neonatal care, according to the health board. .
It claimed that a committed and diligent team ran the community midwifery unit at Wick.
Caithness Health Action Team (Chat) obtained birth statistics from NHS Highland using FOI requests.
164 women gave birth at Caithness General and 91 at Raigmore in 2015.
The numbers dropped to 37 at the hospital in Wick and 156 in Inverness the following year.
The lowest number of births at Caithness General prior to last year was nine in 2019.
Chat called for an independent investigation into the delivery of maternity services and expressed concerns about the future of the unit.
According to NHS Highland, there is currently no change to the way services are being provided and no independent external review.
"However, we are internally evaluating our services, performance, and improvement opportunities in light of the quality and safety standards we must adhere to and the resources at our disposal. ".
The review of women's health services by NHS Highland was confirmed earlier this month by the health secretary, Humza Yousaf.
