Rural Maternal Health Care Outcomes, Drivers, and Patient Perspectives

Abstract

Rural communities are a vital segment of the US population; however, these communities are shrinking, and their population is aging. Rural women experience health disparities including increased risk of maternal morbidity and mortality. In this article, we will explore these trends and their determinants both within and external to the health care system. Health care providers, public health professionals, and policymakers should be aware of these social and structural factors that influence health outcomes and take action to reduce generational cycles of health disparity. Opportunities to improve the health and pregnancy outcomes for rural women and rural populations are highlighted.

Non-specialist delivered psycho-social interventions for women with perinatal depression living in rural communities: A systematic review

“…In researching maternal mental health interventions within rural communities, it’s also crucial for researchers to acknowledge and address the many logistical barriers faced by rural women when accessing in-person care. This includes but is not limited to addressing issues such as long travel distances to health and mental health clinics, as well as the lack of infrastructure supporting these journeys [ 65 , 66 ]. Understanding and addressing these logistical barriers are paramount in delivering effective mental health support within rural contexts.…”

Mapping high-risk clusters and identifying place-based risk factors of mental health burden in pregnancy

“…Despite our finding of elevated risk in urban areas, the presence of clusters in the predominantly rural western and coastal plains regions reflect substantial rural health disparities that have been documented in North Carolina, due to poor social determinants of health including limited access to mental health care, lack of transportation, a high proportion of uninsured populations, and income disparities ( MAHEC, 2022 ; Baxley, 2023 ). Rural populations as a whole experience lower rates of screening for mental health conditions ( Craemer et al, 2023 ; Mollard et al, 2016 ; Anglim and Radke, 2022 ) and higher rates of maternal mortality and morbidity (CDC, 2023); thus, mental health conditions may be un(der)diagnosed in rural areas relative to urban areas, leading to more severe outcomes (e.g. SMI) without intervention ( Hansen et al, 2022 ).…”

Effects of rurality and distance to care on perinatal outcomes over a 1‐year period during the COVID‐19 pandemic

“…Previous studies on birth outcomes in rural settings have shown higher rates of preterm birth, low birth weight, and NICU admission. [14][15][16][17] One such study specifically investigated the association between the rural-urban continuum, maternal education as a representation of socioeconomic status, and adverse birth outcomes, and found that, upon stratification by education, differences in perinatal health were still present across the rural-urban continuum. 18 This research showed the independent role of rurality on adverse obstetric outcomes when controlling for one of its associated components, low socioeconomic status.…”

“…These rural areas likely also have differential experiences of perinatal care that may inform outreach and treatment strategies. Previous studies on birth outcomes in rural settings have shown higher rates of preterm birth, low birth weight, and NICU admission 14–17 . One such study specifically investigated the association between the rural‐urban continuum, maternal education as a representation of socioeconomic status, and adverse birth outcomes, and found that, upon stratification by education, differences in perinatal health were still present across the rural‐urban continuum 18 .…”