The health of rural families is of growing concern across the U.S. because maternal and infant morbidity and mortality are higher for rural residents, compared to urban residents, and access to care during pregnancy and childbirth is declining in rural communities. Both poor outcomes and lack of access may be related to limited access to evidenced-based maternity care and support programs for pregnant people and their families in rural communities.

Not all rural communities are equally affected; our Center's prior research has shown that rural US counties with a majority Black or Indigenous population have higher rates of premature death. Our data also highlight the particular vulnerability of rural residents and Black and Indigenous people to poor maternal health outcomes. Addressing the intersection of racial and geographic equity in maternity care is therefore an essential step toward addressing the national maternal health crisis. In this project, we compared maternal and infant health outcomes between rural and urban counties and assessed the availability of evidence-based maternity care services and supports, both by geography and by the racial demographics of counties. We conducted case studies in racially diverse rural communities. We explored potential policy options to increase equitable access to evidence-based care during pregnancy and childbirth that may improves outcomes for birthing people and infants across the life course. Pregnancy and childbirth have been identified as a critical juncture in the life course, with the potential to alter the future trajectory for health outcomes and to improve health equity.

Publications

• Inequities in Availability of Evidence-Based Birth Supports to Improve Perinatal Health for Socially Vulnerable Rural Residents
  Journal Article
  University of Minnesota Rural Health Research Center
  Date: 07/2022
  This study aimed to understand the availability of evidence-based supports and services that promote maternal and infant health, in the rural U.S. The study developed a national survey of a sample of rural hospitals and determined the county-level scores on the 2018 CDC Social Vulnerability Index for each responding hospital.
• Maniilaq Health Center: Providing High-Quality Obstetric Care to American Indian/Alaska Native People in Rural Kotzebue, Alaska
  University of Minnesota Rural Health Research Center
  Date: 06/2023
  This case study highlights a hospital providing care to rural American Indian and Alaska Native patients within the state of Alaska. The study examines the maternity care context with attention to the intersection of race and geography with social determinants of health.
• Providing High-Quality Support to Pregnant People and Their Families in Racially Diverse Rural Communities
  University of Minnesota Rural Health Research Center
  Date: 08/2022
  The purpose of this case series is to highlight examples from racially diverse rural communities, where hospitals and health systems with obstetric units strive to meet patient needs and provide evidence-based, supportive services during pregnancy, childbirth, and the postpartum period.
• Racial Inequities in the Availability of Evidence-Based Supports for Maternal and Infant Health in 93 Rural U.S. Counties With Hospital-Based Obstetric Care
  Policy Brief
  University of Minnesota Rural Health Research Center
  Date: 07/2022
  This policy brief examines racial disparities in rural maternal and infant health outcomes between majority-Black, Indigenous, and People of Color versus majority-white rural counties and examines the availability of maternal and infant health evidence-based supports.