Rural-Urban Differences in Severe Maternal Morbidity and Mortality

In a prior Rural Health Research Center-funded project (2018-2019), we studied rural-urban differences in severe maternal morbidity and mortality. Using data for 2007-15 from the National Inpatient Sample, we analyzed severe maternal morbidity and mortality during childbirth hospitalizations among rural and urban residents. We found that severe maternal morbidity and mortality increased among both rural and urban residents during this period, from 109 per 10,000 childbirth hospitalizations in 2007 to 152 per 10,000 in 2015. When we controlled for sociodemographic factors and clinical conditions, we found that rural residents had a nine percent greater odds of severe maternal morbidity and mortality, compared with urban residents.

Much has changed in the maternal health landscape between 2015 and today, including a substantial decline in access to hospital-based maternity care that disproportionately affects rural residents. The purpose of the current project is to provide an updated national look at these trends and to analyze potential strategies for addressing rural-specific challenges in maternal health. The main research questions are:

1. What were the trends in severe maternal morbidity and mortality during childbirth hospitalizations among rural and urban U.S. residents from 2016-2024?
2. Are there differences in severe maternal morbidity and mortality risks among rural residents of noncore and micropolitan areas?
3. What are rural-specific challenges for addressing severe maternal morbidity and mortality?