Predictors and Barriers to Achieving Immunization in Rural and Urban Areas

Research center:
Project funded:
September 2019
Project completed:
April 2021

Infants younger than 6 months old are highly susceptible to severe vaccine-preventable diseases. Immunization of mothers during pregnancy in combination with childhood immunization without delay offers the optimal opportunity to prevent severe infant morbidity and mortality.

Although recent research has highlighted disparities in adolescent immunization among rural-residing adolescents, vaccination rates impacting the youngest infants in rural areas have not yet been comprehensively evaluated. Using the pregnancy risk assessment monitoring system, this project evaluated the predictors and barriers to providing complete and timely coverage of prenatal and early infant immunization in rural areas compared to urban areas.


  • Disparities in Maternal Immunization Among Women Residing in Rural and Urban Areas of the United States
    Journal Article
    Southwest Rural Health Research Center
    Date: 06/2021
    This study evaluates disparities in urban-rural influenza vaccination rates of women prior to and during pregnancy using 2016-2018 Pregnant Risk Assessment Monitoring System data. Findings indicate women residing in rural areas have lower vaccination rates with the greatest differences seen in Hispanic women and women with no health insurance.
  • Disparities in Prenatal Immunization Rates in Rural and Urban U.S. Areas by Indicators of Access to Care
    Journal Article
    Southwest Rural Health Research Center
    Date: 02/2022
    This study evaluates variations in immunization rates among pregnant women across the urban-rural continuum. Results indicate pregnant women in rural areas more commonly rely on Medicaid to fund prenatal care but are less likely to have full or expanded access to Medicaid. This finding may contribute to immunization uptake disparities.
  • Influenza and Pertussis Vaccination Rates Among Pregnant Women in Rural and Urban Areas
    Policy Brief
    Southwest Rural Health Research Center
    Date: 04/2021
    This policy brief evaluates the receipt of influenza and pertussis vaccines from 2012-2018 among pregnant women in rural and urban areas of the U.S. Furthermore, it examines whether pregnant women during this this same period received influenza vaccine recommendations from their healthcare providers.