Rural/Urban Differences in Postpartum Health Insurance, Healthcare Use, and Health Outcomes

Research center:
Lead researcher:
Project funded:
September 2021
Project completed:
May 2023

The postpartum period is important for maternal health, as half of all maternal deaths occur after the day of delivery. Data suggest that recent increases in maternal mortality may be driven, at least in part, by an increasing proportion of the maternal deaths occurring in the postpartum period, especially those related to maternal mental health conditions such as depression, anxiety, and substance use disorders. Public health crises, including the opioid epidemic and rising rates of suicide, have had a disproportionate impact on rural communities, and correspondingly on rural residents who give birth.

In a recent study, the Centers for Disease Control and Prevention (CDC) identified lack of access to quality care as a key contributor to pregnancy-related deaths, including those occurring during the first year postpartum. Health insurance enrollment is often a prerequisite for access to quality care before, during, and after pregnancy. Limited evidence on rural/urban differences suggest that rural residents have less consistent insurance coverage and suffer higher levels of uninsurance. Additional evidence points to variability among pregnant individuals by other geographic factors, including state of residence and Medicaid expansion status. Further, there are stark differences between rural and urban areas in access to healthcare and health during pregnancy and birth. Despite these known realities, very little research exists on understanding receipt of recommended care and health outcomes specifically among postpartum individuals.

To our knowledge, no prior studies have examined rural-urban differences in postpartum insurance status, healthcare use, and health. Information is also needed on how to best design federal, state, and local policy solutions to improve access to recommended postpartum care and postpartum health, especially among rural residents. Such evidence is urgently needed to inform geographically tailored clinical and policy efforts to improve maternal health and to reverse the rising rate of maternal morbidity and mortality in rural communities and nationally.