Postpartum Morbidity and Mortality and Health Care Utilization in Rural vs. Urban Communities

Research center:
Lead researchers:
Project funded:
September 2022
Anticipated completion date:
August 2024

Maternal deaths have increased 40% in the last decade, and half of all maternal deaths occur in the year following birth. Almost 60% of maternal deaths are due to obstetric-related causes while more than one in five deaths are drug-related or due to suicide or homicide. Further, disparities in the rate of maternal death and the causes of death exist by race and ethnicity as well as by rurality. Limited access to care in the postpartum period is frequently cited as a top contributor to these maternal deaths. Rural communities continue to experience hospital and obstetric unit closures, with only 40% of rural counties having hospital-based obstetric units as of 2018. As a result, rural pregnant patients have to travel farther for care and have less frequent prenatal care prior to delivery as well as reduced access to care after childbirth, with disproportional impacts on Black, Indigenous, and low-income people.

Understanding the health needs and access challenges that rural postpartum patients face is essential for improving postpartum health and for reducing postpartum maternal deaths in rural communities. Using 2006-2018 data from the National Health Interview Survey linked to the National Death Index through 2019, this project will examine postpartum mortality among rural and urban residents and at the intersection of rural, race, and ethnicity. We will also evaluate differences in health, health care utilization, and barriers to care across rural and urban communities, assessing the interaction of rurality with race and ethnicity as well as insurance status.