Rural/Urban Differences in Health, Health Care Use, and Barriers to Care for Postpartum and Parenting Women, 2006-2018

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08/2025

Access to maternity care has been declining in rural communities, and rural residents face elevated risks of maternal morbidity and mortality. More than half of maternal deaths in the United States occur in the postpartum year. The goal of this analysis was to describe rural/urban differences in health, health care utilization, and barriers to care for reproductive-age females, with specific focus on those who are parents of young children (ages 1-4) and those who are postpartum (gave birth in the last year).

Key Findings:

• Rural residents who identified as reproductive age females, especially those who were parents of young children or postpartum, more often faced challenges across key indicators of health, health care use, and barriers to care, compared with urban residents.
• Sleep difficulties were common, with 66% of postpartum women reporting not feeling well rested (compared to 57% of parents with young children); rural postpartum women were significantly more likely to report trouble falling or staying asleep than their urban postpartum counterparts (39% vs. 29%).
• Postpartum women were more likely to have emergency room visits, with 43% of rural postpartum women reporting a visit in the last year, compared with 26% of parents of young children and 38% of urban postpartum women.
• One-third of rural postpartum women are below the federal poverty level. Additionally, the largest rural-urban difference in having problems paying medical bills was among postpartum women (rural 26%, urban 20%).
• Prior to the state option to extend Medicaid postpartum coverage to 12 months, rural residents were significantly more likely to experience Medicaid or medical postpartum coverage that stopped after 60 days, an experience faced by 10% of rural and 7% of urban postpartum women during the study period.

University of Minnesota Rural Health Research Center

Julia Interrante, Clara Busse, Alyssa Fritz, Sara Handley, Katy Kozhimannil

Healthcare access, Hospitals and clinics, Maternal health, Quality, Women