Maternal and child health

Research Products

Listed by publication date. You can also view these publications alphabetically.



  • Rural Women Delivering Babies in Non-Local Hospitals: Differences by Rurality and Insurance Status
    University of Minnesota Rural Health Research Center
    Date: 06/2015

    This policy brief describes the extent to which rural pregnant women give birth in non-local hospitals, and to analyze current patterns of non-local delivery by rural women's health insurance status and residential rurality.

    Key Findings:

    • In nine geographically-diverse states with substantial rural populations, 25.4% of rural pregnant women delivered their babies in non-local hospitals in 2010 and 2012.
    • Rural women living in more densely populated rural areas were less likely to give birth in a non-local hospital (19.5%) than those in less densely populated rural areas, either next to a metropolitan area (35.9%) or not (33.7%).
    • Privately-insured rural women were more likely to give birth in non-local hospitals than rural women who were covered by Medicaid (28.6% vs. 22.5%).
    • Rural women with Medicaid coverage were more likely than privately-insured women to deliver their babies in a hospital where more than half of all births were covered by Medicaid (63.8% vs. 36.7%).


  • The Obstetric Care Workforce in Critical Access Hospitals (CAHs) and Rural Non-CAHs
    University of Minnesota Rural Health Research Center
    Date: 11/2014

    This policy brief describes obstetric staffing patterns in rural hospitals in nine states by Critical Access Hospital (CAH) status. The purpose of this study was to examine current obstetric practice models in rural hospitals, with a goal of providing timely and useful information to rural hospitals with obstetric care units regarding the obstetric workforce and to inform policymakers involved in shaping healthcare about the context in which rural hospitals operate.

    Key Findings:

    • In the nine states we studied, almost two-thirds of the 244 rural hospitals (64.3%) had more than one type of clinician providing obstetric care. The most frequent combinations were obstetricians working with certified nurse midwives (CNMs) (17.2% of hospitals) and obstetricians working with family physicians (15.6%).
    • Critical Access Hospitals (CAHs) were significantly more likely than rural non-CAHs to have family physicians and general surgeons attending deliveries, and significantly less likely to have obstetricians attending deliveries.
    • When asked about the challenges they face staffing rural obstetric units, survey respondents most frequently cited census variability, retention and recruitment, maintenance of skills and competencies, and staffing arrangements (scheduling, taking call, unit coverage, etc.).




  • Why Are Fewer Hospitals in the Delivery Business?
    NORC Walsh Center for Rural Health Analysis
    Date: 04/2007
    Examines the declining availability of hospital-based obstetric services in rural areas from the mid-1980s to the early 2000s. Examines potential causes for this trend and explores the effects of medical malpractice reforms.


  • Cesarean Section Rates in Rural Hospitals
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 03/2005
    Findings Brief examining childbirth delivery patterns in rural hospitals and comparing the C-section rate in rural hospitals to that in urban hospitals using the Nationwide Inpatient Sample (NIS). Working Paper No. 80 on this topic is also available.