Maternal and child health

Publications

Alphabetical list. You can also view by publication date.

  • Access to Maternity Care in Rural Washington: Its Effect on Neonatal Outcomes and Resource Use
    Date: 01/1997
    Compares birth outcomes for areas with poor health care access to those with adequate health care access in rural Washington state.
  • Assessing the Effect of a Lay Home Visitation Program for Rural High-Risk Women and Infants
    Date: 2004
    This pilot study tested a retrospective data set approach for evaluating the effectiveness of a community health worker program at improving pregnancy and birth outcomes. The home visitation program uses lay health workers to provide health education, referral, and social support to rural, low income, Medicaid-insured pregnant African American women and their infants.
  • Cesarean Section Patterns In Rural Hospitals
    Date: 11/2004
    Examines childbirth delivery patterns in rural hospitals and compares the cesarean section (c-section) rate in rural hospitals to that in urban hospitals. The c-section rate for rural hospitals was well above the 10-15% rate recommended by the World Health Organization, and was higher (but not statistically significant) in rural hospitals than in urban hospitals. A Findings Brief on this topic is also available.
  • Cesarean Section Rates in Rural Hospitals
    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.
  • Delivery Complications Associated With Prenatal Care Access for Medicaid-Insured Mothers in Rural and Urban Hospitals
    Date: 2005
    Examined access to health care during pregnancy for mothers insured by Medicaid as well as the risks of potentially avoidable maternity complications among rural and urban hospital deliveries for groups of mothers defined by race or ethnicity. Within groups defined by race or ethnicity, unadjusted rates for potentially avoidable maternity complications did not differ significantly by hospital location. Holding other factors constant, potentially avoidable maternity complications were less common in rural hospitals than in urban hospitals. In rural hospitals, African Americans had notably higher risk for potentially avoidable maternity complications than did non-Hispanic whites. The authors conclude that providers and policymakers should work to reduce the risks of potentially avoidable maternity complications for African American women in rural areas who are insured by Medicaid.
  • Development of a Methodology for Assessing the Effect of a Lay Home Visitation Program for Rural High-Risk Women and Infants
    Date: 02/2004
    This pilot study successfully demonstrated that a retrospective, population-based, comparative design is a feasible method for evaluating the effectiveness of a community health worker program for women at risk for poor pregnancy and birth outcomes.
  • Effects of Medicaid Managed Care and Medicaid Managed Care Penetration On Potentially Avoidable Maternity Complications (Fact Sheet)
    Date: 2004
    The effects of Medicaid Managed Care on pregnancy-related complications affecting mothers during their delivery hospitalizations were examined using the Potentially Avoidable Maternity Complications (PAMCs) indicator.
  • Impact Of Medicaid Managed Care, Race/Ethnicity, and Rural/Urban Residence On Potentially Avoidable Maternity Complications: A Five-State Multi-Level Analysis
    Date: 12/2004
    Complications of pregnancy affect the lives of many women and infants. This study examines pregnancy-related complications using Potentially Avoidable Maternity Complications (PAMCs) as an indicator of access. Findings include: 1) Mothers delivering in rural hospitals had lower PAMC risks than those with urban deliveries.; 2) In rural hospitals, African American women had greater PAMC risks than white women.; and 3) In urban hospitals, adjusted PAMC risks were substantially lower for Hispanics and Asians than for whites.
  • National Trends in the Perinatal and Infant Health of Rural American Indians (AIs) and Alaska Natives (ANs): Have the Disparities Between AI/ANs and Whites Narrowed? (Policy Brief)
    Date: 06/2008
    Brief overview of findings from a study examining trends in prenatal care receipt, low-birthweight rates, neonatal and postneonatal death rates, and cause of death among rural American Indians/Alaska Natives (AI/ANs) and whites between 1985 and 1997.
  • The Obstetric Care Workforce in Critical Access Hospitals (CAHs) and Rural Non-CAHs
    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.
  • Obstetric Services and Quality among Critical Access, Rural, and Urban Hospitals in Nine States
    Date: 06/2013
    Compares the characteristics and quality of obstetric care in Critical Access Hospitals, other rural hospitals, and their urban counterparts.
  • Perinatal and Infant Health Among Rural and Urban American Indians/Alaska Natives
    Date: 09/2002
    Provides a national profile of rural and urban American Indian/Alaska Native (AI/AN) maternal and infant health.
  • Poor Birth Outcome in the Rural United States: 1985-1987 to 1995-1997 (Final Report)
    Date: 02/2008
    Rates of low birthweight, poor outcomes, and inadequate prenatal care among urban and rural areas were evaluated and compared from 1985-1997 using data from the Linked Birth-Death Data Set. The study found that while progress was made in closing rural/urban gaps, rural residence and residence in a persistent poverty county remained independent risk factors for inadequate care and some adverse birth outcomes, especially postneonatal mortality.
  • Poor Birth Outcome in the Rural United States: 1985-1987 to 1995-1997 (Project Summary)
    Date: 02/2008
    Rates of low birthweight, poor outcomes, and inadequate prenatal care among urban and rural areas were evaluated and compared from 1985-1997 using data from the Linked Birth-Death Data Set. The study found that while progress was made in closing rural/urban gaps, rural residence and residence in a persistent poverty county remained independent risk factors for inadequate care and some adverse birth outcomes, especially postneonatal mortality.
  • Racial and Ethnic Disparities in Potentially Avoidable Delivery Complications Among Pregnant Medicaid Beneficiaries in South Carolina
    Date: 2006
    Examined access to health care during pregnancy for mothers insured by Medicaid as well as the risks of potentially avoidable maternity complications among rural and urban hospital deliveries for groups of mothers defined by race or ethnicity. Within groups defined by race or ethnicity, unadjusted rates for potentially avoidable maternity complications did not differ significantly by hospital location. Holding other factors constant, potentially avoidable maternity complications were less common in rural hospitals than in urban hospitals. In rural hospitals, African Americans had notably higher risk for potentially avoidable maternity complications than did non-Hispanic whites. The authors conclude that providers and policymakers should work to reduce the risks of potentially avoidable maternity complications for African American women in rural areas who are insured by Medicaid.
  • Rural Women Delivering Babies in Non-Local Hospitals: Differences by Rurality and Insurance Status
    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%).
  • Why Are Fewer Hospitals in the Delivery Business?
    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.

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