rural residents

Women and people born in rural America are at higher risk of adverse maternal health outcomes, including maternal morbidity and mortality. Now, a new study sheds light on one possible factor: lower enrollment in health insurance.

Residents of rural communities have lower rates of continuous health insurance before, during and after pregnancy compared to those in urban cities, according to the Michigan Medicine led research in Obstetrics & Gynecology.

“Being uninsured during the time of pregnancy has been associated with inadequate prenatal and postpartum care, which reduces opportunities to address risk factors affecting health outcomes for both the birthing person and baby,” said lead author Lindsay Admon, MD, M.Sc. , an assistant professor of obstetrics and gynecology at the University of Michigan Medical School and obstetrician-gynecologist at UM Health Von Voigtlander Women’s Hospital.

“Our study suggests that uninsurance disproportionately affects rural residents during the pivotal stages of pregnancy. We hope these findings help inform policies that address rural–urban inequities in maternity care access and maternal health across the country.”

Previous studies indicate that rural Americans—who often have less access to local obstetric services and need to drive farther for care—face higher risks of severe maternal complications and death than their urban peers.

A lack of health insurance may exacerbate these inequities, the authors of the new study say.

Michigan Medicine researchers analyzed survey data from 154,992 postpartum individuals in 43 states between 2016-2019, including roughly 16 %, or 32,178, rural residents.

They compared rates of those without any insurance or had gaps in coverage between rural and urban residents during preconception, at the time of birth, and postpartum.

In each of the three periods, rural residents who were non-Hispanic white, married, and with intended pregnancies experienced greater odds of less adequate or consistent insurance