The postpartum period is important for maternal health, as half of all maternal deaths occur after the day of delivery. Data suggest that recent increases in maternal mortality may be driven, at least in part, by an increasing proportion of the maternal deaths occurring in the postpartum period, especially those related to maternal mental health conditions such as depression, anxiety, and substance use disorders. Public health crises, including the opioid epidemic and rising rates of suicide, have had a disproportionate impact on rural communities, and correspondingly on rural residents who give birth.

In a recent study, the Centers for Disease Control and Prevention (CDC) identified lack of access to quality care as a key contributor to pregnancy-related deaths, including those occurring during the first year postpartum. Health insurance enrollment is often a prerequisite for access to quality care before, during, and after pregnancy. Limited evidence on rural/urban differences suggest that rural residents have less consistent insurance coverage and suffer higher levels of uninsurance. Additional evidence points to variability among pregnant individuals by other geographic factors, including state of residence and Medicaid expansion status. Further, there are stark differences between rural and urban areas in access to healthcare and health during pregnancy and birth. Despite these known realities, very little research exists on understanding receipt of recommended care and health outcomes specifically among postpartum individuals.

To our knowledge, no prior studies have examined rural-urban differences in postpartum insurance status, healthcare use, and health. Information is also needed on how to best design federal, state, and local policy solutions to improve access to recommended postpartum care and postpartum health, especially among rural residents. Such evidence is urgently needed to inform geographically tailored clinical and policy efforts to improve maternal health and to reverse the rising rate of maternal morbidity and mortality in rural communities and nationally.

Publications

• Association of Health Insurance, Geography, and Race and Ethnicity With Disparities in Receipt of Recommended Postpartum Care in the U.S.
  Journal Article
  University of Minnesota Rural Health Research Center
  Date: 10/2022
  This study used data from the Pregnancy Risk Assessment Monitoring System and looked at receipt of recommended postpartum care content. The study describes variations across health insurance type, rural or urban residence, and race and ethnicity.
• Racial/Ethnic Disparities in Postpartum Health Insurance Coverage Among Rural and Urban U.S. Residents
  Journal Article
  University of Minnesota Rural Health Research Center
  Date: 09/2022
  Using data from the 2016-2019 Pregnancy Risk Assessment Monitoring System, this study describes postpartum health insurance coverage for rural and urban U.S. residents who are Black, Indigenous, and people of color (BIPOC) compared to those who are white.
• Rural and Urban Differences in Insurance Coverage at Prepregnancy, Birth, and Postpartum
  Journal Article
  University of Minnesota Rural Health Research Center
  Date: 03/2023
  In this manuscript, the research team used data from the Pregnancy Risk Assessment Monitoring System to measure insurance coverage at prepregnancy, birth, and postpartum, and insurance coverage continuity across these periods among rural and urban U.S. residents.