Rural Health
Research Gateway

Women

Research Products & Journal Articles

Browse the full list of research publications on this topic completed by the Rural Health Research Centers.

Products – Freely accessible products include policy briefs, fact sheets, full reports, chartbooks, and interactive data websites.

Journal Articles – Articles in peer-reviewed journals may require a subscription or affiliation with a subscribing library. For these publications, Gateway lists the article citation, a brief summary, a link to additional information and access to the full-text of the article, if available.

2024

2023

2022

2021

2020

  • Emergency Obstetric Training Needed in Rural Hospitals Without Obstetric Units
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 11/2020
    This policy brief discusses the types of training identified by respondents and how those trainings may or may not meet the needs of those managing emergency obstetric situations in rural communities.
  • Local Capacity for Emergency Births in Rural Hospitals Without Obstetrics Services
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 11/2020
    As increasing numbers of rural hospitals stop offering maternity care, limited information is available about local preparedness to address obstetric emergencies. This paper explores the capacity to treat obstetric emergencies encountered among rural hospitals without obstetric units.
  • Making It Work: Models of Success in Rural Maternity Care
    University of Minnesota Rural Health Research Center
    Date: 11/2020
    The goal of this case series is to describe key factors that underlie three successful models of rural maternity care and to inform communities, clinicians, and hospitals that wish to keep obstetric services available locally.
  • Obstetric Emergencies in Rural Hospitals: Challenges and Opportunities
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 09/2020
    The purpose of this policy brief is to describe the challenges rural hospitals face in providing emergency obstetric care and to highlight resources that could help rural hospitals more safely respond to obstetric emergencies.
  • Characteristics of U.S. Rural Hospitals by Obstetric Service Availability, 2017
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 08/2020
    This study described characteristics of rural U.S. hospitals by whether they provide labor and delivery care for pregnant patients. Researchers used the 2017 American Hospital Association Annual Survey to identify rural hospitals and detail their characteristics based on whether they provide obstetric services.
  • Providing Maternity Care in a Rural Northern Iowa Community
    University of Minnesota Rural Health Research Center
    Date: 08/2020
    This case study highlights how one rural hospital in northern Iowa has successfully sustained a maternity care practice and identifies opportunities for other rural hospitals and communities seeking to ensure local access to care for pregnancy and childbirth.
  • Rural Versus Urban Prevalence of Intimate Partner Violence-Related Emergency Department Visits, 2009-2014
    Policy Brief
    Southwest Rural Health Research Center
    Date: 08/2020
    This project examines rural-urban disparities in the prevalence of intimate partner violence-related emergency department visits using a nationally representative sample of emergency room visits for the years 2009-2014.
  • Changes in Hospital-Based Obstetric Services in Rural U.S. Counties, 2014-2018
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 07/2020
    In 2014, 54% of rural U.S. counties had no hospital-based obstetric services, following a steady decrease during the previous decade. Loss of rural maternity care is tied to adverse maternal and infant health outcomes. This study shares hospital-based obstetric service losses in rural U.S. counties from 2014 to 2018.
  • The Supply and Rural-Urban Distribution of the Obstetrical Care Workforce in the U.S.
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 06/2020
    Monitoring the supply of the obstetrical (OB) care workforce is important for identifying areas that may lack OB care access. This brief describes the supply and geographic distribution of obstetricians, advanced practice midwives, midwives (not advanced practice), and family physicians in rural versus urban counties.
  • The Supply and Rural-Urban Distribution of the Obstetrical Care Workforce in the U.S. - A State-Level Analysis
    Report
    WWAMI Rural Health Research Center
    Date: 06/2020
    Monitoring the supply of the obstetrical (OB) care workforce is important for identifying areas that may lack OB care access. This set of data briefs describes the supply and geographic distribution of obstetricians, advanced practice midwives, midwives (not advanced practice), and family physicians in rural versus urban counties for every state.
  • Are Rural Infants Benefiting From Woman, Infants, and Children (WIC) Food Package Rule Changes? Breastfeeding and Infant Feeding Behaviors
    Policy Brief
    Southwest Rural Health Research Center
    Date: 02/2020
    This study compared breastfeeding initiation for rural and urban Women, Infants, and Children (WIC) participants before and after the changes in WIC Food Packages (WIC-FPs). In addition, changes in breastfeeding and infant feeding practices before and after changes in WIC program benefits were explored.

2019

  • Rural-Urban Differences in Severe Maternal Morbidity and Mortality in the U.S., 2007-15
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 12/2019
    In the U.S., severe maternal morbidity and mortality (SMMM) is climbing—a reality that is especially challenging for rural communities, which face declining access to obstetric services. Using data for 2007-15 from the National Inpatient Sample, we analyzed SMMM during childbirth hospitalizations among rural and urban residents.
  • Differences in Preventive Care Among Rural Residents by Race and Ethnicity
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 11/2019
    Disparities in preventive care by rural and urban location and by race and ethnicity are well documented in the literature, but less is known about whether there are differences in healthcare use among rural residents by race and ethnicity. We address this gap by examining differences in preventive care among rural residents by race and ethnicity.
  • Severe Maternal Morbidity and Hospital Transfer Among Rural Residents
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 11/2019
    In this brief, we compare hospital transfer rates for rural and urban residents who gave birth. We also provide descriptive information about the relationship between transfer status and severe maternal morbidity and mortality for rural residents nationally who gave birth 2008-2014.
  • Rural Focus and Representation in State Maternal Mortality Review Committees: Review of Policy and Legislation
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 08/2019
    Between 1990 and 2013, maternal mortality nearly doubled in the U.S., and rural residents experienced decreasing access to obstetric care. To improve maternal health, many states have established maternal mortality and morbidity review committees (MMRCs). We assessed the extent of rural representation in state policy efforts related to MMRCs.
  • Preventive Health Service Use Among Rural Women
    Policy Brief
    Maine Rural Health Research Center
    Date: 04/2019
    This study used the National Health Interview Survey to examine differences in receipt of preventive health services among rural and urban women. It found that rural women are less likely to receive HPV vaccines and mammograms, even controlling for rural-urban sociodemographic and resource differences.

2018

2017

2016

  • Relationship Between Hospital Policies for Labor Induction and Cesarean Delivery and Perinatal Care Quality Among Rural U.S. Hospitals
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 11/2016
    This study focused on maternity care quality by taking a look at hospitals' policies regarding induced labor and Cesarean deliveries.
  • Why Are Obstetric Units in Rural Hospitals Closing Their Doors?
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 08/2016
    Analyzes the reasons behind hospital- and county-level factors for rural obstetric unit closures.
  • Factors Associated With High-Risk Rural Women Giving Birth in Non-NICU Hospital Settings
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 07/2016
    Identifies rick factors for childbirth in facilities without neonatal intensive care unit (NICU) capacities among high-risk rural women. The study found that rural women with preterm birthday and multiple gestation pregnancies were less likely to give birth in a hospital with NICU capacity if no local hospital had this capacity.
  • The Practice of Midwifery in Rural U.S. Hospitals
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 07/2016
    Analyzes the role of certified nurse-midwives (CNMs) in providing maternity care in rural US hospitals and to examine state-level variations on rural CNM practice. CNMs play an important role in the maternity care workforce in rural US hospitals.
  • Ensuring Access to High-Quality Maternity Care in Rural America
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 05/2016
    Examines the access to high-quality for rural women care during pregnancy and childbirth. Policy interventions at the local, state, and federal levels could help to address maternity care workforce shortages and improve quality of care available to the one-half million rural U.S. women who give birth each year.
  • Location of Childbirth for Rural Women: Implications for Maternal Levels of Care
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 05/2016
    This study looks into the rate at which rural women give birth at nonlocal hospitals. Approximately 75% of rural women gave birth at local hospitals. However, after controlling for clinical complications, rural Medicaid beneficiaries were less likely to give birth at nonlocal hospitals, implying a potential access challenge for this population.
  • State Variations in the Rural Obstetric Workforce
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 05/2016
    Many types of staff are necessary to successfully run an obstetrics unit. Rural hospitals face unique staffing challenges. This policy brief describes the obstetric workforce in rural hospitals by state for nine states: Colorado, Iowa, Kentucky, New York, North Carolina, Oregon, Vermont, Washington, and Wisconsin.
  • Rural Implications of Expanded Birth Volume Threshold for Reporting Perinatal Care Measures
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 04/2016
    In 2016 the minimum annual birth volume threshold for required reporting of the Joint Commission Perinatal Care measures by accredited hospitals decreased from 1,100 to 300 births. This study used the publicly available Join Commission Quality Check data from April 2014 to March 2015.

2015

  • Implications of Rural Residence and Single Mother Status for Maternal Smoking Behaviors
    Policy Brief
    Maine Rural Health Research Center
    Date: 11/2015
    This study finds rural mothers are more likely than urban mothers to smoke. The authors suggest policymakers consider extending insurance for smoking cessation programs through the Affordable Care Act and Medicaid. Programs at the local, state, and national levels also could help reduce disparities in smoking-related morbidity and mortality.

2014

  • The Obstetric Care Workforce in Critical Access Hospitals (CAHs) and Rural Non-CAHs
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 11/2014
    This brief details rural hospital obstetric staffing patterns in nine states by critical access hospital status. The purpose was to examine obstetric practice models in rural hospitals, providing information to rural hospitals with obstetric care units regarding workforce and informing policymakers about the context in which the hospitals operate.

2013

  • Obstetric Services and Quality Among Critical Access, Rural, and Urban Hospitals in Nine States
    University of Minnesota Rural Health Research Center
    Date: 06/2013
    This policy brief compares the characteristics and quality of obstetric care in critical access hospitals, other rural hospitals, and their urban counterparts.
  • Diffusion of Preventive Innovation: Racial and Rural Differences in Cervical Cancer Prevention and Control Practices
    Rural and Minority Health Research Center
    Date: 05/2013
    This report examines differences associated with residence and race/ethnicity in receipt of cervical cancer screening and HPV vaccination.
  • Rural Border Health Chartbook
    Rural and Minority Health Research Center
    Date: 01/2013
    The chartbook examines potential geographic and ethnic disparities among U.S. border residents and describes select indicators related to access to care, women's preventive services, oral health, infectious and communicable diseases, and mental health that have been identified as disparities.
  • Rural Border Health Chartbook (Key Facts)
    Rural and Minority Health Research Center
    Date: 01/2013
    This report examines potential geographic and ethnic disparities among U.S. border residents and describes select indicators related to access to care, women's preventive services, oral health, infectious and communicable diseases, and mental health that have been identified as disparities.

2008

2006

  • Professional Liability Issues and Practice Patterns of Obstetrical Providers in Washington State
    Journal Article
    WWAMI Rural Health Research Center
    Date: 2006
    Objective: To describe recent changes in obstetric practice patterns and liability insurance premium costs and their consequences to Washington State obstetric providers (obstetrician-gynecologists, family physicians, certified nurse midwives, licensed midwives).
    Methods: All obstetrician-gynecologists, rural family physicians, certified nurse midwives, licensed midwives, and a simple random sample of urban family physicians were surveyed about demographic and practice characteristics, liability insurance characteristics, practice changes and limitations due to liability insurance issues, obstetric practices, and obstetric practice environment changes.
    Results: Fewer family physicians provide obstetric services than obstetrician-gynecologists, certified nurse midwives, and licensed midwives. Mean liability insurance premiums for obstetric providers increased by 61% for obstetrician-gynecologists, 75% for family physicians, 84% for certified nurse midwives, and 34% for licensed midwives from 2002 to 2004. Providers' most common monetary responses to liability insurance issues were to reduce compensation and to raise cash through loans and liquidating assets. In the 2 years of markedly increased premiums, obstetrician-gynecologists reported increasing their cesarean rates, their obstetric consultation rates, and the number of deliveries. They reported decreasing high-risk obstetric procedures during that same period.
    Conclusion: Liability insurance premiums rose dramatically from 2002 to 2004 for Washington's obstetric providers, leading many to make difficult financial decisions. Many obstetric providers reported a variety of practice changes during that interval. Although this study's results do not document an impending exodus of providers from obstetric practice, rural areas are most vulnerable because family physicians provide the majority of rural obstetric care and are less likely to practice obstetrics.
  • Racial and Ethnic Disparities in Potentially Avoidable Delivery Complications Among Pregnant Medicaid Beneficiaries in South Carolina
    Journal Article
    Rural and Minority Health Research Center
    Date: 2006
    Within groups defined by race or ethnicity, unadjusted rates for potentially avoidable maternity complications did not differ significantly by hospital location. Potentially avoidable maternity complications in rural hospitals, African Americans had higher risk for complications than did non-Hispanic whites.

2005

2004

  • Impact of Medicaid Managed Care, Race/Ethnicity, and Rural/Urban Residence on Potentially Avoidable Maternity Complications: A Five-State Multi-Level Analysis
    Rural and Minority Health Research Center
    Date: 12/2004
    This study examines pregnancy-related complications using Potentially Avoidable Maternity Complications as an indicator of access.
  • Development of a Methodology for Assessing the Effect of a Lay Home Visitation Program for Rural High-Risk Women and Infants
    Rural and Minority Health Research Center
    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.
  • Assessing the Effect of a Lay Home Visitation Program for Rural High-Risk Women and Infants
    Rural and Minority Health Research Center
    Date: 2004
    This study tested a retrospective data set approach for evaluating the effectiveness of a community health worker program to improve pregnancy and birth outcomes. The 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.
  • The Productivity of Washington State's Obstetrician-Gynecologist Workforce: Does Gender Make a Difference?
    Journal Article
    WWAMI Rural Health Research Center
    Date: 2004
    Objective: To compare the practice productivity of female and male obstetrician-gynecologists in Washington State.
    Methods: The primary data collection tool was a practice survey that accompanied each licensed practitioner's license renewal in 1998-1999. Washington State birth certificate data were linked with the licensure data to obtain objective information regarding obstetric births.
    Results: Of the 541 obstetrician-gynecologists identified, two thirds were men and one third were women. Women were significantly younger than men (mean age 43.3 years versus 51.7 years). Ten practice variables were evaluated: total weeks worked per year, total professional hours per week, direct patient care hours per week, nondirect patient care hours per week, outpatient visits per week, inpatient visits per week, percent practicing obstetrics, number of obstetrical deliveries per year, percentage working less than 32 hours per week, and percentage working 60 or more hours per week. Of these, only 2 variables showed significant differences: inpatient visits per week (women 10.1 per week, men 12.8 per week, P <= .01) and working 60 or more hours per week (women 22.1% versus men 31.5%, P <= .05). After controlling for age, analysis of covariance and multiple logistic regression confirmed these findings and in addition showed that women worked 4.1 fewer hours per week than men (P < .01). When examining the ratio of female-to-male practice productivity in 10-year age increments from the 30-39 through the 50-59 age groups, a pattern emerged suggesting lower productivity in many variables in the women in the 40-49 age group.
    Conclusion: Only small differences in practice productivity between men and women were demonstrated in a survey of nearly all obstetrician-gynecologists in Washington State. Changing demographics and behaviors of the obstetrician-gynecologist workforce will require ongoing longitudinal studies to confirm these findings and determine whether they are generalizable to the rest of the United States.

2003

2001

2000

  • U.S. Medical Schools and the Rural Family Physician Gender Gap
    Journal Article
    WWAMI Rural Health Research Center
    Date: 05/2000
    Women comprise increasing proportions of med school graduates. They tend to choose primary care but are less likely than men to choose rural practice. This study identified the U.S. medical schools most successful at producing rural family physicians and general practitioners of both genders.
  • The Distribution of Rural Female Generalist Physicians in the United States
    Journal Article
    WWAMI Rural Health Research Center
    Date: 2000
    Female physicians are underrepresented in rural areas. What impact might the increasing proportion of women in medicine have on the rural physician shortage? To begin addressing this question, we present data describing the geographic distribution of female physicians in the United States.

1999

  • The Production of Rural Female Generalists by U.S. Medical Schools
    WWAMI Rural Health Research Center
    Date: 05/1999
    This paper compares the production of rural female generalists among medical schools. Data from the AMA Physician Masterfile for the 1988-1996 graduate cohort were used to compare the production of rural female generalists by medical school. Outcome measures included total number and percentage of rural female generalist graduates of each school.