New research from the University of Minnesota shows that mothers living in rural areas are more likely than mothers in cities to die or come close to dying in childbirth.
"This research has revealed a higher risk of severe morbidity and mortality for rural residents simply because they are rural,” said Katy Kozhimannil, an associate professor at the university’s school of public health. “This is after we control for all the risk factors that we know are present."
Kozhimaninl’s research, which looked at mothers across the country, concluded that rural moms — those who live nonmetropolitan counties — are 9 percent more likely to die or experience life-threatening complications like hemorrhage as compared to urban mothers.
The findings coincide with a nationwide trend of rural hospitals cutting labor and delivery services or closing altogether. Today, more than half of rural counties nationally have no hospital that offers labor and delivery services outside of emergencies. That includes hospitals in at least 29 Minnesota counties where no hospitals deliver babies.
The reasons behind these closures involve a complicated combination of financial, demographic and staffing concerns.
In many areas, hospital administrators say, too few babies are being born to justify the cost of keeping labor and delivery wards staffed all the time. And with so few babies being born, practitioners aren't able to keep up their skills — which can also be risky for mothers and babies.
Kozhimannil said it’s not just distance from a hospital that delivers babies that can put pregnant and new mothers at risk of death or serious complications in childbirth. Structural disadvantages can also contribute to the risks pregnant women face.
“Those include ... unemployment, the opioid epidemic, transportation, housing, poverty, food security, violence,” she said. “These are all factors that differ by geography, and can increase risks for folks who are pregnant and having babies."
As a possible solution, Kozhimannil and the study’s coauthors recommend that pregnancy-related eligibility for Medicaid be available to mothers for a full year after a baby is born. Right now, it’s only available for two months postpartum, and third of all maternal deaths happen within the year after someone has a baby.
Kozhimannil also points to a bipartisan bill sponsored by DFL Sen. Tina Smith called the Rural MOMs Act as another promising solution. The bill would do things like award grants to train healthcare workers to practice obstetrics in rural areas, improve data collection around rural obstetrics care and expand the use of telemedicine to improve access to care.