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• Posted February 3, 2023

Pregnant Women in Rural America Often Lack Health Insurance, Upping Risks

New research suggests that pregnant women and new moms in rural U.S. areas are at greater risk of adverse outcomes, including death, because they are more likely to be uninsured.

Women living in rural communities had lower rates of uninterrupted health insurance before, during and after pregnancy compared to those in urban areas, a University of Michigan study found.

"Being uninsured during the time of pregnancy has been associated with less adequate prenatal and postpartum care, which decreases opportunities to address risk factors affecting health outcomes for both the birthing person and baby,"said lead author Dr. Lindsay Admon. She's an assistant professor of obstetrics and gynecology at the University of Michigan Medical School.

"Our study suggests that uninsurance disproportionately affects rural residents during pivotal stages of pregnancy," Admon said in a school news release.

Past research has shown that women in rural areas have greater risks for severe complications during pregnancy, birth and afterward. Many times, they also have limited access to local obstetric services and live farther from care.

For the new study, researchers analyzed survey data obtained from nearly 155,000 postpartum women in 43 states between 2016 and 2019. About 16% lived in rural areas.

Researchers compared rates of insurance and coverage gaps between rural and urban residents before conception, at birth and after delivery.

Rural women who were white, married and intentionally pregnant were less likely to have adequate or consistent insurance compared to their urban counterparts. They were also less likely to have commercial health insurance.

Rural residents who were Spanish-speaking or Hispanic had the highest rates of uninsurance before pregnancy, closely followed by those from Indigenous communities.

"Rural inequities persisted regardless of age, marital status or insurance type," Admon said. "But these differences were even more significant among specific racial and ethnic groups."

Within three months after delivery, nearly 13% of people in rural areas were uninsured, the study found.

Rural residents were more likely to be insured by Medicaid, a federal-state program that helps cover medical costs for people with limited income. And these people were at higher risk of losing access to insurance since pregnancy-related Medicaid coverage typically ends 60 days after delivery.

Admon called this especially worrisome. The study found that rural residents without postpartum coverage were more likely to be over 35 and have obesity or chronic high blood pressure compared with uninsured urban residents.

"It's extremely concerning to see that postpartum individuals at greater risk of medical complications in the postpartum year are more likely to be uninsured,"Admon said. "Postpartum insurance disruptions are associated with lower rates of receiving recommended care to address concerns like complications related to hypertension or depression."

She said one way to improve access to commercial health insurance would be incentives for smaller employers to provide affordable coverage for families.

"We need to explore policies that help increase insurance enrollment during all phases of pregnancy and that account for rural differences in employment and employment-based insurance,"Admon said. "Health insurance is critical to accessing quality health care and improving maternal health in the U.S."

Study findings were published Feb. 2 in Obstetrics & Gynecology.

More information

The U.S. Centers for Disease Control and Prevention has more on pregnancy complications.

SOURCE: University of Michigan - Michigan Medicine, news release, Feb. 2, 2023