This blog post was prepared by RNO Website Committee Chair Joan Grant Keltner.
About 1 million infants and toddlers live in rural areas in the U. S., with many parents facing challenges, such as an inadequate number of healthcare providers and a need to travel long distances to access them, transportation issues, and lower income levels. In fact, rural mothers are less likely to receive adequate prenatal care than those who live in urban areas, with mothers living in Arizona (13.7%), Alabama (9.9%), North Dakota (8.2%), South Dakota (7.4%), and Wyoming (5.9%) with the highest percentage point difference when comparing rural and urban states (Keating et al., 2020; Centers for Medicare & Medicaid Services, 2019). Women who live in the Southeastern and Southwestern U.S. also have higher rates of inadequate prenatal care (Laurore et al., 2022). Unplanned home births in rural areas are primarily assisted by “other” individuals (68.1% in rural areas; 24.3% in urban areas) rather than certified healthcare providers US DHHS; 2019). These data suggest an increased risk for complications because “other” individuals may be less well-prepared in managing maternal and infant complications. Preventive health and dental visits also are fewer in rural areas, perhaps due to a lack of health insurance (Keating et al., 2020).
Negative health outcomes in rural areas are many. Unfortunately, infant mortality and preterm birth rates are higher in rural communities than in urban areas (CDC, 2019b; Ely & Hover, 2018). Three of the five leading deaths, congenital malformation, sudden death syndrome, and unintentional injuries are higher in rural areas compared to urban ones. Although rural infants are less likely to die from birthweight and maternal complications when compared to their urban counterparts, some rural states such as Mississippi have higher rates of lower birthweight rates (12.5%) (Ely & Hover, 2018). Breastfeeding rates also are lower in rural areas than in urban ones (CDC, 2019a), perhaps due to limited access to breastfeeding programs (Keating et al., 2020).
So, how do we support infants, toddlers, mothers, fathers, and significant others, as rural healthcare providers? Laurore and colleagues (2020) suggested several strategies including:
- 1) assisting families to enroll their infants in their state’s Children Health Insurance Program (CHIP) that is designed to provide insurance to families not eligible for Medicaid;
- 2) investigating other methods to provide health services, such as mobile health clinics and telemedicine for well-child and ill-focused visits, including video conferencing and telephone and email contacts;
- 3) encouraging appropriate vaccinations for all rural families, utilizing resources such as the Vaccine for Children (VFC) program that provides vaccinations to children under 19 years old who are without insurance, those eligible for Medicaid, and those of either an American Indian or Alaska Native race/ethnicity (CDC, n.d.);
- 4) utilizing state public health departments through task forces or directives to identify strategies for meeting gaps in home visiting programs; and
- 5) developing relationships with community resources (e.g., hospitals, birthing centers, and mobile health clinics, etc.) to provide group prenatal visits, etc.
These statistics indicate potential gaps which rural healthcare providers can fill by being creative in providing care. State and federal funding and other community resources enable health professionals to provide more comprehensive care to these individuals prior to, during, and after birth.
Centers for Disease Control and Prevention (CDC; n.d.). Vaccines for Children Program (VFC). https://www.cdc.gov/vaccines/programs/vfc/about/index.html
Centers for Disease Control and Prevention. (CDC; 2019a). Breastfeeding facts. https://www.cdc.gov/breastfeeding/data/facts.html
Centers for Disease Control and Prevention (CDC; 2019b). Infant mortality. https://www.cdc.gov/reproductivehealth/maternalinfanthealth/infantmortality.htm#about
Centers for Medicare & Medicaid Services. (2019). Improving access to maternal health care in rural communities. https://www.cms.gov/About-CMS/AgencyInformation/OMH/equity-initiatives/rural-health/rural-maternal-health
Ely, D. M. & Hoyert, D. L. (2018). Differences between rural and urban areas in mortality rates for the leading causes of infant death: United States, 2013-2015. https://www.cdc.gov/nchs/data/databriefs/db300.pdf
Keating, K., Cole, P., & Schaffner, M. (2020). State of babies yearbook: 2020. Washington, DC: ZERO TO THREE.
Laurore, J., Baziyants, G., & Daily, S. (2020). Health care access for infants and toddlers in rural areas. https://cms.childtrends.org/wp-content/uploads/2020/07/Rural-health-iniquities_ChildTrends_July2020.pdf
United States Department of Health and Human Services (US DHHS; 2019), Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), Division of Vital Statistics, Natality public-use data 2018, on CDC WONDER Online Database, September 2019. http://wonder.cdc.gov/natalityexpanded-current.html
