Earlier this summer, we called attention to the challenges that women in rural communities face during pregnancy and the postpartum period, and new research from Child Trends shows those challenges and health disparities extend to their young children as well.

“Health Care Access for Infants and Toddlers in Rural Areas” found that rural infant and toddler health disparities are, at least in part, attributable to poor prenatal health care in rural areas. Appropriate prenatal care is linked to better outcomes for both the birthing person and infant. These outcomes include newborns with healthier birth weights, fewer preterm births, and fewer unplanned home births.

Infants and toddlers living in rural areas are also more likely to be uninsured (7% rural uninsured) than their non-rural peers (5.1% uninsured), the report found. Notably, the two states with the lowest and highest rate of uninsured rural infants and toddlers (Vermont and Arizona, respectively) also have the lowest and highest rates of mothers who lack access to timely prenatal care.

In some states there is nearly a five percent disparity between rural and urban pregnant women receiving prenatal care. Hospital closures and provider shortages are limiting birthing options all over the country, but these shortages are disproportionately affecting rural areas. The percentage of out of hospital births is growing in rural areas, both planned and unplanned (due to lack of accessible hospital care).

In some cases, this lack of care leads to birth complications or maternal mortality. In response, the CDC’s new campaign, Hear Her, aims to amplify women’s voices and underscore the need for maternal care. This campaign provides resources to friends and family, birthing people, as well as policy makers in hopes of improving maternal health outcomes in America.

These personal stories illustrate how difficult getting care in rural areas can be. In more than 174 counties across the country, there are no obstetric care providers. Pregnant women like Kela Abernathy, who was profiled in the New York Times last year, have to drive 100 miles (while in labor) to deliver their babies. In Kela’s case, her twin babies were born early and needed extended care in the neonatal intensive care unit at a hospital even further away from her home in southwest Missouri. This meant frequent 200-mile drives during the immediate weeks after her C-section delivery to take care of her new twins in the NICU and her two-year old son back at home.

Importantly, the Child Trends report calls attention to the connection between the rural maternal health crisis and its effects on young children. Recommendations to address these issues in future policy include:

• Explore mobile health clinics, home visiting programs, and telehealth as options to support the health of rural parents and children. Each of these models can supplement the provider shortage in rural areas.
• Encourage outreach for Medicaid and CHIP enrollment, with particular focus on children in families with slightly higher incomes that could be eligible for CHIP but not enrolled.
• Support programs to boost vaccination for kids in rural areas such as the Vaccines For Children (VFC) program.
• Implement and support group prenatal visits and support birthing professionals. Use of midwives and doulas has been found to lead to better birth outcomes for mothers and infants.

States need to focus attention and support on the health of infants and toddlers in rural areas, which, as research shows, necessitates supporting the health of mothers.