Remote Chance: Health Care in Rural America, a digital-first series of short films by award-winning filmmaker Elizabeth Arledge, made possible by the National Alliance on Mental Illness 
and The Annette Harkins Family Trust
Rural Community Access to Obstetrics Services
As of 2014, 54% of rural U.S. counties had no hospital-based obstetric services, following a steady decline over the prior decade. Loss of rural maternity care is associated with adverse maternal and infant health outcomes. Rural counties that have lost hospital-based obstetric services experienced higher rates of emergency department births, and in rural counties not adjacent to urban areas, increases in preterm birth, a leading cause of infant mortality.
Risks of infant and maternal mortality are elevated for rural residents, highlighting the importance of clinical and policy efforts to ensure rural obstetric care access.
In Rural Areas, Adequate Prenatal Care Less Likely Compared To The U.S. Overall
Sixty-three percent of counties nationwide are rural, and
approximately 15 percent of all births annually in the U.S.
occur in rural areas, where the initiation rate of prenatal
care is lower than the U.S. as a whole. Women living in rural areas tend to experience poorer health than their urban counterparts, with higher rates of obesity, smoking, and heart-disease-related deaths and lower preventive screenings rates for cervical and breast cancer.
These outcomes also impact children of women with untreated mental health and substance use disorders, who often have low birth weight, lower Apgar scores, sleep dysfunction, and poorer parent-infant bonding.
Rates of Postpartum Depression Are Higher in Some Rural States
Postpartum depression is depression that occurs after having a baby. Feelings of postpartum depression are more intense and last longer than those of “baby blues,” a term used to describe the worry, sadness, and tiredness many women experience after having a baby. Symptoms of postpartum depression are similar to symptoms for depression but may also include crying more often than usual, feelings of anger, and feeling numb or disconnected from your baby.
CDC research shows that nationally, about 1 in 8 women experience symptoms of postpartum depression. Estimates of the number of women affected by postpartum depression differ by age and race/ethnicity. Additionally, postpartum depression estimates vary by state and can be as high as 1 in 5 women.
Rural Women Have Longer Commutes to Access Perinatal Services
Between 2004 and 2014, 179 rural counties lost or closed their hospital obstetric services. And between 2010 and 2019, more than 100 rural hospitals closed, with a disproportionate share occurring in the South.
Multiple factors contributed to these closures. Among them were higher rates of uninsured patients, large amounts of uncompensated care, financial distress, hospital size, and community poverty rates. Between 2004 and 2014, 179 rural counties lost or closed their hospital obstetric services. Consequentially, fewer than 50% of rural women have access to perinatal services within a 30-mile drive from their home.
More than 10% of rural women drive 100
miles or more for these services. Within a 60-minute drive, the proportion increases to 87.6% in rural towns and 78.7% in the most isolated areas. These conditions affect access to care before, during, and after pregnancy, are more pronounced in Black and Hispanic communities, and disproportionately affect low-income women.
About the Series
Remote Chance: Health Care in Rural America is a series leading to the upcoming 2023 documentary Critical Condition: Health Care in Rural America (WT), a production of Gurney Street Films and WETA Washington, D.C. Produced, directed and written by Elizabeth Arledge.
Support for Remote Chance: Health Care in Rural America provided by the National Alliance on Mental Illness (NAMI) and The Annette Harkins Family Trust.