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TOPLINE:

Parents in the year following birth residing in rural areas experienced more healthcare barriers, including reduced access to obstetric care and increased emergency department visits, than their urban counterparts. While infant care was similar between rural and urban areas, postpartum parents reported delays in medical care compared with their infants in both settings.

METHODOLOGY:

• Researchers conducted a cross-sectional analysis using data from the National Health Interview Survey to examine rural-urban differences in healthcare access in postpartum parents and infants.
• They included nonpregnant women aged 18-49 years who had infants aged 1 year or younger. A total of 2019 postpartum parents (mean age, 27.1 years) and 2191 infants residing in rural areas, and 12,112 postpartum parents (mean age, 29.2 years) and 13,088 infants residing in urban areas were included in the study.
• Self-rated health was assessed on a five-point scale ranging from excellent to poor for both postpartum parents and infants.
• Healthcare utilization was evaluated based on the location where the care was received, the number of office or emergency department visits in the prior year, visits to specific clinicians, and the number of hospitalizations.
• Barriers to care were categorized into insurance coverage issues (such as gaps in coverage, losing coverage after pregnancy, or changes in care location) and reasons for delayed medical care.

TAKEAWAY:

• Parents residing in rural areas were less likely to see an obstetrician-gynecologist (P = .002), visited the emergency department more frequently (P = .030), and had more hospitalizations (P = .041) than those residing in urban areas.
• Parents residing in rural areas experienced more disruptions in medical care, gaps in insurance coverage, and loss of Medicaid coverage after pregnancy than their urban counterparts.
• Delays in medical care were also more prevalent among parents residing in rural vs urban areas (20.3% vs 15.8%; P = .009); this pattern was not observed among infants.
• Among both rural and urban parent-infant dyads, adults were more likely to experience uninsurance and delayed medical care than their infants. Cost was a more common reason for delayed care among postpartum parents than among infants in the same household, regardless of where they lived.

IN PRACTICE:

“Investments in rural health care infrastructure may support rural families,” the authors wrote. “Integrating and incentivizing care for postpartum parents alongside their infants may address differential use and access to care in this critical period.”

SOURCE:

The study was led by Sara C. Handley, MD, MSCE, of the Perelman School of Medicine at the University of Pennsylvania in Philadelphia. It was published online on August 3, 2025, in The Journal of Rural Health.

LIMITATIONS:

The analysis did not include specific weighting to represent the US population of parent-infant dyads. The cross-sectional design did not specify the age of the infant, which could have affected the reported number of visits and limited comments on completeness of the care. 

DISCLOSURES:

The study received support through grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the University of Minnesota Foundation Rural Health Research Center Fund, and the Federal Office of Rural Health Policy. The authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.