The U.S. maternal mortality rate is higher than in any other wealthy country. In 2022, the U.S. experienced 22 pregnancy-related deaths for every 100,000 live births. In comparison, high-income countries such as Germany, Australia, Japan and the Netherlands had fewer than 5 deaths per 100,000 births that year.

The problem is particularly stark for people in rural areas of the U.S., who have a 50% higher death rate from pregnancy-related causes than people in urban areas. Rural people also have higher rates of maternal morbidity. As in the rest of the nation, pregnancy-related death rates in rural areas are higher for Black people and American Indian/Alaska Native people than for white people.

A shortage of maternity care in rural areas is one barrier to good pregnancy and postpartum health. Over half of U.S. counties lack hospitals that provide pregnancy care. More than 2.3 million women of reproductive age in the U.S. live in maternity care deserts where there are not enough obstetric providers or birthing facilities, according to a recent report from the March of Dimes. That means patients face long travel times to access needed care, which can increase the risk of complications and death for both patients and their babies.

Other barriers to maternal health care include a lack of paid leave, cost of care and a lack of transportation.

Several initiatives at the state and federal level are working to change those statistics. Among those is the Health Resources Service Administration’s Rural Maternity and Obstetrics Management Strategies Program, which awards funding to rural communities in need of financial assistance to improve maternal health.

The program collects rural hospital obstetric data, builds networks to coordinate care and allows local partners to organize projects according to their specific needs. It also uses telehealth and extended specialty care, connecting high-risk pregnant people to maternal fetal medicine specialists.

As of June, HRSA has funded 14 initiatives in 11 states. The first round of funding supported work in Missouri, New Mexico and Texas. Within two years, the programs created formal collaboration that included hospitals, support services and clinicians. Within the first year of implementation, over 3,000 people were served. Each program, tailored to local needs, managed to increase and improve pregnancy-related care to rural people, showing that progress can be made.

This Thursday, Nov. 21, is National Rural Health Day. It offers the opportunity to honor the important contributions health workers and communities make to improving rural health outcomes. It also allows us to draw attention to challenges and build support for solutions to address the maternal health crisis in rural America.

Claire Kolmansberger works in APHA’s Center for Public Health Policy.

Photo by FatCamera, courtesy iStockphoto