Study: Pregnant Rural Residents Often Have Worse Insurance Coverage Than Urban

It’s been shown that women in rural communities have higher rates of maternal mortality and health complications than those in urban communities. But they also have less adequate health insurance, a new study shows.

The Michigan Medicine study, published in Obstetrics & Gynecology, found that rural residents had higher rates of uninsurance before, during and after pregnancy than urban residents. About 15.4% of those in rural areas were uninsured before pregnancy, compared to 12.1% of those in urban areas. At birth, 4.6% of rural residents were uninsured, compared to 2.8% of urban residents. Lastly, 12.7% of those in rural communities were uninsured during postpartum, versus 9.8% of urban residents.

“Being uninsured during the time of pregnancy has been associated with less adequate prenatal and postpartum care, which decreases opportunities to address risk factors affecting health outcomes for both the birthing person and baby,” said lead author Dr. Lindsay Admon in a news release.

The researchers analyzed data from 154,992 postpartum individuals across 43 states between 2016 and 2019. About 16% of these individuals were rural residents.

Michigan Medicine also discovered significant racial and ethnic disparities. About 40% of rural residents who were uninsured during the perinatal period were Hispanic or Indigenous. These communities only represent about 10% of the rural population, according to the report. 

“Rural inequities persisted regardless of age, marital status or insurance type. But these differences were even more significant among specific racial and ethnic groups,” Admon said.

Additionally, the study found that the rural population was less likely to have commercial insurance and more likely to have Medicaid. This is worrisome considering pregnancy-related Medicaid coverage usually ends 60 days after giving birth. Rural residents without insurance during the postpartum period were also more likely to be older than 35 and have health conditions like obesity and chronic hypertension, compared to uninsured urban residents.

“It’s extremely concerning to see that postpartum individuals at greater risk of medical complications in the postpartum year are more likely to be uninsured,” Admon said. “Postpartum insurance disruptions are associated with lower rates of receiving recommended care to address concerns like complications related to hypertension or depression.”

The findings show the need for policy changes and increased access to commercial insurance, Admon declared.

“We need to explore policies that help increase insurance enrollment during all phases of pregnancy and that account for rural differences in employment and employment-based insurance,” she said.

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