In its report, Maternal Mortality and Morbidity: Additional Efforts Needed to Assess Program Data for Rural and Underserved Areas, the U.S. General Accountability Office (GAO) issued recommendations to capture, and understand, indicators for lower maternal health outcomes in rural and underrepresented areas. By disaggregating and analyzing maternal health data, researchers will be able to identify factors that contribute to poorer maternal health outcomes among those living in rural and underserved areas.

To inform the above report, the GAO reviewed maternal mortality and severe maternal morbidity (SMM) outcomes in rural and underserved areas between 2011 and 2016. GAO’s review found that maternal mortality rates in rural U.S. counties were between 19.8 and 23.8/100k live births compared to 14.6/100k live births in urban counties.

Across the board, those living in rural and underserved areas face greater barriers to accessing healthcare services. For maternity care specifically, the lack of access to postpartum care contributes to higher rates of maternal mortality and SMM among those rural and underserved populations. GAO notes that the Centers for Disease Control and Prevention (CDC) and the Health Resources and Services Administration (HRSA) currently collect data on postpartum visits and follow-up care, but do not isolate these data by population size.

Generating population-specific data can help identify unique and common factors contributing to these outcomes, and can help redirect funds to address these disparities. In doing so, GAO calls on the U.S. Health and Human Services Department (HHS), which oversees the CDC and HRSA, can help implement funding strategies specific to rural-area needs.

To help facilitate effective funding guidance, the GAO issued three specific recommendations:

Recommendation 1

The CDC should systematically disaggregate and analyze maternal health program data by rural and underserved areas, and make adjustments to program efforts, as needed.

Recommendation 2

HRSA should systematically disaggregate and analyze maternal health program data by rural and underserved areas and make adjustments to program efforts, as needed.

Recommendation 3

HHS should direct the Healthy People Maternal, Infant, and Child Health Workgroup and the Maternal Health Working Group to establish a formal coordinated approach for monitoring maternal health efforts across HHS, including in rural and underserved areas. Such an approach could include establishing a process for exchanging information and discussing relevant program efforts and outcomes across HHS during regular standing meetings on a routine basis.

While HHS continues to take action to improve U.S. maternal health outcomes through funding, coordination, and facilitation, the GAO, per Recommendation 3, states that HHS should take additional steps eliminate existing inter-competitiveness and develop formal communication channels. Such efforts would reduce intra-agency competitiveness, duplicity, and inefficiencies.

Ensuring access to care in rural and underserved areas continues to be a Lamaze priority. Efforts to increase access to Lamaze childbirth education by training more educators from rural areas, providing more virtual education offerings, and working with local hospitals and maternal-health practitioners are a few of Lamaze initiatives to ensure that everyone, regardless of location, background, or financial position, has access to LCCEs and Lamaze evidence-based education.

Resources

Centers for Disease Control and Prevention Pregnancy Mortality Surveillance System data. Rural areas indicate populations of 50,000 or fewer.

About Molly Giammarco

Molly Giammarco has consulted for professional healthcare associations for more than eight years. As Lamaze International’s Senior Manager for Policy & Government Relations, Molly monitors legislation regulations related to maternal and child health, as well as advises the Lamaze Advocacy + Collaboration Committee.

Molly received her undergraduate degree from Smith College in Northampton, Massachusetts and her master’s degree in public policy from the George Washington University in Washington, D.C.  She currently lives in Washington, D.C.

Tags