Preventive Care Utilization among Rural vs. Urban Women 12 Months Prior to Pregnancy

Abstract

Introduction. Pregnancy-related mortality in the United States occurs in 32.3 per 100,000 live births. Rural maternal mortality rates are even higher, and these patients are less likely to receive routine care. The purpose of this cross-sectional study was to compare primary and prenatal care and health behaviors among perinatal mothers living in rural and urban Kansas.

Methods. Data were collected from 1,971 pregnant women who participated in Phase 8 Pregnancy Risk Assessment Monitoring System (PRAMS) for Kansas between 2016 and 2018. Respondent location (urban or rural based on NIH classification) was abstracted from birth certificates and frequencies of healthcare visits and secondary healthcare variables were compared.

Results. Most respondents (75.1%, n = 1,481) resided in an urban area. Most (80.4%, n=1664) women were Caucasian, and 31.1% (n = 613) were 25 to 29 years old. More urban women reported having insurance via employer pre-pregnancy (P = .017) and during pregnancy (P = .015) than rural women. More urban women reported visiting an obstetrician/gynecologist within 12 months before pregnancy than rural women (P < .0001). Urban women reported attending pre-pregnancy dental visits (P = .019) and teeth cleanings (P = .004) more than rural women. Of the 35.7% of respondents (n = 516) who reported receiving pre-pregnancy counseling on folic acid, prenatal vitamins, or multivitamins, 78.9%, (n = 407) resided in an urban area.

Conclusions. Rural women reported fewer routine primary and prenatal care behaviors compared to their urban counterparts. Efforts are needed to improve access to obstetrician/gynecologist services, especially for women in rural areas.