Health Insurance Coverage and Rural–Urban Differences in Maternal Health Care Among Postpartum Women—National Health Interview Survey

Background: Rural–urban differences in access to and quality of health care shape health and well-being during pregnancy, childbirth, and the postpartum period. An important determinant of care access is health insurance coverage, yet rural residents have higher rates of uninsurance and public insurance (vs. private insurance). This study examined rural–urban differences in maternal health and care among postpartum women, assessing how those differences vary by insurance coverage. Methods: We used cross-sectional data from the 2013–2018 National Health Interview Surveys (NHIS) with restricted geographic data. The study population (n = 2664) included all non-pregnant female respondents ages 18–49 with an infant under age one. We determined patient rurality using the National Center for Health Statistics 2013 Urban–Rural Classification Scheme. Health insurance was self-reported. Study outcomes included: (1) sleep problems, (2) acute care utilization, (3) dissatisfaction with care, and (4) delayed or forgone care. Results: From 2013 to 2018, postpartum rural residents were more likely to be publicly insured or uninsured than their urban counterparts. Sleep challenges were common and experienced by one-third of rural and one-fourth of urban postpartum women and were most frequently experienced by those publicly insured (compared with privately insured or uninsured). Delayed or forgone care was heightened for those uninsured (rural: 33%, urban: 41%) or publicly insured (rural: 19%, urban: 24%), compared to privately insured postpartum women (rural: 10%, urban: 13%). Discussion: Some maternal health challenges were different for rural and urban residents, and challenges were more common for publicly insured or uninsured than privately insured postpartum women.