Rural-Urban Differences In Severe Maternal Morbidity And Mortality In The US, 2007-15

Katy Backes Kozhimannil, Julia D Interrante, Carrie Henning-Smith, Lindsay K. Admon

Research output: Contribution to journalArticlepeer-review

137 Scopus citations


In the United States, severe maternal morbidity and mortality is climbing-a reality that is especially challenging for rural communities, which face declining access to obstetric services. Severe maternal morbidity refers to potentially life-threatening complications or the need to undergo a lifesaving procedure during or immediately following childbirth. Using data for 2007-15 from the National Inpatient Sample, we analyzed severe maternal morbidity and mortality during childbirth hospitalizations among rural and urban residents. We found that severe maternal morbidity and mortality increased among both rural and urban residents in the study period, from 109 per 10,000 childbirth hospitalizations in 2007 to 152 per 10,000 in 2015. When we controlled for sociodemographic factors and clinical conditions, we found that rural residents had a 9 percent greater probability of severe maternal morbidity and mortality, compared with urban residents. Attention to the challenges faced by rural patients and health care facilities is crucial to the success of efforts to reduce maternal morbidity and mortality in rural areas. These challenges include both clinical factors (workforce shortages, low patient volume, and the opioid epidemic) and social determinants of health (transportation, housing, poverty, food security, racism, violence, and trauma).

Original languageEnglish (US)
Pages (from-to)2077-2085
Number of pages9
JournalHealth affairs (Project Hope)
Issue number12
StatePublished - Dec 1 2019


  • Access to care
  • Children’s health
  • Government programs and policies
  • Health equity
  • Health policy
  • Maternal and child health
  • Maternal health
  • Maternal morbidity
  • Maternal mortality
  • Rural health care

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.


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