Abstract
Rural areas refer to geographical locations situated outside or far away from urban areas. Regardless of economic, technological, or industrial development, all countries possess specific regions that are recognized as rural areas with their residential populations. Typically, urban environments differ significantly from rural settings due to their higher population capacity and increased infrastructural development. Although urban residence experience challenges like overcrowding and crime, urban centers have more efficient public service systems than rural areas. In this case, rural populations face challenges accessing public utilities like transport, emergency services, education, and electricity. Much worse, rural residents lack equal access to quality healthcare services compared to urban populations. Among the worst affected rural residents are the elderly, children, people with disabilities, and expectant mothers. This paper seeks to develop a public health advocacy to enhance healthcare access to pregnant women living in rural areas.
Introduction
According to a recent report by the WHO, the maternal mortality rate has slightly increased in the United States with rural areas are more affected by this problem. According to the statistics, there are 23.4 deaths per 100,000 births in rural areas compared to 14.7 in metropolitan settings (Gingrey, 2020). As per Centers for Medicare & Medicaid (2020), a significant number of maternal deaths are related to complications experienced during pregnancy. Typically the higher number of maternal mortalities recorded in rural settings stems from the adversities that pregnant women living in rural areas experience during the gestation period. These factors include the closure of maternal health units, lack of effective screening and monitoring during pregnancy, traveling long distances to seek medical help, lack of insurance and money to cover medical expenses, and staff shortages in rural healthcare facilities (Center for Medicare & Medicaid Services, 2020). Although pregnant women living in rural areas belong to different races and their residences differ across various dimensions, the factors listed hinder access to maternal healthcare (Center for Medicare & Medicaid Services, 2020).
Literature review
Urban areas have a fair share of health concerns caused by poverty and overstretching of public health resources to meet the escalating healthcare needs of the ever-growing urban populations. Nevertheless, rural residents and specifically pregnant women, face serious health challenges due to several factors. Firstly, a majority of the rural residents are unemployed or work in low-income jobs. In this state of affairs, many rural residents live in poverty without a healthcare insurance program. According to Kozhamill et al. (2017), more rural than urban residents are neither under Medicare or Medicaid in most counties of the United States. Generally, this situation means that most pregnant women living in rural areas cannot access healthcare services due to a lack of money to cater to the expenses involved (Center for Medicare & Medicaid Services, 2020).
Secondly, pregnant women living in rural settings lack access to healthcare because a higher percentage of people living in rural areas are the elderly. Although one would wonder how these issues relate, they are somehow intertwined. Considering that most rural residents are aging, they require more specialized care since they are highly vulnerable and suffer from chronic health conditions like cancer, heart disease, and diabetes (Center for Medicare & Medicaid, 2020). In this situation, most of the resources in rural healthcare facilities are devoted to the aging patients leaving less of nothing to other at-risk groups like pregnant women and children. These resources include healthcare providers and staff that would assist expectant mothers (Hadad et al., 2020).
Thirdly, most rural healthcare facilities lack operational maternal health units. According to Snyder et al. (2020), most rural hospitals have recently closed down maternal health units due to financial constraints, low birth volumes, and staff shortages. Due to such closures, pregnant women living in rural areas lack access to essential maternal health professionals like obstetricians, community health workers, nurses, family physicians, and certified nurse-midwives. Notably, lack of coordinated care from these professionals bears adverse health outcomes for expectant mothers living in rural areas (Snyder et al., 2020).
In addition, rural healthcare facilities in American are presently experiencing a critical shortage of healthcare professionals. As noted by Hadad et al. (2020), several factors have contributed to this crisis. Firstly, a higher percentage of the American population is aging and requires specialized care and treatment against numerous health risks that present with old age. Due to this situation, most resources in healthcare are committed to sustaining the health of this generation. Secondly, like the patient population, the majority of health workers are also aging and approaching retirement. Thirdly, due to the overwhelming pressure stemming from the shortages, more healthcare professionals are experiencing burnout and resigning, thus worsening the situation. Besides, due to commitments like childbearing, more healthcare workers drop out of the profession partially or entirely switch to other professions (Gandi et al., 2011).
Furthermore, since healthcare professionals may prefer working in specific regions rather than others, some areas ultimately experience shortages. Lastly, the aggressiveness and psychological stress experienced in some healthcare professions like nursing discourage more people from venturing into their careers, thus causing shortages (Hadad et al., 2020). Although staff shortage affects both urban and rural healthcare systems, rural hospitals are much worse since the patient population is way higher than the number of healthcare professionals available. Such shortages mean that expectant mothers may lack or experience delays in receiving specialized prenatal care.
Arguably, the location of a healthcare facility in an area determines the quality of healthcare service delivered to the particular community within the location. Since urban centers have an incomparably higher number of public and private healthcare facilities, urban residents have more access to quality healthcare services. The situation is different in rural areas because healthcare facilities are located far away from where most people live. In this situation, pregnant women travel long distances and times, lack transport to rural hospitals. According to Kozhimannil et al. (2017), most pregnant women living in rural areas travel over 50 miles to seek maternal health services. Due to this problem, most pregnant women forfeit critical appointments essential to maternal care. Additionally, the numerous journeys to the hospital are detrimental to their health and that of the unborn child. Much worse, expectant mothers bear the risk of losing their lives or their pregnancies in case of an emergency.
Furthermore, studies indicate that pregnant women living in remote settings have unfavorable health outcomes compared to those from cities and towns. Due to low education attainment, poverty, and lack of profound knowledge on maternal health, pregnant women who are rural residents are highly vulnerable to substance use, smoking, and injury-causing accidents (Center for Medicare and Medicaid, 2020). Furthermore, they are likely to experience physical violence and sexual abuse from their partners. Combined with a lack of effective screening due to the poor state of rural hospitals, pregnant women from rural areas are more likely to suffer from physical and psychological illnesses.
Undoubtedly, technology is one of the modern aspects that have remarkably enhanced the efficacy of healthcare systems around the world. In recent years, the United States healthcare system has witnessed an increase in technologies like artificial intelligence, robotic surgeries, precision medicine, and even virtual reality (Daim et al., 2016). Unfortunately, much of this technology seems concentrated only on urban than rural healthcare settings. Because of a lack of reliable broadband internet access, healthcare professionals working in rural hospitals cannot communicate and monitor their patient’s statuses in real-time (Nelson n.d). In this case, pregnant women must physically attend clinics and checkups in distantly located rural healthcare facilities.
Lastly, the lack of research and data on the health outcome of pregnant women living in rural areas is a significant factor contributing to their detriment. According to Kozhmannil et al. (2017), most studies examining the closure of maternal health units in rural hospitals neither investigate the consequences of such closures nor the strategies pregnant women use to cope with the problem. Such loopholes significantly reduce the efforts to improve rural healthcare systems and promote quality healthcare service delivery to rural populations in America.
Methodology
Based on the latest government reports on maternal health in rural America, this study shall examine aspects relating to healthcare access to expectant mothers within 25 states with a rural population above 5%. From each state, 20 pregnant women living in rural settings and five healthcare professionals working in rural hospitals will be chosen randomly from different counties as the respondents. Data from the respondents on the access and delivery of maternal health services in the selected areas will be obtained through interviews and structured questionnaires. This study is based on two conceptual frameworks. Firstly, it employs the Three-delay model developed by Thaddeus and Maine (Agrawal et al., 2020). As per this model, the first delay refers to the expectant mother’s refusal to seek medical help when she experiences problems relating to her condition. Type 2 delay denotes the difficulties encountered in the process of seeking maternal health services like transportation problems. Type 3 delays are the impediments that present even after the pregnant woman reaches the healthcare facility (Agrawal et al., 2020). Such delays may be caused by staff shortages or the closure of maternal health units. On the other hand, the study will also employ Anderson & Newman’s “health-seeking behavior model.” According to this model, expectant maternal health seeks services depending on various factors like the number of previous pregnancies, age, and education. This means that their perceptions on the importance of accessing maternal health services determine how they utilize such services (Oberoi et al., 2016). The two models selected for this study have enough predictors to create a clear picture of the factors that influence maternal health service delivery in rural areas.
Conclusion
Considering the health challenges discussed in this paper, pregnant women living in rural areas in America should have more access to reliable and efficient maternal health services. In tandem with the current intervention strategies to increase healthcare facilities and professionals in remote parts of the country, the states should allow nurses and midwives to provide maternal health services to pregnant women. Besides, the states should ensure that at-risk groups like pregnant women are insured, and the insurance cover extends to traditional maternal health providers. Furthermore, medical colleges and universities should embark on training healthcare professionals to work in rural settings. Lastly, the government should reduce the closure of maternal units by appointing more staff and allocating more funds to rural healthcare facilities.
References
Agrawal, N., Patel, S., & Badkur, M. (2020). Three delay model: to find out the reason for maternal deaths.
Centers for Medicare & Medicaid Services. (2020). Improving access to maternal health care in rural communities.
Daim, T. U., Behkami, N., Basoglu, N., Kök, O. M., & Hogaboam, L. (2016). Healthcare Technology Innovation Adoption. Innovation, Technology, and Knowledge Management. Switzerland: Springer.
Gandi, J. C., Wai, P. S., Karick, H., & Dagona, Z. K. (2011). The role of stress and level of burnout in job performance among nurses. Mental health in family medicine, 8(3), 181.
Gingrey, J. P. (2020). Maternal mortality: a US public health crisis.
Haddad, L. M., Annamaraju, P., & Toney-Butler, T. J. (2020). Nursing shortage. StatPearls
Kozhimannil, K. B., Henning-Smith, C. E., & Hardeman, R. R. (2017). Reducing maternal health disparities: the rural context. American Journal of Obstetrics & Gynecology, 216(2), 193-194.
Nelson, M., n.d. Rural Americans’ Health Depends on Broadband Access. [online] Fb.org. Available at: https://www.fb.org/market-intel/rural-americans-health-depends-on-broadband-access [Accessed 10 August 2021].
Oberoi, S., Chaudhary, N., Patnaik, S., & Singh, A. (2016). Understanding health seeking behavior. Journal of family medicine and primary care, 5(2), 463.
Snyder, J. E., Stahl, A. L., Streeter, R. A., & Washko, M. M. (2020). Regional variations in maternal mortality and health workforce availability in the United States. Annals of Internal Medicine, 173(11_Supplement), S45-S54.
