Addressing the Unique Health Care Needs of Mothers in Rural Areas
By Moira McLaughlin
March 31, 2026
Every woman in America deserves a safe and healthy pregnancy. Research shows that for a healthy pregnancy, mothers need access to quality, comprehensive, and convenient maternal health care. That means care from health care providers, domestic violence and sexual assault advocates, and other service providers who understand the external factors that contribute to poor maternal health.
Unfortunately, this is not the reality for many women, especially in rural areas.
Women in rural areas experience nearly twice the risk of maternal death as pregnant women in urban areas, due to hospital closures, limited prenatal and postpartum care, and hard-to-reach health care providers.
In addition, domestic violence adds to a pregnant woman’s risks:
- Homicide is the leading cause of death for pregnant women.
- If a firearm is present in the household where domestic abuse is occurring, a woman’s risk of death increases.
Limited Access to Care
What happens if a woman can’t access care and find the support she needs during her pregnancy? For women living in rural areas who already live twice as far from a hospital as their urban counterparts, this is a problem that could only get worse.
“Health care providers, advocates, and service providers in rural communities are critical to supporting the social needs and safety of pregnant families,” said FUTURES Associate Director Elena Josway.
From 2005 to 2024, 193 hospitals closed in rural areas, and of the ones that remain, only 48 percent continue to offer obstetric care. Recent changes to Medicaid, which covers 47 percent of all births, will only exacerbate the problem.
“We see the pending cuts to Medicaid and other programs, and we know that rural America will feel it,” said FUTURES Policy Advocate Tiffany Garner.
Comprehensive, Compassionate, and Close
To expand maternal and infant care in rural communities, FUTURES has launched a new initiative to address the growing and urgent need for obstetric access in rural America.
“We want to expand the workforce and support the providers and advocates that are providing critical care to rural families across the country,” said Josway. “We want to help ensure that every woman has comprehensive, compassionate care that is close to where they live.”
FUTURES kicked off the initiative in March with an online event that brought together national experts and practitioners who shared the latest on barriers to care and innovative solutions. This spring, we will convene experts and practitioners again to talk about state interventions at another roundtable.
With a focus on states such as Alaska, California, Kansas, Maine, Michigan, Mississippi, New Mexico, and West Virginia, and the territory of Puerto Rico, FUTURES’ Rural Maternal and Infant Health initiative will advance policies and programs that expand maternal health access in rural communities, including:
- Protect and expand funding for rural maternal and infant health care: Medicaid and community health center funding is critical.
- Address the shortage of rural healthcare professionals: Support and expand the workforce by promoting Medicaid reimbursement for doulas, home visitors, community health workers, peer support specialists, and advocates.
- Promote virtual health care access to close gaps: Support funding for technological tools such as telehealth, broadband access, and mobile health services.
- Advocate for economic policies and programs that support mothers and babies: Champion paid family leave, guaranteed income, and affordable childcare.
We will also:
- Support community-based providers, including doulas, community health workers, home visitors, peer support specialists, and advocates, to build their capacity to address violence, abuse, and trauma, and connect families to support.
- Convene learning opportunities for rural health care providers.
- Improve coordination between health care providers and health advocates.
This builds on a long history of FUTURES’ work to expand maternal care and health access. FUTURES has trained hundreds of doulas and thousands of community health workers and home visitors in “CUES,” an evidence-based intervention that addresses domestic and sexual violence in health settings. This has been shown to improve health and safety outcomes for survivors.
Join Us
FUTURES will share updates about opportunities with the Rural Maternal and Infant Health initiative in the coming weeks and months. Email the team at ruralmaternalhealth@futureswithoutviolence.org to be added to receive updates.
“Together, we can ensure more moms and babies are healthy and safe. We can do more to support them so we can see more healthy families thriving in rural America,” said Garner.
