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Rural zip codes, riskier deliveries. A large US study found that pregnant people in rural and low-access counties were significantly more likely to have labor induced than those in urban areas — and the gap was driven more by lack of maternity care access than by rurality itself. Researchers say expanding the obstetric workforce and boosting Medicaid reimbursement could help close the divide.
Where a pregnant person lives — and how close they are to maternity care — may have a bigger impact on their delivery experience than previously understood. A new cross-sectional study published in Obstetrics & Gynecology analyzed over 1.15 million low-risk, full-term birth records across the US in 2022 and found that residents of rural and low-access counties were significantly more likely to undergo labor induction compared to their urban, full-access counterparts.
Crucially, the study found that it's not just about being rural — it's about access. County-level maternity care access largely explained the differences in induction rates, suggesting that healthcare infrastructure gaps, not geography alone, are driving the disparity. Interestingly, prelabor cesarean deliveries were actually less common in rural and no-access counties, pointing to a complex picture of how care constraints shape delivery decisions.
By the Numbers:
Why it matters: These findings highlight a systemic gap in maternity care that goes beyond geography. Expanding the obstetric workforce, improving care-delivery models, and increasing Medicaid reimbursement in underserved areas could meaningfully reduce these disparities and improve outcomes for birthing people across the country.
