Rural Focus and Representation in State Maternal Mortality Review Committees: Review of Policy and Legislation

Published:August 05, 2019DOI:https://doi.org/10.1016/j.whi.2019.07.001

      Abstract

      Objectives

      Between 1990 and 2013, maternal mortality nearly doubled in the United States and rural residents experienced decreasing access to obstetric care. To improve maternal health, many states have established maternal mortality and morbidity review committees (MMRCs). We assessed the extent of rural representation in state policy efforts related to MMRCs.

      Methods

      We reviewed publicly available information on MMRCs (websites, statutes, bills, media) in all 50 states and the District of Columbia, separately identifying highly rural states (with >30% of the population being rural residents). We assessed whether each state 1) had established an MMRC, 2) had passed legislation requiring an MMRC, 3) had considered, but not passed, legislation requiring an MMRC, 4) mentioned rural populations in MMRC legislation, 5) required representation on the MMRC from any particular groups, and 6) required rural representation on the MMRC.

      Results

      As of December 2018, MMRCs were established in 45 states and the District of Columbia, an increase from 23 in 2010. Legislation was in place in 27 states, up from 6 in 2010. Only three states specifically mentioned rurality in legislation (including one highly rural state), and only two states required rural representation among their MMRC members (neither of which were highly rural states).

      Conclusions

      Recent growth in MMRCs has had a limited focus on rural residents, despite their worse health outcomes and more limited access to health care, including obstetric services. Lack of rural representation may hamper geographically tailored efforts to reverse rising rates of maternal morbidity and mortality nationally.
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      Biography

      Katy B. Kozhimannil, PhD, MPA, is Associate Professor, University of Minnesota School of Public Health and Director of the University's Rural Health Research Center. Her research contributes evidence for clinical and policy strategies to advance racial, gender, and geographic equity.

      Biography

      Julia D. Interrante, MPH, is a doctoral student in the Division of Health Policy and Management at the University of Minnesota. Her work examines the effects of policies around reproductive health on maternal and child outcomes.

      Biography

      Amanda Corbett, MPH, is a Research Fellow at the University of Minnesota Rural Health Research Center. Ms. Corbett is a qualitative researcher whose research interests include social determinants of health, population and community health, and maternal and family health equity.

      Biography

      Sarah Heppner, MS, leads the Federal Office of Rural Health Policy's Policy Research Division. Her professional interests include using health services research to understand the impact of policies on access to care in rural communities and rural health disparities.

      Biography

      Jennifer Burges, MPH, is a Public Health Analyst at the Federal Office of Rural Health Policy (FORHP). Ms. Burges is the program coordinator for the Rural Health Research Centers and coordinates the research focused programs within FORHP.

      Biography

      Carrie Henning-Smith, PhD, MPH, MSW, is an Assistant Professor and Deputy Director of the University of Minnesota Rural Health Research Center. Dr. Henning-Smith uses quantitative and qualitative research methodologies to study policy-relevant issues for rural populations.