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.
Article Info
Publication History
Published online: August 05, 2019
Accepted:
July 1,
2019
Received in revised form:
June 28,
2019
Received:
May 4,
2019
Footnotes
Supported by the Federal Office of Rural Health Policy (FORHP), Health Resources and Services Administration (HRSA), U.S. Department of Health and Human Services (HHS) under PHS Grant No. 5U1CRH03717. Two employees of the Federal Office of Rural Health Policy are among the authors for this study, and contributed to the analysis and interpretation of data.
Disclaimer: The views expressed in this article are those of the authors and do not necessarily reflect the official policies of the U.S. Department of Health and Human Services or the Health Resources and Services Administration, nor does mention of the department or agency names imply endorsement by the U.S. government.
Identification
Copyright
© 2019 Jacobs Institute of Women's Health. Published by Elsevier Inc.
