Closing the Gap: Meeting Rural Mothers Where They Are

One out of three counties in the U.S. lacks an obstetric provider or birthing hospital. For over 5 million women, they go through their pregnancies hundreds of miles from care. Instead of expecting pregnant women to travel long distances to access care, how can we bring high quality care to them?  

There has been some improvement in maternal health outcomes in the U.S., with the exception of those who live far from women’s health providers.  According to the March of Dimes Maternity Care Deserts report, more than one in three counties lack a single obstetric provider or hospital that includes labor and delivery.  What that means is that close to 2.3 million women of reproductive age live in locations where the prenatal and postpartum care they need is out of reach. In our Community Health Equity Project (CHEP) work in Nevada, we found that nearly half of all counties qualify as maternal care deserts, forcing women to travel long distances, including across state lines, for basic prenatal care.

It is in these same regions where Medicaid coverage is common, transportation is limited and high speed internet is absent or unreliable. When a pregnant woman needs to travel 2+ hours to receive routine care, continuity of care becomes the privileged exception, not the norm.

Meeting mothers where they live

Community Health Workers (CHWs) are trusted local connectors, who can reach women who the health system has left behind. They can facilitate regular check-ins -  in-person, virtual, or by phone, and help women navigate appointments, access benefits, and overcome barriers to care they experience throughout their pregnancy and postpartum period. 

In several states, Medicaid plans are now reimbursing for CHW services, acknowledging their role in helping to address rural access gaps. In Nevada, where doulas can now enroll as Medicaid providers, we’ve seen how trusted non-clinical workers, including CHWs, doulas, and peer navigators, bridge the distance between home and hospital, particularly in communities the health system has historically overlooked. Combined with technology, including telehealth and mobile engagement, CHWs can help to turn “care deserts” into “extended care networks.”

Technology as an enabler, not a replacement

Technology should be a facilitator for a trusted relationship, not a replacement. A text reminder is more meaningful when it is coming from a CHW who knows the woman’s needs and preferences. A video visit is far more effective when it’s part of a broader relationship of trust.

At Activate Care, we’ve built a care coordination platform including tools that make this hybrid approach more readily scalable.  This enables CHWs to manage larger caseloads, make closed loop referrals to address unmet social needs, and track outcomes even in low-resource areas.

The path forward

When we think about adequate access to care, we probably imagine a setting like a hospital or clinic. But for many rural mothers, access starts with phone outreach, a rideshare, or a CHW who knows the landscape of resources. The future of maternal care will depend on how well we are able to support these community-based professionals, and also how we integrate them within existing clinical systems.  Because real access isn’t just about how close you are to a provider. It’s also if you are understood, cared for and empowered throughout the entire maternal health journey.

If we can bring that level of connection to every doorstep, whether literal or virtual,  we will be able to begin to close gaps that are about more than just rural geography.