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Women's Health Frequently Asked Questions


What are the barriers to health care access for rural women?

Problems specific to access to care in rural areas include:

  • A higher rate of uninsured people than in urban areas. More than 28 million women 18 and older live in rural or frontier America. 14% of all rural adult women do not have health insurance.
  • Lack of providers, particularly obstetric providers due to the recruitment and retention problems in rural areas in addition to malpractice suits, which make obstetric care particularly expensive and risky for providers.
  • Transportation barriers, such as geographic isolation which limits carpooling and a lack of public transportation. Also, rural residents must travel a greater distance to access health care which increases the transportation costs.
Source: Rural Women’s Health, 2013

What challenges do rural women face related to childbirth?

According to the report Why Are Fewer Hospitals in the Delivery Business?, there was a reduced availability of hospital-based obstetric services in rural communities from the mid-1980s to the early 2000s. This was due to a steady decline in the number of hospitals in the United States and a significant drop in the fraction of hospitals providing obstetric services. As a result, 44 percent of non-metropolitan counties lacked hospital-based obstetric services in 2002.

In that same 2007 study, the most frequently cited reasons for closing obstetric units were low volume of deliveries in the community, financial vulnerability due to a high proportion of patients on Medicaid, and difficulty in staffing an obstetric unit. Reasons for difficulty in staffing an obstetric unit included malpractice burdens for OB/GYNs and family practitioners, changes in physicians’ attitude toward work, family, and leisure, and the difficulty and costs involved in recruiting supporting specialists such as anesthesiologists and surgeons.

In 2013, the University of Minnesota Rural Health Research Center released a report titled Obstetric Services and Quality among Critical Access, Rural, and Urban Hospitals in Nine States. Key findings include the following:

  • Women who gave birth in CAHs and other rural hospitals in 2010 were younger on average and had lower rates of clinical complications than those who gave birth in urban hospitals.
  • CAHs compared favorably with other rural and urban hospitals on obstetric care quality measures including cesarean delivery among low-risk women, cesarean delivery without medical indication, and labor induction with medical indication.
  • Medicaid covered 49 percent of births in CAHs and 56 percent of births in other rural hospitals, compared to 41 percent of births in urban hospitals.
  • The percentage of CAHs, other rural hospitals, and urban hospitals providing obstetric services in 2010 varied significantly across states, with the greatest variation among CAHs. 
  • Half of the CAHs in this study’s sample provided obstetric services in 2010, likely a higher rate than all CAHs nationwide due to the selection criteria for the sample.

How do chronic diseases and cancer impact rural women?

Chronic illness persists over time and requires ongoing management and treatment. Unfortunately, rural areas report a higher rate of many chronic diseases that affect women.

  • Obesity rates for women in rural areas (23%) are higher than women in large metropolitan areas (16%).
  • Rural areas experience a 17% higher diabetes prevalence rate than urban areas.
  • Rural residents experience a higher mortality rate for cardiac disease.
Breast cancer in rural women is diagnosed at a later stage compared to urban women. Rural women also have lower rates of mammography screening. Lower screening rates may be attributable to lack of insurance, geographic maldistribution of screening facilities, and poor health literacy. Specialized cancer care may also be located at some distance from the woman’s place of residence.

Rural women who suffer from chronic diseases are often undertreated or not treated at all.

Source: Rural Women’s Health, 2013


How does mental illness impact rural women?

Women are twice as likely as men to suffer from depression. A recent national study estimated that 14% of women suffer from depression. Women who are older, less educated, unmarried, unemployed, or have a low income are at higher risk, and rural women may be especially vulnerable.

One study of a community health center in the rural South estimated that 44.3% of female clients suffered from major depressive episodes. These findings are similar to the findings of a study at a rural community health center in Central Virginia, which found that 41% of female clients were suffering from depression, compared to the typical urban prevalence rates of 13-20 percent.

Rural residents are far less likely to receive mental health treatment. A variety of barriers keeps people from seeking and receiving mental health care, including the cost of treatment, lack of awareness of mental illness, not believing that treatment is necessary, lack of time, not knowing where to go for services, and stigma surrounding mental illness. Some of these barriers are amplified in rural and frontier communities due to the lack of anonymity in rural communities, the distance and time to services, and the fact that rural residents are more likely to be uninsured and poorer than their urban counterparts.

Some aspects of rural residence may help protect women’s mental health. One study showed that women living on farms scored higher than average on mental health assessments. Additionally, residents of the rural Midwest may experience fewer depressive symptoms than non-rural residents.

Source: Rural Women’s Health, 2013

Is there ethnic diversity among rural women?

Most women in rural areas identify themselves as non-Hispanic white. However, population shifts throughout the last decade have included changes in many communities' racial and ethnic makeup. Many growing rural counties are also experiencing growth in the diversity of residents. One source of increasing diversity is the change in immigration patterns in response to employment opportunities in rural areas. Many immigrants, especially Hispanic and Asian immigrants, are increasingly settling in the rural U.S.


How many rural women are elderly?

An estimated 5 million rural adult women are 64 years and older. Rural areas have a higher proportion of elderly residents and women tend to live longer than men. The result is that women make up a larger fraction of seniors.

Rural senior women are more likely to be disabled, widowed, older and poorer than urban or suburban senior women. Rural areas lack many health services to care for elderly women such as primary care physicians trained in gerontology and geriatrics, geriatricians and other specialists, social workers, and nurse managers. This lack of providers can affect elderly women’s access to health services such as preventive screenings for age-related diseases.

Rural women also lack access to many human services that are available in urban areas. In-home social services such as adult day care, respite care and meals on wheels are less likely to be available in rural areas.

Source: Rural Women’s Health, 2013


How can health and social services providers work together to help rural women?

The strong relationship between adequate income, sufficient food, strong social networks and good health necessitates coordination among various health care and social service agencies. This coordination is especially important in rural communities, where services and providers are limited in numbers.



Last Reviewed: 3/18/2014

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Funding for this project was supported by Grant Number U56RH05539 from the Office of Rural Health Policy, Health Resources and Services Administration, U.S. Department of Health and Human Services. The contents of this website are solely the responsibility of the authors and do not necessarily represent the official views of the funder.