Rural health clinics (RHCs) are Medicaid-funded community-based interventions that significantly improve maternal health in rural areas by increasing access to care. A study done in Egypt, an extremely rural country, showed that community clinics for rural health provided evidence-based interventions that have drastically lowered complication rates during pregnancy. Complications during pregnancy dropped from 38.1 percent to 15.1 percent, and postpartum complications from 81.7 percent to 7.0 percent. Although these solutions seem promising, surgical access for rural mothers in the United States is still a huge discrepancy in U.S. health care. Maternal and infant mortality remain an extenuating problem in the U.S. In 2023, the U.S.’s maternal mortality rate was 18.6 deaths per 100,000 people, roughly 669 mothers. As with most aspects of health care, this intersects with other vital statistics such as infant mortality. The same year there were a total of 20,162 infant deaths. These rates fall in between that of Romania’s and Qatar’s and are higher than the majority of all high-income countries, despite the economic advancement of the U.S. So what triggers these issues? Access.
One of the biggest barriers to U.S. health care is accessibility. Whether it be financial, regional, or political, there are many factors that restrict Americans from receiving needed care. One of the biggest groups who experience issues with health care accessibility are those living in rural regions. In the United States, rural Americans live 24.5 miles on average from obstetric care compared to 8.4 miles for urban areas. Furthermore, hospitals with NICUs are around 50.6 miles away on average. In extremely remote areas, this distance is often doubled, especially when specialty care is needed. According to the NIH, over 10 percent of rural women drive more than 100 miles for specialized maternity care. These access disparities are reflected by U.S. vital statistics. In 2023, Mississippi reported the highest rate of infant mortality, while Louisiana recorded the highest rate of maternal mortality.
While rural health clinic funding is an effective solution to these discrepancies, policy is cutting back. RHCs receive funding from a Centers for Medicare & Medicaid Services (CMS) certification based on location that is designated as rural and underserved or facing shortages. However, new policy proposals that scale back Medicaid funding are impacting essential resources that are utilized by RHCs to combat maternal complications such as surgical technology, medication, and needed specialists. A new $50 billion Rural Health Transformation Program (2026-2030) under the One Big Beautiful Bill Act provides federal, state-level grants to support rural health, with 50 percent distributed equally and 50 percent based on factors like rural population and facility count. While meant to support rural care, this funding is simply an inefficient band-aid for this access issue, estimated to cover only about 37 percent of the roughly $137-$155 billion in federal Medicaid cuts to rural areas over the next decade, leaving many with uncompensated care. This also places additional constraints on states, requiring them to allocate Medicaid funding with fewer available resources, potentially introducing complications for access to maternal care in already under-resourced regions.
Going forward, policymakers should evaluate the effectiveness of programs that are being successfully implemented in other countries and producing positive outcomes to determine funding allocations. Current state clinics and volunteer programs that support rural health care access may face increased pressure to expand care and help cover gaps created by the defunding of certain Medicaid-supported resources. Attention to these targeted demographic areas are what will holistically address accessibility issues within U.S. health care.
Alyssa Sterner is a policy writer.
