Professional value of the advanced palliative and hospice social work certification: Findings from a national survey of palliative social workers.

Birthing people in much of rural America experience pregnancy and the vulnerable first year after birth, or the “postpartum cliff,” in communities that have seen a decline in investment and access to health services. This contributes to higher rates of rural maternal and infant mortality. As of 2022, 52.4% of rural hospitals lacked obstetric units. The ongoing closure of obstetric units at rural hospitals contributes to lower rates of prenatal care utilization (even when prenatal care remains available), late or no prenatal care, and higher preterm birth rates. This is amplified for those who are publicly insured, low-income, or people of color. In the postpartum period, rural parents report worse health and are more likely than their urban counterparts to experience emergency department visits, hospitalizations, loss of health care coverage, and barriers to care. Perinatal people in rural communities are more likely to experience (and less likely to have supportive resources for) the social factors contributing to maternal morbidity, like intimate partner violence (IPV), substance use, and mental health conditions. IPV is more common during pregnancy than health issues like preeclampsia or gestational diabetes and is a leading non-obstetric cause of maternal morbidity. Rural residents, particularly Medicaid beneficiaries and uninsured populations, have a higher prevalence of perinatal IPV and are less likely to be screened for abuse compared with urban perinatal populations. Despite higher rates, services in rural counties are less well-funded or comprehensive. There are additional barriers to IPV support unique to rural geographies, like increased stigma, perceived lack of confidentiality in reporting or seeking care, and increased social isolation amplified by lack of transportation. Rates of maternal opioid use and neonatal abstinence syndrome are rising in rural areas, compared with urban areas, but treatment engagement lags due to substantial care gaps in rural communities. Few treatment location options, lack of mother/child dyad support, fewer knowledgeable health care providers, long wait times, transportation barriers, lack of childcare, and stigma delay or prevent perinatal addiction treatment. Rural-living perinatal women using substances often experience intersecting challenges related to food, housing, and transportation insecurity alongside increased stigma, social isolation, and lack of mental health supports.