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Access Is Not Utilization: Why Sustainable Rural Maternity Care Requires Investment in Women's Trust, Continuity, and

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Summary

Rural women bypass local maternity services due to concerns about trust, workforce stability, and care continuity, not just access. Policy should focus on relational aspects of care to improve utilization.

Keywords:
care bypasscontinuity of carematernity care desertrural maternity caretrust in healthcarewomen’s health equityworkforce stability

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Area of Science:

  • Health Services Research
  • Maternal Health Policy
  • Rural Health Systems

Background:

  • US rural maternity care policy primarily focuses on geographic access and facility availability.
  • Despite available services, many pregnant individuals in rural areas bypass local maternity care options.
  • This underutilization suggests factors beyond geographic barriers influence care choices.

Purpose of the Study:

  • To reframe rural maternity systems as relational environments, not just physical locations.
  • To identify key factors influencing pregnant women's decisions to bypass local maternity services.
  • To propose policy strategies for strengthening rural maternity care systems.

Main Methods:

  • Analysis of health services research, behavioral theory, and maternity care literature.
  • Reframing rural maternity systems through a relational lens.
  • Identifying impacts of workforce instability, fragmented continuity, and community engagement on trust and decisions.

Main Results:

  • Low utilization of rural maternity services is linked to women's assessments of trust, continuity, and workforce stability.
  • Workforce instability, fragmented care continuity, and limited community engagement erode institutional trust.
  • These relational factors significantly influence pregnant women's childbirth decisions.

Conclusions:

  • Rural maternity care is a relational environment influenced by trust, continuity, and workforce stability.
  • Policy interventions must address workforce recruitment, stability, team-based perinatal continuity, and community partnerships.
  • Strengthening these relational aspects is crucial for improving rural maternity care utilization and outcomes.