Researchers examined 6.3 million births in urban areas and 837,772 in rural areas based on information from the National Inpatient Sample, a 20 percent sample of U.S. hospital admissions. In rural hospitals, the share of deliveries in which labor was induced for no medical reason increased from 9.3 percent in 2002 to 16.5 percent in 2010, in the same period, the share at urban hospitals rose from 10.3 percent to 12 percent. Cesarean births at rural hospitals rose to 16.9 percent from 14.3 percent; at urban hospitals, they rose to 17.8 percent.
"With approximately 4 million births per year in the United States, a 1-percentage-point difference in the use of a procedure affects 40,000 women and infants annually," the researchers wrote. "Based on our findings, we estimate that differences due to rural or urban location — rather than differences in patient or hospital characteristics — may affect between 24,000 and 200,000 mothers and their babies each year." (Read more)
Researchers suggested that financial concerns may have contributed to the rise in rural areas, reports Connie Hughes for EurekAlert, an online science news service. Researchers wrote, "This analysis indicates that women giving birth in rural and urban hospitals may experience different childbirth-related benefits and risks. Due to Medicaid's important role in financing childbirth care, particularly in rural hospitals, Medicaid payment policy has great potential to inform and catalyze quality improvement in obstetric care." Researchers note that more than half of babies born at rural hospitals are covered by Medicaid. "However, such reforms may 'face different implementation challenges' at rural versus urban hospitals, according to the authors," Hughes writes.