Rural maternal health interventions: A scoping review and implications for best practices

Purpose

Maternal health outcomes in rural areas of the United States are persistently poor, with pregnant individuals in rural areas facing complex health care obstacles. Interventions adapted to the needs of rural patients are critical to mitigate worsening health disparities. To inform future efforts in this field, we conducted a scoping review, given the complex and diverse nature of existing interventions, to synthesize the literature on rural maternal health interventions, analyze mechanisms to improve care, and identify barriers and facilitators to intervention implementation.

Methods

We conducted a scoping review of peer-reviewed literature across six databases for maternal health interventions in rural populations. Relevant studies were analyzed for study setting, intervention type, impact on maternal health outcomes, and facilitation and barriers of intervention implementation mapped to the Consolidated Framework for Implementation Research.

Findings

We identified 64 studies published between 2010 and 2024 through comprehensive database searches relevant to our review. We determined six proposed mechanisms of action via thematic analysis across the pregnancy continuum: increased care connection, social support, care frequency, education, self-efficacy, and positive reinforcement. While the facilitators and barriers to implementation varied across the six themes, common facilitators included state-level buy in, integration of community partnerships, cultural humility in study design, and dedicated interdisciplinary teams. Common barriers included lapses in insurance, transportation difficulties, and communication challenges.

Conclusions

Our review shares lessons that future interventions and policies can build upon to improve peripartum care for individuals living in rural communities. Further work is needed to address intersectional disparities in rural maternal health and ensure equitable implementation.