The Impact of the COVID-19 Pandemic on Obstetric Access in Rural and Urban Areas in the United States
Year: 2026
Type: dissertation
Abstract: Maternal health outcomes in the United States are closely linked to structural access to obstetric (OB) services, yet geographic disparities in service availability persist, particularly in rural areas.The purpose of this secondary, quantitative, ecological study was to examine changes in hospital-based OB service availability across U.S. counties before (2010-2019) and during (2020-2022) the COVID-19 period as well as determine whether these changes differed between rural and urban counties.Guided by the socioecological model, OB service availability was conceptualized as a community-and organizational-level determinant of maternal health access in this study.All U.S. counties (N = 3,144) with data available from 2010-2022 were analyzed using descriptive statistics, chi-square tests, and logistic regression models, including an interaction term to assess a difference-in-differences effect between COVID-19 period and locality.Descriptive findings indicated a decline in the proportion of counties with hospital-based OB services during the COVID-19 period.Logistic regression analysis revealed that the COVID-19 period was significantly associated with OB service availability, and urban counties had significantly higher odds of maintaining OB services compared to rural counties (OR = 1.302, p < .001).However, the interaction between COVID-19 period and locality was not statistically significant (B = .135,p = .208,OR = 1.145), indicating that the magnitude of change in OB availability did not significantly differ between rural and urban counties.These results have implications for professional practice and policy development by informing strategies to sustain OB services during public health emergencies and advance maternal health equity at the community and national level.
Source: ScholarWorks (Walden University)
Author: Chandradasa, Sandali
Institution: Walden University
Language: English
Subfield: Obstetrics and Gynecology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7168438134