Approximately 1 million infants and toddlers live in rurali areas in the United States. While some rural communities offer certain protective factors that support positive health and development, many children in rural areas are more likely to face a unique combination of challenges that impact their health and development—for instance, fewer health care providers, barriers to accessing care, and higher rates of poverty.1 Understanding the unique opportunities and challenges that very young children and their families living in rural areas encounter is an important step for any policymaker working to improve outcomes for all children in their state.

While many public reports provide indicator data on rural health care access at the national level, this brief uses data from the State of Babies Yearbook: 2020ii to examine state-level differences in how infants and toddlers living in rural areas are faring. Equipped with these data, state policymakers can explore strategies to support the needs of very young children and their families.

Key findings include the following:

  • Mothers in rural areas are less likely to receive timely prenatal care and more likely to have births that occur outside of hospitals than mothers in urban areas.
  • Infants and toddlers in rural areas are less likely to receive a preventive medical or dental visit and less likely to receive recommended vaccines; low-income infants and toddlers in rural families with low incomes are less likely to have health insurance than their peers in urban areas.

Key health outcomes for infants and toddlers in rural areas:

  • Infant mortality and preterm birth rates are higher in rural communities than in urban areas.
  • Low birth weight is a significant challenge in rural areas for some states, compared to more urban areas.
  • Infants in rural areas are less likely than urban infants to be breastfed.

At the conclusion of this brief, we provide a few recommendations for policymakers to ensure equitable health care access for infants and toddlers living in rural areas, including the following:

  • Identify any existing barriers rural families may face in enrolling their infants and toddlers in their state’s Children’s Health Insurance Program (CHIP).
  • Promote the importance of timely and appropriate vaccinations among rural families and utilize existing programs designed to help cover the cost.
  • Explore options such as mobile health clinics and telemedicine to ensure that children in rural areas have access to a pediatrician for routine check-ups and to address their health needs.
  • Identify whether there are gaps in how existing home visiting programs in a state serve rural children and families. If these exist, states can employ a variety of approaches to address the issue—for example, a task force or directive to the state public health department to identify potential reasons for these gaps—and can identify strategies for reaching these families. States can also work with community hospitals, doulas, birthing centers, and mobile health clinics to provide group prenatal
    visits.
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Footnotes and Reference

Footnotes

i State of Babies Yearbook products use the Office of Management and Budget and Census Bureau definitions for rural: “nonmetropolitan areas of ‘open countryside’ and ‘towns’ and places with fewer than 2,500 people,” as well as “urban clusters with populations ranging from 2,500 to 49,000 people that are not part of a larger metro area.”

ii State of Babies Yearbook: 2020 is a national and state resource developed by ZERO TO THREE that compiles national and state-level data on children ages 0 to 3. These data measure progress across three policy areas: good health, strong families, and positive early learning experiences.

Reference

1 Keating, K., Cole, P., & Schaffner, M. (2020). State of babies yearbook: 2020. Washington, DC: ZERO TO THREE.