University of Minnesota Rural Health Research Center, Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota.
University of Minnesota Rural Health Research Center, Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota.
Womens Health Issues. 2019 Sep-Oct;29(5):357-363. doi: 10.1016/j.whi.2019.07.001. Epub 2019 Aug 5.
Between 1990 and 2013, maternal mortality nearly doubled in the United States and rural residents experienced decreasing access to obstetric care. To improve maternal health, many states have established maternal mortality and morbidity review committees (MMRCs). We assessed the extent of rural representation in state policy efforts related to MMRCs.
We reviewed publicly available information on MMRCs (websites, statutes, bills, media) in all 50 states and the District of Columbia, separately identifying highly rural states (with >30% of the population being rural residents). We assessed whether each state 1) had established an MMRC, 2) had passed legislation requiring an MMRC, 3) had considered, but not passed, legislation requiring an MMRC, 4) mentioned rural populations in MMRC legislation, 5) required representation on the MMRC from any particular groups, and 6) required rural representation on the MMRC.
As of December 2018, MMRCs were established in 45 states and the District of Columbia, an increase from 23 in 2010. Legislation was in place in 27 states, up from 6 in 2010. Only three states specifically mentioned rurality in legislation (including one highly rural state), and only two states required rural representation among their MMRC members (neither of which were highly rural states).
Recent growth in MMRCs has had a limited focus on rural residents, despite their worse health outcomes and more limited access to health care, including obstetric services. Lack of rural representation may hamper geographically tailored efforts to reverse rising rates of maternal morbidity and mortality nationally.
1990 年至 2013 年间，美国的孕产妇死亡率几乎翻了一番，农村居民获得产科护理的机会减少。为了改善孕产妇健康，许多州都设立了孕产妇死亡率和发病率审查委员会（MMRC）。我们评估了各州在与 MMRC 相关的政策努力中农村代表的程度。
我们审查了所有 50 个州和哥伦比亚特区的 MMRC（网站、法规、法案、媒体）的公开信息，分别确定了高度农村州（人口中超过 30%为农村居民）。我们评估了每个州是否：1）设立了 MMRC；2）通过了要求设立 MMRC 的立法；3）考虑但未通过要求设立 MMRC 的立法；4）在 MMRC 立法中提到农村人口；5）要求 MMRC 代表任何特定群体；6）要求 MMRC 中有农村代表。
截至 2018 年 12 月，MMRC 在 45 个州和哥伦比亚特区设立，高于 2010 年的 23 个。27 个州制定了立法，高于 2010 年的 6 个。只有三个州在立法中特别提到农村性（包括一个高度农村州），只有两个州要求 MMRC 成员中有农村代表（都不是高度农村州）。
尽管农村居民的健康状况较差，获得医疗保健的机会有限，包括产科服务，但最近 MMRC 的增长对农村居民的关注有限。缺乏农村代表可能会阻碍全国范围内针对农村地区孕产妇发病率和死亡率上升的地理定制努力。
