Perinatal & Pediatric
Racial and Rural Disparities in Hybrid Prenatal and Postpartum Care Use During the COVID-19 Pandemic Taylor Lange* Andrew Williams Williams Williams Williams University of North Dakota
Background: Disparities in access to prenatal and postpartum care in the US are persistent. COVID-19 accelerated telehealth adoption for perinatal care, but uptake varied, with racially minoritized and rural populations facing barriers like limited provider access and poor broadband. This study examines how telehealth prenatal and postpartum care use during COVID-19 in the US varied across race/ethnicity and rurality.
Methods: Analysis included 2020-2021 PRAMS participants completing the COVID-19 Supplement (weighted n=465,983). Participants reported care modality (in-person, hybrid telehealth/in-person, no care). Urban counties were Metropolitan Statistical Areas; rural counties were non-Metropolitan. Race/ethnicity was self-reported as AI/AN, Hispanic, White, Black, and Other. Logistic regression models estimated odds ratios for telehealth use among minoritized groups versus White women, stratified by rurality and adjusted for demographic and health factors.
Results: Telehealth use and access to care varied by race/ethnicity, and geography. Rural patients had 39–43% lower odds of telehealth use than urban patients, with racially minoritized rural patients often faring worse than rural White patients. Compared to White patients, Black and Hispanic patients were less likely to receive no prenatal care but more likely to lack postpartum care. Racially minoritized groups had elevated odds of no postpartum care. Rural residence amplified racial disparities in both telehealth use and care access.
Conclusion: Findings reveal persistent racial/ethnic and rural disparities in hybrid perinatal care access, especially pronounced postpartum. Also, racialized minorities in rural areas faced increased odds of no care. Results emphasize need for policies and rural health infrastructure improvements to address perinatal care gaps.