Legislative Gaps in Addressing Rural Women’s Access to Obstetric Care in the United States: A Case Study of the North Carolina Home Birth Freedom Act

Abstract

Rural women in the United States face numerous barriers to accessing obstetric care. Hospitals and obstetric wards in rural areas are closing, and there is a shortage of rurally-located obstetric care providers. Recent experience in North Carolina provides insight into current legislative barriers to improving rural women’s access to obstetric care. In 2015, legislators in the North Carolina General Assembly unsuccessfully advocated for the Home Birth Freedom Act, which would have allowed certified professional midwives to practice in the state.While the Home Birth Freedom Act would have helped to address rural women’s access to care, it would not have been sufficient. This analysis describes why rural women’s access to obstetric care is limited and offers recommendations to expand access to care by providing certified nurse-midwives with more autonomy, appropriating funds to place obstetric care providers in rural areas, and improving Medicaid reimbursement rates.