Birth Professionals, Research

Know your clientele – Rural and Urban Differences

If you remember that I research maternal mortality, it may not surprise you to know that my mind often considers the differences for women in rural and urban areas. As I reviewed the latest report on urban and rural differences in fertility-related behavior from the CDC, I realized the information was potentially useful and interesting for birth professionals. The information may help you plan expansions of your business, prepare for a future move to a new part of the country, or understand why the advice you get from other professionals does not always work the way you expect.

Difference #1

Women in rural areas begin having sex at a younger age. Over half the women in rural areas have had sex by age 16 compared to 42% in urban areas.  The gap remains at age 18 when 80% of rural but less than 70% of urban women have had sex. This report does not explore age at first pregnancy, but given this difference it is likely women in rural areas have their first pregnancy at a younger age.

Similarity #1

Women in rural areas are less likely to be married, though they are more likely to be cohabiting with their partner. This results in near equal proportions of women who live with their current partner, suggesting the proportion of women with social support is probably similar.

Difference #2

Urban women are less likely to have ever given birth, 41.6% have never given birth compared to 30.35 having never given birth in rural areas. The distributions among women who have given birth area little different as well, with urban women less likely to have given birth 2 or more times (40% compared to 50% in rural areas). This may translate to longer relationships with families in rural areas who return for services during the next pregnancy. This may also translate to more time spent in education for women in urban areas who are more likely to be having their first child.

Similarity #2

Urban and rural women are equally likely to use no method of birth control (21% in both urban and rural). This may mean the same proportion of women are planning pregnancies, especially since there are similar proportions of women who are not currently living with a partner. But women in urban areas are also less likely to have had sex by age 18 which may mean they are not using birth control because they are not having sex. This would mean professionals working in rural areas may be more likely to help women with unplanned pregnancies. Maybe…

Interestingly, rural women are almost one-third more likely to be using the most effective birth control methods, sterilization or a long acting contraceptive like an IUD or an implant (40% compared to 30%). This may be because women in urban areas are less likely to have had a sterilization procedure because they have not yet started their families. Urban women are more likely to be using moderately effective methods (birth control pills, patches, or shots) and also the least effective methods of birth control (25% compared to 18%); these are methods that are easily available to women without health insurance such as male and female condoms, fertility awareness methods, and spermicidal foams and jellies. This may mean professionals working in urban areas have slightly more unplanned pregnancies due to contraceptive failure, but we cannot be sure.

Jennifer (Author)