Document Type

Presentation

Publication Date

Fall 10-5-2026

Abstract

Background: Tennessee has been associated with having poorer birth outcomes compared to other states in America. Current data suggest that rural communities face greater barriers in accessing maternity care than urban areas, which can lead to adverse outcomes for these populations. Identifying factors that may contribute to low birth outcomes between rural and urban counties of Tennessee is essential to improve infant health outcomes. Objective: To examine the factors associated with adverse birth outcomes, comparing rural versus urban Tennessee counties. Method: The population size of all 95 Tennessee counties was obtained from the Data Commons. Birth outcomes and socioeconomic data for each county were obtained from County Health Rankings & Roadmaps. Data on healthcare access and structural factors for each county were obtained from the March of Dimes Tennessee Report. Counties were classified as rural or urban using the Health Resources and Services Administration (HRSA) rural-urban definition and further grouped into one of three population groups. Statistical analyses for each variable obtained were calculated to compare birth outcomes, socioeconomic factors, and maternity healthcare access across population groups. Peer-reviewed literature was used to explain how maternal healthcare disparities and social factors contribute to adverse birth outcomes in Tennessee. Results: A total of 95 counties were accounted for in Tennessee and divided into three groups: rural counties < 20,000 residents (n=27), rural counties with 20,000-50,000 residents (n=35), and urban counties with >50,000 residents (n=33). There was statistical significance in factors for premature death (p=0.00032), uninsured individuals (p=0.00008), teen births (p=0.00605), and unemployment rates (p=0.00069). Low birth weight was not considered statistically significant (p=0.39299). Conclusions: Rural and intermediate counties face greater barriers than urban counties in Tennessee. There are multiple significant contributing factors, including the rate of uninsured, teen births, and the unemployment rate. This comes to show how a multitude of socioeconomic factors play a role in influencing birth outcomes.

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