Black individuals in urban areas were at highest risk of postpartum readmission. Rural residence was also associated with increased readmission risk and seemed to eclipse differences in readmission rates by race/ethnicity.
December 10, 2025 | Erin Bluvas, bluvase@sc.edu
USC researchers continue to uncover new insights from a five-year project launched by health services policy and management associate professor Peiyin Hung and health promotion, education, and behavior professor Xiaoming Li to investigate maternal care and outcomes, particularly in the wake of the COVID-19 pandemic. Last year, their team received a $200,000 supplement to the initial $3 million National Institutes of Health U01 grant to further explore postpartum trends related to the intersection of residence location and race/ethnicity.
Their recent paper, published in JAMA Network Open, outlines some of their initial results from this supplemental project. The authors
found that Black individuals in urban areas were at highest risk of postpartum readmission.
Rural residence was also associated with increased readmission risk and seemed to
eclipse differences in readmission rates by race/ethnicity. However, in alignment
with research published by the team last year, significant geographic and racial disparities persist.
“The postpartum period is an essential time for individual recovery and sustained long-term well-being,” says Curisa Tucker, an assistant professor in the College of Nursing and a multiple principal investigator on this supplement. “Postpartum individuals are especially vulnerable during this time, with racial and ethnic disparities in adverse outcomes becoming more evident.”
Two percent of Americans are readmitted to hospitals after giving birth. These readmissions are often the result of mental health conditions, which are the most common complication of pregnancy and childbirth and impact one in every five mothers. In a review of maternal mortality across 38 states in 2020, 23% of maternal deaths were attributed to mental health conditions.
Accessing mental health and substance use treatment can be especially challenging for individuals in rural areas due to limited health care access, lack of childcare, transportation barriers, and feelings of shame or stigma. Black individuals are 80% more likely than whites to experience postpartum readmission, and rural populations are at higher risk compared to their urban peers.
In the present study, the researchers examined data related to more than 190,000 births that took place in South Carolina between 2018 and 2021. Their analysis revealed that while Black individuals were at highest risk for all-cause postpartum readmissions, this group, as well as Hispanic individuals, were less likely to be readmitted for mental health conditions or substance use treatment compared to whites. All rural residents were at a similar, elevated risk for postpartum readmission, suggesting that some other factors, perhaps individual-level characteristics, may play a role in overshadowing or alleviating disparities.
Efforts such as the expansion of telehealth services have made inroads towards reducing disparities between rural and urban populations, though access and technology may be unevenly distributed across different pockets of rural communities. Still, it’s possible these initiatives have been somewhat successful in mitigating the risks associated with postpartum readmissions overall.
“More research is needed to explore how structural and geographic factors intersect with individual risk to inform targeted postpartum care strategies,” Hung says. “These findings emphasize the need for interventions that expand access to mental health care and substance use treatment, particularly for white populations, while also improving community support for postpartum families.”
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