Rural women are active players in achieving the Millennium Development Goals (MDGs). They play a critical role in the rural economies of both developed and developing countries through their activities to agriculture and rural enterprises which contribute to local and global economies.

Rural women play a key role in supporting their households and communities in achieving food and nutrition security, generating income, and improving rural livelihoods and overall well-being. In addition, they carry out vital functions in caring for children, older persons and the sick.

Most people who live in extreme poverty live in rural areas of developing countries, and rural women fare worse than rural men and urban women and men for every MDG indicator for which data are available.

Rural women and maternal health

Achieving MDGs 4 and 5 to reduce child and maternal mortality are of particular importance to women living in rural areas.  Because of the location of their homes, rural women are disadvantaged in accessing emergency obstetric and neonatal care, because of geography, local support, autonomy, culture, finance and ergonomics. 

When unpredictable complications happen during pregnancy or delivery, women need urgent medical care. For women living in rural areas they have more challenges in reaching medical treatment and this contributes to higher maternal mortality rates.

Additionally, early marriage is more common among rural communities and often leads to early childbearing, with negative health consequences for young women, including obstructed labour and obstetric fistula, which is more common among women from rural areas.   

Inequity in maternal health services

It is important for all pregnant women to have access to a skilled birth attendant at the time of delivery, and is the "single most important factor in preventing maternal deaths”. A skilled birth attendant is someone with midwifery skills, who is able to manage a normal delivery and who can recognize and manage obstetric complications, or refer in time if needed. Skilled attendance at birth is also critical to prevent stillbirths and to improve newborn survival .

Women living in rural areas have more births that those in urban areas; the average number of births per woman (fertility rates) are higher among women in rural areas.

Yet the proportion of women with skilled birth attendance (SBA) and delivering in health care facilities are two of the indicators of the MDGs that are most inequitable in coverage .

More births happen in rural areas but many of those births are left unattended without skilled birth attendance and outside of a facility.

Across the MamaYe countries, more women live in rural than in urban areas, yet fewer women give birth in health facilities and in attendance by a skilled birth attendant than their urban counterparts. 

Rural living confers a distinct disadvantage in accessing health facilities for deliveries including MamaYe countries like Ethiopia, Tanzania and Ghana. In Nigeria, most rural women are disadvantaged compared to their urban counterparts, although there is a growing population of urban poor who also have less access to facility deliveries.

In sub-Saharan Africa, this contributes to a far higher maternal mortality ratio among rural women of 640 per 100,000 livebirths compared to their urban counterparts at 447 deaths per 100,000 livebirths. 

What is needed?

To reduce the inequity in maternal health outcomes for rural women, all rural women should have access to adequate health care facilities as stated in the Convention on the Elimination of All Forms of Discrimination against Women .

We know that providing women with skilled attendants in a health facility is what works to reduce maternal mortality; that means safe clinics and more midwives.

To make the fastest progress, strategies to scale up interventions aimed directly at the poorest should be adopted.  

Greater investments in health are required; studies have shown that a 10% increase in spending on health can result in a decrease of maternal mortality of 5%.