By Elizabeth Kizer, DrPH

In an exciting development for rural healthcare, the Arizona Rural Health Association (AzRHA), in collaboration with the Arizona State Office of Rural Health (AzSORH), has been awarded a grant to enhance obstetric (OB) care in communities with non birthing Critical Access Hospitals (CAHs). This initiative, which began under the Arizona Rural Hospital Flexibility program (AzFlex), will bring OB simulation training to seven CAHs and communities lacking birthing centers over the coming year, enhancing maternal care and emergency preparedness.

Rural community hospitals are vital in maternity care, delivering 15% of babies in the U.S. However, by 2020, less than half of these hospitals could offer obstetric services, leaving many rural women in Arizona traveling over 100 miles to reach the closest birthing hospital. The Arizona reproductive healthcare Maternal Vulnerability Index is 94/100, indicating an extremely high level of vulnerability for Arizona women. Of all U.S. states, Arizona ranks one of highest in maternal mortality with a rate of 31.4 per 100,000 live births as compared to 23.5 in the US

AzFLEX and the Nurse Midwife program at the University of Arizona developed a novel OB simulation training to address these gaps. The initial training was successfully offered in January 2025 at the White Mountain Regional Medical Center, located 50 miles from the closest birthing center at Summit Healthcare in Show Low. However, expanding the program to other regions across the state was not feasible due to limited resources. 

When funding became available through the National Rural Health Association, the Arizona Rural Health Association (AzRHA) took the lead in expanding OB Simulation training. Partnering with the AzSORH, AzFLEX,  the University of Arizona’s Nurse Midwife program, and Arizona State University’s (ASU) College of Health Solutions,  AzRHA developed a proposal that would expand training to equip non-birthing CAHs and first responders with the skills needed to support emergency OB care in rural communities.The training will be provided to seven CAHs without OB services, including two located in OB deserts, and three serving tribal communities.  The priority hospitals for this initiative include:

1. Copper Queen Community Hospital & Douglas Emergency Department 

2. San Carlos Apache Healthcare Center

3. Hopi Health Care Center

4. Huhukam Memorial Hospital / Gila River Healthcare

5. La Paz Regional Hospital (OB desert) & Parker Indian Healthcare Center (OB desert)

6. Northern Cochise Community Hospital

7. Benson Community Hospital

A graduate student from ASU’s College of Health Solutions, specializing in healthcare systems and quality improvement within the Master of Science in Healthcare Administration and Policy program, will lead the program evaluation and share the findings. The evaluation will focus on measuring changes in participant knowledge, assessing program impact, and conducting interviews with medical personnel to gain insights and establish best practices.  

This collaborative effort underscores AzRHA’s and the SORH's commitment to elevating the standard of care in rural healthcare settings and ensuring all communities have access to quality obstetric services. As the program unfolds, it promises to foster safer birthing experiences and enhance health outcomes in Arizona's rural populations.