Understanding Perceived Access to Prenatal Care and the Role of Telehealth In Rural Areas: Insights from Pregnant Women In Rural South Carolina

Background and purpose: Access to prenatal care remains a persistent challenge in rural areas of the United States, where transportation barriers, provider shortages, and socioeconomic constraints limit timely and adequate care. While telehealth has emerged as a promising strategy to improve access to health care, there is limited understanding of how pregnant women perceive access to prenatal care across both in-person and virtual modalities in rural areas. This study aims to examine how pregnant women in rural South Carolina perceive access to prenatal care and to explore the role of telehealth in prenatal care.

Methods: Guided by a perceived accessibility framework that includes awareness, infrastructure reliability, affordability, and service satisfaction, this study employs a qualitative research design using semi-structured interviews. Nine pregnant women were recruited through rural healthcare providers and community networks. Interviews were conducted either in person or virtually, audio-recorded, and transcribed verbatim. A thematic analysis approach was used to identify key themes related to perceived access to prenatal care and experiences with both in-person and telehealth prenatal care.

Findings: First, pregnant women in rural South Carolina reported persistent transportation-related barriers, including long travel distances, limited mobility during pregnancy, and reliance on informal transportation networks. Second, telehealth was perceived as a valuable complement to in-person care, particularly for routine consultations, but was not viewed as a complete substitute due to concerns about physical examinations, care quality, and trust. Third, affordability emerged as a critical constraint: many study participants were low-income and relied on Medicaid; however, limited provider availability and capacity to serve Medicaid patients in rural areas resulted in long wait times and necessitated travel over greater distances to access care. Transportation costs further exacerbated these barriers. Finally, informational barriers and uneven awareness of available services continued to affect perceived accessibility across both care modalities.

Conclusions and Implications: These findings underscore the importance of perceived accessibility in healthcare systems and highlight the need for integrated, patient-centered approaches to service delivery in rural areas. The study further emphasizes the role of telehealth as part of a hybrid care model and points to the need for targeted interventions addressing transportation, digital infrastructure, and information accessibility to improve the quality of prenatal care for pregnant women in rural communities.