1. 1. Because current large-scale reporting methods distinguish only between "metropolitan" and "nonmetropolitan" residence, important differences between communities within these gross measures (such as frontier versus large farming towns) cannot be measured.
2. 2. This figure was compiled by the authors from published state vital statistics.
3. 3. Public Law 100-360, the Medicare Catastrophic Coverage Act (MCCA), mandates coverage by July 1,1990, of all pregnant women and infants with incomes below the federal poverty level and assets below state-established standards. When this law was enacted, only about seven states had not already extended coverage pursuant to an option to cover all poverty level women and infants that was enacted by Congress in 1986. Four of these seven (Wyoming, Montana, North Dakota and Idaho), had 50 percent or more of their population residing in rural areas.
4. 4. Maternity services can also be found at some (although no estimates exist) of the 435 health clinics located in rural underserved areas that do not receive federal community or migrant health center funding, but that are certified to participate in the Medicare and Medicaid rural health clinic program. That program is designed to provide additional public insurance support for clinics that employ midlevel practitioners and that serve rural areas. However, unlike, community and migrant health centers, Medicare and Medicaid-certified rural health clinics are not obligated to accept all patients regardless of their ability to pay for care.