Increasing Access to Perinatal Care in Rural Settings: A Washington State Global to Local Scoping Review

Rural Washington State (WA) communities face persistent barriers to perinatal care, with 20.5% of counties classified as maternity care deserts. Using a Global to Local (G2L) lens, the WA Department of Health (WA DOH), in partnership with PATH, conducted a rapid scoping review to identify models and approaches for improving access to perinatal care in rural settings. The search strategy yielded 1,830 unique records. Following screening, data were extracted from 261 studies that met inclusion criteria. We spotlighted four articles for their salience to WA. Evidence was drawn from 261 studies across 54 countries, along with 16 global or multi-country reviews. Most studies were conducted in the WHO African Region (37.9%) and the Region of the Americas (30.1%). Nearly one-third employed qualitative or mixed-methods designs. Training and task-shifting strategies predominated, often combined with digital health and outreach. Interventions most frequently targeted antenatal and postnatal periods, commonly delivered by midwives, nurses, and community health workers. Mental and behavioral health interventions were less common but increased in postnatal and extended postpartum periods. Findings indicate that perinatal health interventions in rural and resource-constrained settings globally emphasize workforce optimization and access-enhancing strategies, with training and task shifting most prominent. Gaps persist in early mental and behavioral health support. Promising approaches leverage interprofessional collaboration, including telehealth-enabled hub-and-spoke models, hybrid primary–specialty care linkages, and community-guided co-design. Translating models to rural WA will require community-driven innovation, investment in supportive systems, and centering Tribal and local leadership to advance resilient, culturally responsive, and integrated perinatal care. • Mapped 261 articles of models or approaches for improving perinatal care access globally • Spotlighted four models with salience for Washington State • Identified gaps in perinatal mental/behavioral health, culturally grounded care, and co-design • Provides evidence to guide rural perinatal policy and health system innovation