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What Explains Divorced Women's Poorer Health? The Mediating Role of Health Insurance and Access to Health Care in a Rural Iowan Sample


  • Direct correspondence to Bridget Lavelle, National Poverty Center, University of Michigan, 735 South State Street, Suite 5100, Ann Arbor, MI 48109 ( This research was supported by grants from the National Institute of Child Health and Human Development, the National Institute on Drug Abuse, and the National Institute of Mental Health (HD047573, HD051746, and MH051361). Support for earlier years of the study also came from multiple sources, including the National Institute of Mental Health (MH00567, MH19734, MH43270, MH59355, MH62989, and MH48165), the National Institute on Drug Abuse (DA05347), the National Institute of Child Health and Human Development (HD027724), the Bureau of Maternal and Child Health (MCJ-109572), and the MacArthur Foundation Research Network on Successful Adolescent Development among Youth in High-Risk Settings. Lavelle is an NSF Graduate Research Fellow.


Economic restructuring in rural areas in recent decades has been accompanied by rising marital instability. To examine the implications of the increase in divorce for the health of rural women, we examine how marital status predicts adequacy of health insurance coverage and health care access, and whether these factors help to account for the documented association between divorce and later illness. Analyzing longitudinal data from a cohort of over 400 married and recently divorced rural Iowan women, we decompose the total effect of divorce on physical illness a decade later using structural equation modeling. Divorced women are less likely to report adequate health insurance in the years following divorce, inhibiting their access to medical care and threatening their physical health. Full-time employment acts as a buffer against insurance loss for divorced women. The growth of marital instability in rural areas has had significant ramifications for women's health; the decline of adequate health insurance coverage following divorce explains a component of the association between divorced status and poorer long-term health outcomes.