Childbirth in rural Appalachia has long been a subject of concern. Infant mortality rates are higher in Appalachia than in other parts of the United States. Additionally, poor health in utero, at birth, and in childhood can contribute to poor health throughout life. The region's low income, geographic isolation, and low levels of educational attainment reduce both access to and utilization of modern medical care. Traditional medical practices, including lay midwifery, persisted longer in Appalachia than in other U.S. regions.