Evaluating disparities in access to obstetric services for American Indian women across Montana

Abstract

Purpose Pregnant women across the rural United States have increasingly limited access to obstetric care, especially specialty care for high‐risk women and infants. Limited research focuses on access for rural American Indian/Alaskan Native (AIAN) women, a population warranting attention given persistent inequalities in birth outcomes. Methods Using Montana birth certificate data (2014–2018), we examined variation in travel time to give birth and access to different levels of obstetric care (i.e., the proportion of individuals living within 1‐ and 2‐h drives to facilities), by rurality (Rural‐Urban Continuum Code) and race (White and AIAN people). Findings Results point to limited obstetric care access in remote rural areas in Montana, especially higher‐level specialty care, compared to urban or urban‐adjacent rural areas. AIAN women traveled significantly farther than White women to access care (24.2 min farther on average), even compared to White women from similarly rural areas (5–13 min farther, after controlling for sociodemographic characteristics, risk factors, and health care utilization). AIAN women were 20 times more likely to give birth at a hospital without obstetric services and had less access to complex obstetric care. Poor access was particularly pronounced among reservation‐dwelling AIAN women. Conclusions It is imperative to consider racial disparities and health inequities underlying poor access to obstetric services across rural America. Current federal policies aim to reduce maternity care professional shortages. Our findings suggest that racial disparities in access to complex obstetric care will persist in Montana unless facility‐level infrastructure is also expanded to reach areas serving AIAN women.

Determinants of ethnic differences in the uptake of child healthcare services in New Zealand: a decomposition analysis

“…Important underlying reasons for such gaps included lack of transport, cost, and low levels of trust and confidence in the child's GP. A similar pattern is found internationally, with lower utilisation of healthcare services among ethnic minority groups [6][7][8], and particularly for indigenous ethnic groups [9]. In the US, children from racial minority and marginalised communities were found to have poorer health status and disrupted access to care [10].…”

Dual Barriers: Examining Digital Access and Travel Burdens to Hospital Maternity Care Access in the United States, 2020

“…Travel burdens in rural America pose a significant challenge to rural health care access 17,42,43 . Rural communities, especially those in frontier and/or remote areas, face persistent barriers to maintaining local maternity units, 3–6,44 challenging the ongoing efforts to ensure access to maternity care.…”

“…Travel burdens in rural America pose a significant challenge to rural health care access. 17,42,43 Rural communities, especially those in frontier and/or remote areas, face persistent barriers to maintaining local maternity units, [3][4][5][6]44 challenging the ongoing efforts to ensure access to maternity care. Several statewide studies have found that travel burdens to maternity care were associated with lower rates of prenatal care uptake, and higher rates of preterm births, low birthweights, and neonatal mortality.…”

The implications of using maternity care deserts to measure progress in access to obstetric care: A mixed-integer optimization analysis

“…[7][8][9][10][11] Recent findings suggest a lack of access and disparities in geographic access will persist unless facility-level infrastructure is expanded. 12 However, geographic access to obstetric care is measured in several ways, which causes uncertainty about how to optimally invest in infrastructure to expand access. One common measure of access in the academic literature and news media is the maternity care desert, as defined by the March of Dimes.…”

“…16,17 However, the maternity care deserts access measure does not necessarily reflect distance to care because counties differ in size and some pregnant women within a county may live close to an obstetric facility in a neighboring county. Other studies have measured geographic access as driving time to the nearest facility offering obstetric services at different levels of care 12,18 and distance to the nearest facility offering critical care obstetric (CCO) services 19,20 as key measures for quantifying potential access.…”