Geographic variation of reproductive health indicators and outcomes in the United States: place matters

Abstract

The social determinants of health are the circumstances in which people are born, grow up, live, work, and age and the systems put in place to deal with illness. These circumstances, in turn, are shaped by a wider set of forces: economics, social policies, and politics. Reproductive health indicators and conditions that are germane to obstetricians and gynecologists vary across states and regions in the United States as well as within regions and states. The aim of this article is to illustrate this variation with the use of examples of gynecologic malignancies, sexually transmitted infections, teen birth rates, preterm birth rates, and infant mortality rates. Using the example of infant death, the difficulties in “unpacking” the construct of place will be discussed, and a special emphasis is placed on the interaction of race, place, and disparities in shaping perinatal outcomes. Finally, readily available and easy-to-use online data resources will be provided so that obstetricians and gynecologists will be able to assess geographic variation in health indicators and outcomes in their own localities.

County‐level Variation in Infant Mortality Reporting at Early Previable Gestational Ages

“…As researchers and public health providers increasingly focus efforts on population health, IMR is often used as a key measure at the county level to assess community health status, socio‐economic conditions, and health care access and quality. Consistent with prior literature, our analysis demonstrates disparities in county IMR by rural status, demographics, and county size, all of which illustrate the very real impact of place on reproductive health and wellness . However, our findings also suggest that there are limitations to the validity of IMR comparisons across the US due to differences in how previable gestation deaths are reported.…”

“…However, wide IMR variation across the US has persisted, with generally higher rates in the Southern and Midwestern US compared with other regions of the country (most recent high of 8.24 for Mississippi and a low of 4.30 for California). Such geographic variation is likely related to multiple factors including maternal health, prenatal care quality and access, and socio‐economic conditions …”

“…Such geographic variation is likely related to multiple factors including maternal health, prenatal care quality and access, and socio-economic conditions. 3,4 However, variation in how infant deaths are reported may also be a significant contributor. 5,6 Based on World Health Organisation standards, a livebirth with infant death includes delivery of any product of human conception showing initial evidence of life, regardless of gestational age.…”

Using geographical analysis to identify child health inequality in sub-Saharan Africa

“…These cross-border bands may be due to cultural influences that underlie some of the indicators studied [17], and the fact that many ethnic groups reside in geographic areas that cross colonial-era geo-political boundaries that divided ethnic groups among countries [61] and shared geographic features that make access to health care, e.g., immunization campaigns, difficult.…”

“…Research on spatial patterns of diarrheal disease in Malawi found that climatic, environmental and geographic effects were mediated by EBF [16]. Interpretation of spatial analysis of EBF draws upon understanding the spatial distribution of natural and cultural features, considering “the context of place” to incorporate social determinants of health [17]. No research has yet examined the spatial distribution of EBF practice across and within a large proportion of countries on the African continent, where EBF prevalence is generally less than 50% [18].…”