The distribution of maternity services across rural and remote Australia: does it reflect population need?

Abstract

BackgroundAustralia has a universal health care system and a comprehensive safety net. Despite this, outcomes for Australians living in rural and remote areas are worse than those living in cities. This study will examine the current state of equity of access to birthing services for women living in small communities in rural and remote Australia from a population perspective and investigates whether services are distributed according to need.MethodsHealth facilities in Australia were identified and a service catchment was determined around each using a one-hour road travel time from that facility. Catchment exclusions: metropolitan areas, populations above 25,000 or below 1,000, and a non-birthing facility within the catchment of one with birthing. Catchments were attributed with population-based characteristics representing need: population size, births, demographic factors, socio-economic status, and a proxy for isolation - the time to the nearest facility providing a caesarean section (C-section). Facilities were dichotomised by service level – those providing birthing services (birthing) or not (no birthing). Birthing services were then divided by C-section provision (C-section vs no C-section birthing). Analysis used two-stage univariable and multivariable logistic regression.ResultsThere were 259 health facilities identified after exclusions. Comparing services with birthing to no birthing, a population is more likely to have a birthing service if they have more births, (adjusted Odds Ratio (aOR): 1.50 for every 10 births, 95% Confidence Interval (CI) [1.33-1.69]), and a service offering C-sections 1 to 2 h drive away (aOR: 28.7, 95% CI [5.59-148]). Comparing the birthing services categorised by C-section vs no C-section, the likelihood of a facility having a C-section was again positively associated with increasing catchment births and with travel time to another service offering C-sections. Both models demonstrated significant associations with jurisdiction but not socio-economic status.ConclusionsOur investigation of current birthing services in rural and remote Australia identified disparities in their distribution. Population factors relating to vulnerability and isolation did not increase the likelihood of a local birthing facility, and very remote communities were less likely to have any service. In addition, services are influenced by jurisdictions.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-017-2084-8) contains supplementary material, which is available to authorized users.

Adherence to clinical practice guidelines for South Australian pregnant women with cardiac conditions between 2003 and 2013

“…Although recent research reported a disparity in maternity services for Australians living in rural and remote areas, interesting results were observed in this study [32]. Health care professionals in these postcode locations may have an increased risk awareness, initiate early multidisciplinary collaboration and retrieval of the women to the appropriate maternal centre.…”

Born before arrival in NSW, Australia (2000–2011): a linked population data study of incidence, location, associated factors and maternal and neonatal outcomes

“…The disparities in the geographical distribution of maternity services in Australia have been previously identified showing that they do not meet population need, nor do they factor in population vulnerability or isolation. 26 Distance as a contributing factor in the incidence of BBA has been explored previously in Queensland Australia, 6 where it was found that the increase in the incidence of BBA in that state was associated with the closure of rural and remote maternity units, thereby increasing the distance women were required to travel to birth. This factor is further supported by the low incidence of BBA within the Sydney region.…”

A woman's hand and a lion's heart: Skills and attributes for rural midwifery practice in New Zealand and Scotland

“…Providing a sustainable rural midwifery service is a priority area not only in New Zealand and Scotland but in numerous countries world-wide. Provision of rural maternity services is an international issue of providing equitable and safe maternity services for all women (Kennedy et al, 2016, Rolfe et al, 2017. A recent Australian study found that the equitable planning and maintenance of rural and remote Australian maternity services is sub-optimal, and birthing outcomes consistently show that rural and remote Australians have worse outcomes compared to urban families (Rolfe et al, 2017).…”

“…Provision of rural maternity services is an international issue of providing equitable and safe maternity services for all women (Kennedy et al, 2016, Rolfe et al, 2017. A recent Australian study found that the equitable planning and maintenance of rural and remote Australian maternity services is sub-optimal, and birthing outcomes consistently show that rural and remote Australians have worse outcomes compared to urban families (Rolfe et al, 2017). In the international forum, Kennedy et al (2016) in the Lancet series for global health have identified research priorities to improve the quality of care for every woman and child.…”