Health care use and health consequences of geographic lack of access to abortion and maternity care

IF 2.8 3区医学 Q1 NURSING

Birth-Issues in Perinatal Care Pub Date : 2023-11-15 DOI:10.1111/birt.12792

Maeve E. Wallace PhD, MPH, Dovile Vilda PhD, Lauren Dyer MPH, Iman Johnson MPH, Lillian Funke CMN, MPH

{"title":"Health care use and health consequences of geographic lack of access to abortion and maternity care","authors":"Maeve E. Wallace PhD, MPH, Dovile Vilda PhD, Lauren Dyer MPH, Iman Johnson MPH, Lillian Funke CMN, MPH","doi":"10.1111/birt.12792","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>Recent years have brought substantial declines in geographic access to abortion facilities and maternity care across the US. The purpose of this study was to identify the reproductive health consequences of living in a county without access to comprehensive reproductive health care services.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>We analyzed National Center for Health Statistics data on all live births occurring in the US in 2020. We used data on locations of abortion facilities and availability of maternity care in order to classify counties by level of access to comprehensive reproductive health care services and defined comprehensive reproductive health care deserts as counties that did not have an abortion facility in the county or in any neighboring county and did not have any maternity care practitioners. We fit modified Poisson regression models with generalized estimating equations to estimate the degree to which living in a comprehensive reproductive health care desert was associated with receipt of timely and adequate prenatal care and risk of preterm birth, controlling for individual-level and county-level characteristics.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>In 2020, one third of counties in the US were comprehensive reproductive health care deserts (<i>n</i> = 1082), and 136,272 births occurred in these counties. In adjusted models, there was no difference in prenatal health care use (timeliness or adequacy of care) between persons in comprehensive reproductive health care deserts and those with full access to care, but the risk of preterm birth was significantly elevated (aRR =1.09, 95% CI = 1.06, 1.13).</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Lack of access to comprehensive reproductive health care services may increase the incidence of preterm birth.</p>\n </section>\n </div>","PeriodicalId":55350,"journal":{"name":"Birth-Issues in Perinatal Care","volume":"51 2","pages":"363-372"},"PeriodicalIF":2.8000,"publicationDate":"2023-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11093883/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Birth-Issues in Perinatal Care","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/birt.12792","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"NURSING","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Recent years have brought substantial declines in geographic access to abortion facilities and maternity care across the US. The purpose of this study was to identify the reproductive health consequences of living in a county without access to comprehensive reproductive health care services.

Methods

We analyzed National Center for Health Statistics data on all live births occurring in the US in 2020. We used data on locations of abortion facilities and availability of maternity care in order to classify counties by level of access to comprehensive reproductive health care services and defined comprehensive reproductive health care deserts as counties that did not have an abortion facility in the county or in any neighboring county and did not have any maternity care practitioners. We fit modified Poisson regression models with generalized estimating equations to estimate the degree to which living in a comprehensive reproductive health care desert was associated with receipt of timely and adequate prenatal care and risk of preterm birth, controlling for individual-level and county-level characteristics.

Results

In 2020, one third of counties in the US were comprehensive reproductive health care deserts (n = 1082), and 136,272 births occurred in these counties. In adjusted models, there was no difference in prenatal health care use (timeliness or adequacy of care) between persons in comprehensive reproductive health care deserts and those with full access to care, but the risk of preterm birth was significantly elevated (aRR =1.09, 95% CI = 1.06, 1.13).

Conclusions

Lack of access to comprehensive reproductive health care services may increase the incidence of preterm birth.

Abstract Image

查看原文本刊更多论文

医疗保健的使用和地理上无法获得堕胎和产妇护理的健康后果。

背景:近年来，美国各地获得堕胎设施和产科护理的地理位置大幅下降。这项研究的目的是确定生活在一个无法获得全面生殖保健服务的县的生殖健康后果。方法:我们分析了美国国家卫生统计中心2020年所有活产婴儿的数据。我们使用了堕胎设施的位置和产科护理的可用性数据，以便根据获得综合生殖保健服务的水平对县进行分类，并将综合生殖保健沙漠定义为在本县或任何邻近县没有堕胎设施，也没有任何产科护理从业人员的县。我们用广义估计方程拟合修正泊松回归模型，以估计生活在综合生殖保健沙漠中与接受及时和充分的产前护理和早产风险相关的程度，控制了个人水平和县级特征。结果:2020年，美国三分之一的县是综合生殖保健沙漠(n = 1082)，这些县的出生人数为136272人。在调整后的模型中，接受综合生殖保健服务的人和完全获得保健服务的人在产前保健使用(护理的及时性或充足性)方面没有差异，但早产的风险显著升高(aRR =1.09, 95% CI = 1.06, 1.13)。结论:缺乏全面的生殖保健服务可能会增加早产的发生率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Birth-Issues in Perinatal Care 医学-妇产科学

CiteScore

4.10

自引率

4.00%

发文量

审稿时长

>12 weeks

期刊介绍： Birth: Issues in Perinatal Care is a multidisciplinary, refereed journal devoted to issues and practices in the care of childbearing women, infants, and families. It is written by and for professionals in maternal and neonatal health, nurses, midwives, physicians, public health workers, doulas, social scientists, childbirth educators, lactation counselors, epidemiologists, and other health caregivers and policymakers in perinatal care.