Mapping access to prenatal care: Geographic disparities in West Virginia's rural communities.

Abstract

Introduction: Adequate prenatal care (PNC) is essential to the overall health of mother and her infant. Previous research has demonstrated that rural areas have a higher risk of inadequate PNC compared to their urban counterparts. No studies to date have applied spatial statistical modeling to understand community level factors related to PNC inadequacy.

Purpose: To identify communities where the adjusted rate of PNC inadequacy is high, and the insurance type and drive time driving these geographic differences.

Methods: Data were obtained from Project WATCH/Birth Score Program for WV zip codes from May 2018 to March 2022. Stratified spatial regression analyses were conducted for women with public and private insurance to understand the extent to which predictors affected risk of PNC inadequacy, and whether relationships differed depending on insurance type.

Results: For both insurance types, 30-minute drive time from a birthing facility had a statistically significant association with risk of inadequate PNC (public IRR:3.83, CI:(2.85,5.18)) (private IRR:4.31, CI:(3.17,5.88). Hot spots of model adjusted inadequate PNC risk were clustered in the mid-eastern and southern parts of WV. Importantly, communities with highest risk of inadequate PNC were located further than 30-minutes from a birthing center.

Discussion: This study identified strong associations between restricted access to birthing facilities and inadequacy of PNC for women with public and private insurance. Differences in hotspot locations between public and private insurance groups suggest these groups experience different barriers, such as lack of public transportation and drive time.