Birth Outcomes Among Older Mothers in Rural Versus Urban Areas: A Residence-Based Approach

Abstract

Older women in rural versus urban areas had a lower rate of cesarean section and increased risk of perinatal death. The risk of perinatal death increased with the distance to hospital. Further studies need to evaluate the contribution of underlying perinatal risks, access to care, and decision making regarding referral and transport.

Maternal morbidity and perinatal outcomes among women in rural versus urban areas

“…This is in agreement with findings from some studies, 17,18 but not with others. 19,29,30 The risk of severe neonatal morbidity was higher in the rural group than in the urban group after we adjusted for potential confounding factors related to delivery, obstetric interventions and type of attendant at delivery.…”

“…13 Most studies examining geographic barriers to maternity care in industrialized countries focused solely on perinatal death and infant mortality and morbidity, showing elevated rates among infants of women residing in rural areas. 14,[16][17][18][19][20] Geographic disparity in severe maternal morbidity has not been adequately examined.…”

“…Most studies of rural maternity care have focused solely on infant outcomes, [16][17][18][19][20]29,30 and population-based studies examining different components of severe maternal morbidity associated with rural residence in industrialized countries are rare. Our study showed that the risk of Note: CI = confidence interval, CNS = central nervous system, OR = odds ratio.…”

“…This finding suggests that, when stratified by obstetric interventions, infants in rural areas had elevated rates of morbidity. It has been shown that the rates of perinatal mortality and morbidity are elevated among women from rural areas delivering in urban hospitals 18 and among older women who may require timely intervention, 17 and that the risk increases with the distance to the hospital. 19,29,30 All of these findings underscore a need to identify and carefully monitor women in rural areas who have a high-risk pregnancy, because proper clinical management and timely intervention may be crucial to prevent adverse maternal and infant outcomes.…”

Geographic Accessibility to Health Services and Neonatal Mortality Among Very-Low Birthweight Infants in South Carolina

“…Some other studies have evaluated the impact of road distance traveled to health facilities on either perinatal, neonatal, or infant mortality in both developed (Lisonkova et al, 2011;Pasquier et al, 2007;Pilkington, Blondel, Drewniak, & Zeitlin, 2014) and developing (Armstrong Schellenberg et al, 2008;Kashima et al, 2012;Lohela, Campbell, & Gabrysch, 2012;Malqvist, Sohel, Do, Eriksson, & Persson, 2010) countries but with varied results. Very few studies have used a more accurate measure, namely travel time to health care services, and studied its impact on mortality in infancy (Combier et al, 2013;Dummer & Parker, 2004;Grzybowski, Stoll, & Kornelsen, 2011;Moisi et al, 2010;Okwaraji, Cousens, Berhane, Mulholland, & Edmond, 2012;Ravelli et al, 2011;Schoeps, Gabrysch, Niamba, Sie, & Becher, 2011).…”