Children and Pregnant Women*

Abstract

A review of the literature of the 1980s reveals that women living in rural American are at risk for receiving inadequate prenatal and maternal care. Documented risk factors include poverty and concomitant lack of medical insurance, residence in the most restrictive Medicaid states, and loss of local services including the closure of obstetric units of rural hospitals and the decision by local physicians to discontinue obstetrics. A prominent factor in a physician's decision to stop providing maternity care is the escalating cost of medical liability insurance; however, other forces are also at work, including interference with personal and family activities, disruption of other aspects of professional life (e.g., office schedule), inadequate reimbursement, and an inability to keep up with advancing technology. A research agenda for the 1990s should be consistent with previous recommendations and must stimulate the development of new programs that will induce the maximum number of providers to again offer high quality perinatal care to rural women. Other items on the 1990s research agenda include: (1) the clarification of the impact of lost perinatal services in rural areas, (2) the effects of travel time and distance on perinatal outcomes and cost of care, (3) the effect of loss of obstetric services on other health care services for women and children, and (4) comparisons of regionalized versus centralized systems for the provision of perinatal services.

A Multivariate Assessment of the Effects of Residence on Infant Mortality*

“…In general, residents of small towns and rural communities have a smaller number and a narrower range of medical services and health providers available to them. This trend has been observed, as well, in services for pregnant women (Lawhorne, Zweig & Tinker, 1990). Pregnant women from small towns and rural communities have reduced accessibility to primary and specialized maternity care (American Nurses' Association, 1989; Institute of Medicine, 1989); have experienced severe reductions in the obstetrical care available to them in recent years, for the most part due to increasing malpractice premiums (Nesbitt, Scherger, & Tanji, 1989); and have seen the obstetric units of their rural hospitals close in unprecedented numbers Taylor, Zweig, Williamson, Lawhorne, & Wright, 1989).…”

Travel time from home to hospital and adverse perinatal outcomes in women at term in the Netherlands

“…Our study of the effect of longer travel time and adverse outcome ismore generally applicable to other countries with a hospital‐based maternity care system considering centralisation of care facilities, especially for rural areas 32,33 …”

“…Our study of the effect of longer travel time and adverse outcome ismore generally applicable to other countries with a hospital-based maternity care system considering centralisation of care facilities, especially for rural areas. 32,33 In the Netherlands these findings also have implications for the choice of concentration of care facilities to be able to provide 24-hour acute obstetrical and neonatal services 7 days a week. If this concentration implies that travel time increases, the potential benefits of large-scale care might be jeopardized by the longer travel time both for low-risk women planning home delivery, as well as for women classified as high risk prior to the onset of labour.…”

Community assessment of the barriers to primary health care for children and families

“…A review of empirical studies on barriers related to primary health care, prenatal care, well-child care and screening services, immunizations, and familyfocused health education identified a variety of financial, structural, and personal barriers. Inadequate, or lack of, health insurance coverage, cost of program materials, and unstable funding sources for health-care agencies were the primary financial barriers (Dutton, 1982;Fire, 1990;Lawhorne, Zweig & Tinker, 1990;Spoth & Redmond, 1993a). Unavailability of services in the community, transportation problems, difficulty recruiting and retaining staff, insufficient community resources, insensitive and inappropriate practices for meeting family needs, community attitudes toward seeking help, inconvenient program features, and lack of interagency coordination contributed to structural barriers (Bedics, 1994;Dutton, 1982;Gibbons, 1990;Lamsam, 1993;Lawhorne et al, 1990;Lugo, 1993;Mack, 1989;McDiarmid, 1988;Orenstein, 1990;Patrick, Stein, Porta, & Ricketts, 1988;Shelton, 1987;Spoth & Redmond, 1993a;Weinert & Long, 1987).…”

“…Inadequate, or lack of, health insurance coverage, cost of program materials, and unstable funding sources for health-care agencies were the primary financial barriers (Dutton, 1982;Fire, 1990;Lawhorne, Zweig & Tinker, 1990;Spoth & Redmond, 1993a). Unavailability of services in the community, transportation problems, difficulty recruiting and retaining staff, insufficient community resources, insensitive and inappropriate practices for meeting family needs, community attitudes toward seeking help, inconvenient program features, and lack of interagency coordination contributed to structural barriers (Bedics, 1994;Dutton, 1982;Gibbons, 1990;Lamsam, 1993;Lawhorne et al, 1990;Lugo, 1993;Mack, 1989;McDiarmid, 1988;Orenstein, 1990;Patrick, Stein, Porta, & Ricketts, 1988;Shelton, 1987;Spoth & Redmond, 1993a;Weinert & Long, 1987). Personal barriers included lack of education and knowledge, family poverty and low income, personal attitudes towards seeking help and participating in education, personal lifestyle, mothers' labor force participation, and stressful events (Bedics, 1994;Dowswell & Hewison, 1993;Fire, 1990;Lamsam, 1993;National Commission on Infant Mortality, 1991;Spoth & Redmond, 1993b;Spoth & Redmond, in press).…”