Distance as a barrier to obstetric care among indigenous women in Panama: a cross-sectional study

Abstract

ObjectivesWe assess the relationship between distance to a woman’s assigned health clinic and obstetric care utilisation.DesignWe employ a cross-sectional study design using baseline data from the evaluation of a conditional cash transfer programme to promote greater utilisation of maternal and infant health services. Data were collected between December 2016 and January 2017.SettingThe study is conducted in Ngäbe Buglé, the largest of Panama’s three indigenous territories, where maternal mortality is three times the national average.ParticipantsWe analyse a representative sample of 1336 indigenous women with a birth in the 12 months prior to the survey.Primary and secondary outcome measuresPrimary outcomes include obstetric care utilisation measures for prenatal, childbirth and postpartum events. Secondary outcomes include reasons for not receiving prenatal care, alarming symptoms, child weight at birth and stillbirths or miscarriages.ResultsCompared with women in closest geographic proximity to a health centre (top quintile, Q1), women who lived farthest from a health centre (bottom quintile, Q5) had significantly lower obstetric care utilisation outcomes for critical prenatal, childbirth and postpartum events. Mothers in Q5 were 36 percentage points less likely to have had at least one prenatal care appointment in a hospital, health centre or clinic compared with mothers in Q1 (p<0.01), and 52 percentage points less likely to attend an institutional first appointment (p<0.01). The gap in institutional delivery and postnatal care between mothers in Q1 and Q5 was about 35 percentage points (p<0.01). All utilisation outcomes were negatively correlated with distance, and differences in obstetric care utilisation persisted even when controlling for household wealth, maternal age and maternal education.ConclusionDistance is an important barrier to obstetric care utilisation, with women in more distant locations suffering significantly lower use of prenatal, childbirth and postpartum care compared with women in closer vicinity to a health establishment. Expanding the supply of healthcare and implementing demand side incentives to promote the use of health services in remote communities are relevant policies to reduce disparities in obstetric care utilisation.Trial registration numberAEA Registry (RCT ID AEARCTR-0001751).

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“…Long distances leading to long travel hours contribute to a lack of immediate access to medical facilities since available hospitals are located relatively far from the people who need them, leading to delay in care [69]. Previous research has evaluated the effect of distance as a barrier to care leading to delay, which yielded similar results to those of our study [70][71][72][73][74].…”

Factors associated with antepartum pilgrimage at a reference maternity hospital in Ceará

“…International studies have highlighted the association between physical barriers to access and use of obstetric health care equipment ( 19 , 20 ) . A study with 6,655 African women (Burkina Faso) showed that those who lived further away were significantly less likely to give birth in a health unit ( 19 ) .…”

Fatores associados à peregrinação anteparto em maternidadede referência no Ceará

“…Estudos internacionais têm evidenciado a associação entre barreiras físicas de acesso e uso dos equipamentos de atenção à saúde obstétrica (19,20) . Estudo com 6.655 mulheres africanas (Burkina Faso) evidenciou que as que viviam mais longe eram significativamente menos propensas a parir em unidade de saúde (19) .…”