Where does distance matter? Distance to the closest maternity unit and risk of foetal and neonatal mortality in France

Abstract

Background: The number of maternity units has declined in France, raising concerns about the possible impact of increasing travel distances on perinatal health outcomes. We investigated impact of distance to closest maternity unit on perinatal mortality. Methods: Data from the French National Vital Statistics Registry were used to construct foetal and neonatal mortality rates over 2001–08 by distance from mother’s municipality of residence and the closest municipality with a maternity unit. Data from French neonatal mortality certificates were used to compute neonatal death rates after out-of-hospital birth. Relative risks by distance were estimated, adjusting for individual and municipal-level characteristics. Results: Seven percent of births occurred to women residing at ≥30 km from a maternity unit and 1% at ≥45 km. Foetal and neonatal mortality rates were highest for women living at <5 km from a maternity unit. For foetal mortality, rates increased at ≥45 km compared with 5–45 km. In adjusted models, long distance to a maternity unit had no impact on overall mortality but women living closer to a maternity unit had a higher risk of neonatal mortality. Neonatal deaths associated with out-of-hospital birth were rare but more frequent at longer distances. At the municipal-level, higher percentages of unemployment and foreign-born residents were associated with increased mortality. Conclusion: Overall mortality was not associated with living far from a maternity unit. Mortality was elevated in municipalities with social risk factors and located closest to a maternity unit, reflecting the location of maternity units in deprived areas with risk factors for poor outcome.

Elective induction of labour and maternal request: a national population‐based study

“…Also, their cervix is more often ripe at the end of pregnancy, which encourages obstetricians to choose to induce labour or accept the request of the woman. Finally, obstetricians may also choose induction for multiparas for fear that rapid labour might result in delivery before arrival at the hospital and thus increase the risk for both mother and child …”

Determinants of Neonatal Mortality in the Health Districts of Labe, Mamou, Faranah and Kankan

“…Environmental neonatal mortality factors The different statements made by participants from the four Health Districts on neonatal mortality factors related to the environment are: worsening degradation of roads and bridges, ecosystem, isolation of housing areas, insalubrity, lack of decent housing, pollution, and the effects of climate change, distance of the population from health facilities. On the other hand, a study of the impact of distance from home to the nearest maternity hospital on neonatal mortality and stillbirths has not found a national link, although in more rural areas too long a distance can be harmful to the health of newborns [6]. Paradoxically, it has been found in France that neonatal mortality is higher for women whose homes are close to maternity [7].…”

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).…”