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American Indians travel great distances for obstetrical care: Examining rural and racial disparities

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  • Thorsen, Maggie L.
  • Harris, Sean
  • Palacios, Janelle F.
  • McGarvey, Ronald G.
  • Thorsen, Andreas

Abstract

Rural, American Indian/Alaska Native (AI/AN) people, a population at elevated risk for complex pregnancies, have limited access to risk-appropriate obstetric care. Obstetrical bypassing, seeking care at a non-local obstetric unit, is an important feature of perinatal regionalization that can alleviate some challenges faced by this rural population, at the cost of increased travel to give birth. Data from five years (2014–2018) of birth certificates from Montana, along with the 2018 annual survey of the American Hospital Association (AHA) were used in logistic regression models to identify predictors of bypassing, with ordinary least squares regression models used to predict factors associated with the distance (in miles) birthing people drove beyond their local obstetric unit to give birth. Logit analyses focused on hospital-based births to Montana residents delivered during this time period (n = 54,146 births). Distance analyses focused on births to individuals who bypassed their local obstetric unit to deliver (n = 5,991 births). Individual-level predictors included maternal sociodemographic characteristics, location, perinatal health characteristics, and health care utilization. Facility-related measures included level of obstetric care of the closest and delivery hospitals, and distance to the closest hospital-based obstetric unit. Findings suggest that birthing people living in rural areas and on American Indian reservations were more likely to bypass to give birth, with bypassing likelihood depending on health risk, insurance, and rurality. AI/AN and reservation-dwelling birthing people traveled significantly farther when bypassing. Findings highlight that distance traveled was even farther for AI/AN people facing pregnancy health risks (23.8 miles farther than White people with pregnancy risks) or when delivering at facilities offering complex care (14–44 miles farther than White people). While bypassing may connect rural birthing people to more risk-appropriate care, rural and racial inequities in access persist, with rural, reservation-dwelling AI/AN birthing people experiencing greater likelihood of bypassing and traveling greater distances when bypassing.

Suggested Citation

  • Thorsen, Maggie L. & Harris, Sean & Palacios, Janelle F. & McGarvey, Ronald G. & Thorsen, Andreas, 2023. "American Indians travel great distances for obstetrical care: Examining rural and racial disparities," Social Science & Medicine, Elsevier, vol. 325(C).
    • Handle: RePEc:eee:socmed:v:325:y:2023:i:c:s027795362300254x
    DOI: 10.1016/j.socscimed.2023.115897
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    1. Bezu, Sosina & Binyaruka, Peter & Mæstad, Ottar & Somville, Vincent, 2021. "Pay-for-performance reduces bypassing of health facilities: Evidence from Tanzania," Social Science & Medicine, Elsevier, vol. 268(C).
    2. Probst, J.C. & Moore, C.G. & Glover, S.H. & Samuels, M.E., 2004. "Person and place: The compounding effects of race/ethnicity and rurality on health," American Journal of Public Health, American Public Health Association, vol. 94(10), pages 1695-1703.
    3. Rao, Krishna D. & Sheffel, Ashley, 2018. "Quality of clinical care and bypassing of primary health centers in India," Social Science & Medicine, Elsevier, vol. 207(C), pages 80-88.
    4. Kotelchuck, M., 1994. "The Adequacy of Prenatal Care Utilization Index: Its US distribution and association with low birthweight," American Journal of Public Health, American Public Health Association, vol. 84(9), pages 1486-1489.
    5. Johnson, P.J. & Call, K.T. & Blewett, L.A., 2010. "The importance of geographic data aggregation in assessing disparities in American Indian prenatal care," American Journal of Public Health, American Public Health Association, vol. 100(1), pages 122-128.
    6. Warne, D. & Frizzell, L.B., 2014. "American Indian Health Policy: Historical trends and contemporary issues," American Journal of Public Health, American Public Health Association, vol. 104(S3), pages 263-267.
    7. Jaramillo, Elise Trott & Willging, Cathleen E., 2021. "Producing insecurity: Healthcare access, health insurance, and wellbeing among American Indian elders," Social Science & Medicine, Elsevier, vol. 268(C).
    8. Gauthier, Bernard & Wane, Waly, 2011. "Bypassing health providers: The quest for better price and quality of health care in Chad," Social Science & Medicine, Elsevier, vol. 73(4), pages 540-549, August.
    9. Caldwell, J.T. & Ford, C.L. & Wallace, S.P. & Wang, M.C. & Takahashi, L.M., 2016. "Intersection of living in a rural versus urban area and race/ethnicity in explaining access to health care in the United States," American Journal of Public Health, American Public Health Association, vol. 106(8), pages 1463-1469.
    10. Baldwin, L.-M. & Grossman, D.C. & Murowchick, E. & Larson, E.H. & Hollow, W.B. & Sugarman, J.R. & Freeman, W.L. & Hart, L.G., 2009. "Trends in perinatal and infant health disparities between rural American Indians and Alaska Natives and rural Whites," American Journal of Public Health, American Public Health Association, vol. 99(4), pages 638-646.
    11. Cunningham, Peter J. & Cornelius, Llewellyn J., 1995. "Access to ambulatory care for American Indians and Alaska Natives; the relative importance of personal and community resources," Social Science & Medicine, Elsevier, vol. 40(3), pages 393-407, February.
    12. Feagin, Joe & Bennefield, Zinobia, 2014. "Systemic racism and U.S. health care," Social Science & Medicine, Elsevier, vol. 103(C), pages 7-14.
    Full references (including those not matched with items on IDEAS)

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