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Availability and access in modern obstetric care: a retrospective population-based study.
H M Engjom1, N-H Morken, O F Norheim
1Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
BJOG : an International Journal of Obstetrics and Gynaecology
|November 29, 2013
Summary
Reduced obstetric institutions increased travel times and unplanned deliveries. Maternal morbidity rose unexpectedly, indicating access issues despite centralization efforts.
Area of Science:
- Public Health
- Healthcare Access
- Maternal Health
Background:
- National obstetric institution numbers decreased significantly over 30 years.
- Centralization of obstetric services raises concerns about accessibility and outcomes.
Purpose of the Study:
- To evaluate obstetric institution availability and access.
- To assess the risk of unplanned delivery outside institutions.
- To examine maternal morbidity trends in relation to institutional changes.
Main Methods:
- Retrospective population-based study using Norwegian registry data (1979-2009).
- Geographic Information Systems (GIS) for travel time analysis.
- Logistic regression to analyze changes in access and maternal morbidity.
Main Results:
- Proportion of women outside 1-hour travel zone increased (2000-2010).
- Risk of unplanned delivery outside institutions doubled (1979-2009).
- Maternal morbidity increased, with growing regional disparities.
Conclusions:
- Obstetric institution availability and access have decreased.
- Centralization did not lead to the expected reduction in maternal morbidity.
- Reduced access to obstetric care may be linked to increased maternal morbidity.
