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Geographic Access to Early Pregnancy Loss Management.

Jamie W Krashin1, Patricia Black, Eric Brannen

  • 1Department of Obstetrics and Gynecology, the Department of Geography and Environmental Studies, and the Department of Emergency Medicine, University of New Mexico, Lovelace Medical Center, and the Department of Economics, Applied Statistics, and International Business, New Mexico State University, Albuquerque, New Mexico; and the Department of Obstetrics & Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania.

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Summary

Access to early pregnancy loss (EPL) treatments like mifepristone and uterine aspiration is limited, especially in rural and deprived areas of New Mexico. Improving access to these essential EPL management options is crucial for equitable patient care.

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Area of Science:

  • Reproductive Health
  • Geospatial Analysis
  • Healthcare Access

Background:

  • Early pregnancy loss (EPL) management options, including medication (mifepristone/misoprostol) and procedural (uterine aspiration) methods, face accessibility barriers for patients.
  • Effective EPL management is critical, yet disparities exist in accessing timely and appropriate care.

Purpose of the Study:

  • To analyze geospatial access to mifepristone, misoprostol, and uterine aspiration for early pregnancy loss (EPL) management in New Mexico.
  • To identify factors associated with disparities in EPL treatment access, including rurality, area deprivation, race, and ethnicity.

Main Methods:

  • Cross-sectional geospatial analysis of hospital-based EPL management options in New Mexico.
  • Data collected via hospital key informants and public databases (October 2020 - August 2021).
  • Logistic regression used to assess associations between access (defined as ≤60-minute car commute) and demographic/geographic factors.

Main Results:

  • Only 5.7% of responding hospitals offered comprehensive EPL management (mifepristone/misoprostol and aspiration).
  • 68.6% of hospitals provided uterine aspiration for EPL.
  • Lower adjusted odds of access for both comprehensive management and aspiration were observed in rural and higher deprivation areas.

Conclusions:

  • Significant disparities in access to effective early pregnancy loss (EPL) treatments exist, particularly impacting rural and underserved populations in New Mexico.
  • Implementation of mifepristone and uterine aspiration services is essential to address these access gaps and improve equitable EPL care.
  • Geospatial analysis highlights the need for targeted interventions to improve healthcare access for early pregnancy loss management.