Patterns of obstetrical care in single-hospital, rural counties

This study used logistic regression to identify differences in community-level characteristics of small, rural hospitals that provided obstetrical services compared to those that did not. The hypothesis was that community characteristics, such as demographics, geographic location, and socioeconomic status influence the ability of rural hospitals to sustain obstetrical services locally. The sample included small (fewer than 100 beds) non-federal, general, acute-care hospitals that were the only hospitals in their nonmetropolitan counties with fewer than 50,000 people in 1989 (n = 963). Data came from the Area Resource File and the American Hospital Association 1989 Survey. The results suggest that: 1) hospitals in the South are much less likely to offer obstetrical services; 2) hospitals in counties with higher socioeconomic status, measured by unemployment rate and percentage of the population who are white, have an increased likelihood of providing obstetrics; 3) hospital ownership has a relatively strong association with the provision of obstetrical services; and 4) the same characteristics that predict a hospital has obstetrical services do a poor job at predicting which hospitals do not offer those services. These results encourage researchers to examine areas where hospitals do not provide obstetrical care, and to investigate the dynamic between community characteristics and provider and consumer behavior. This study suggests to policymakers that targeting vulnerable communities and promoting regional and alternative modes of delivering obstetrical services may be effective means to ensuring that rural women have equitable access to obstetrical care.