Top

Published in:

01-02-2021 | Care | Original Paper

Routine Healthcare Utilization Among Reproductive-Age Women Residing in a Rural Maternity Care Desert

Authors: Natalie A. DiPietro Mager, Terrell W. Zollinger, Jack E. Turman Jr, Jianjun Zhang, Brian E. Dixon

Published in: Journal of Community Health | Issue 1/2021

Abstract

It is important that women of reproductive age have access to and use routine health services to improve birth outcomes. While it is estimated that more than 5 million women in over 1000 counties across the United States live in maternity care deserts, to date there have been no published studies characterizing access and barriers to routine healthcare utilization in these areas. Therefore, a cross-sectional study was conducted in a rural county in northwest Ohio with 315 women ages 18–45 years. Health insurance coverage, usual source of care, length of time since routine check-up, and barriers to receipt of health services were assessed via a self-reported, anonymous survey. Over one-tenth (11.3%) of participants reported having no health insurance coverage. A total of 14.4% reported having no usual source of care and 22.8% reported not having a routine check-up in the past year. Just over one-half (53.0%) of participants reported having at least one barrier to accessing health care. In a logistic regression analysis, having a routine check-up in the past year was inversely associated with number of barriers (OR 0.73, 95% CI 0.56–0.95; p = 0.019); women who reported more barriers were less likely to report receipt of preventive care in the past year. The results of this study reveal that many reproductive-age women living in a maternity care desert face challenges in accessing health services. Policies and programs need to be developed and implemented to close these gaps and maximize opportunities for optimal health.

World Health Organization. (2009). Women and health: Today’s evidence, tomorrow’s agenda. Retrieved April 30, 2020, from https://apps.who.int/iris/bitstream/handle/10665/44168/9789241563857_eng.pdf?sequence=1.

Daniel, H., Erickson, S. M., & Bornstein, S. S. (2018). Women’s health policy in the United States: An American College of Physicians position paper. Annals of Internal Medicine, 168, 874–875.CrossRef

Fine, A., Kotelchuck, M., & Pies, C. (2009). A new agenda for MCH policy and programs: Integrating a life course perspective. Retrieved April 30, 2020, from https://cchealth.org/lifecourse/pdf/2009_10_policy_brief.pdf

The American College of Physicians. (1997). Comprehensive women's health care: the role and commitment of internal medicine. The American Journal of Medicine, 103(6), 451–457.CrossRef

American College of Obstetricians and Gynecologists. (2009). ACOG Committee Opinion No. 429: Health disparities for rural women. Obstetrics & Gynecology, 113(3), 762–765.

National Rural Health Association. (2013). Rural women’s health policy brief. Retrieved April 30, 2020, from https://www.ruralhealthweb.org/getattachment/Advocate/Policy-Documents/RuralWomensHealth-(1).pdf.aspx.

Rural Health Information Hub. (2019). Rural health disparities. Retrieved April 30, 2020, from https://www.ruralhealthinfo.org/topics/rural-health-disparities

Hart, L. G., Larson, E. H., & Lishner, D. M. (2005). Rural definitions for health policy and research. American Journal of Public Health, 95, 1149–1155.CrossRef

Jones C. A., Parker T. S., Ahearn M., Mishra A. K., & Variyam J. N. (2009). Health status and health care access of farm and rural populations. Retrieved April 30, 2020, from https://pdfs.semanticscholar.org/fe01/6c3006f06385bda09ad205c09850db0c9d52.pdf

10.

Rural Health Information Hub. (2019). Health care access in rural communities. Retrieved April 30, 2020, from https://www.ruralhealthinfo.org/topics/healthcare-access

11.

Wright Morton, L., & Blanchard, T. C. (2007). Starved for access: Life in rural America’s food deserts. Retrieved April 30, 2020, from https://www.iatp.org/sites/default/files/258_2_98043.pdf

12.

National Center for Health Statistics. (2012). Health, United States, 2011: With special feature on socioeconomic status and health. Retrieved April 30, 2020 from https://www.cdc.gov/nchs/data/hus/hus11.pdf.

13.

Kozhimannil, K. B., Hardeman, R. R., & Henning-Smith, C. (2017). Maternity care access, quality, and outcomes: A systems-level perspective on research, clinical, and policy needs. Seminars in Perinatology, 41(6), 367–374.CrossRef

14.

Ingram, D. D., & Franco, S. J. (2014). 2013 NCHS urban–rural classification scheme for counties. National Center for Health Statistics. Vital and Health Statistics, Series, 2(166), 1–73.

15.

March of Dimes. (2018). Nowhere to go: Maternity care deserts across the United States, Retrieved April 30, 2020, from https://www.marchofdimes.org/materials/Nowhere_to_Go_Final.

16.

Hung, P., Kozhimannil, K., Henning-Smith, C., & Casey, M. (2017). Closure of hospital obstetric services disproportionately affects less-populated rural counties. Retrieved April 30, 2020, from https://rhrc.umn.edu/wp-content/files_mf/1491501904UMRHRCOBclosuresPolicyBrief.pdf.

17.

Kozhimannil, K. B., Henning-Smith, C., Hung, P., Casey, M. M., & Prasad, S. (2016). Ensuring access to high-quality maternity care in rural America. Women’s Health Issues, 26(3), 247–250.CrossRef

18.

Kozhimannil, K. B., Hung, P., Henning-Smith, C., Casey, M. M., & Prasad, S. (2018). Association between loss of hospital-based obstetric services and birth outcomes in rural counties in the United States. Journal of the American Medical Association, 319(12), 1239–1247.CrossRef

19.

Chartis Center for Rural Health. (2020). Tracking the decline of OB access. Retrieved April 30, 2020, from https://www.ivantageindex.com/declining-access-to-ob-in-rural-communities/

20.

National Rural Health Association. (2019). Policy brief: Access to rural maternity care. Retrieved April 30, 2020, from https://www.ruralhealthweb.org/NRHA/media/Emerge_NRHA/Advocacy/Policy%2520documents/01-16-19-NRHA-Policy-Access-to-Rural-Maternity-Care.pdf

21.

Hung, P., Kozhimannil, K. B., Casey, M. M., & Moscovice, I. S. (2016). Why are obstetric units in rural hospitals closing their doors? Health Services Research, 51(4), 1546–1560.CrossRef

22.

Lorch, S., Srinivas, S. K., Ahlberg, C., & Small, D. S. (2013). The impact of obstetric unit closures on maternal and infant pregnancy outcomes. Health Services Research, 48(2 Pt 1), 455–475.CrossRef

23.

Ely, D. M., & Driscoll, A. K. (2019). Infant mortality in the United States, 2017: Data from the period linked birth/infant death file. National Vital Statistics Reports (Vol. 68, No. 10). Hyattsville, MD: National Center for Health Statistics.

24.

Grobman, W., Bailit, J. L., Rice, M. M., et al. (2015). Racial and ethnic disparities in maternal morbidity and obstetric care. Obstetrics & Gynecology, 125(6), 1460–1467.CrossRef

25.

Centers for Medicare and Medicaid Services. (2019). Maternal health care in rural communities. Retrieved April 30, 2020, from https://www.cms.gov/About-CMS/Agency-Information/OMH/equity-initiatives/rural-health/09032019-Maternal-Health-Care-in-Rural-Communities.pdf?utm_campaign=fyi_newsletter&utm_medium=email&utm_source=govdelivery&deliveryName=USCDC_277%2520-%2520DM9603.

26.

Health Resources and Services Administration. (2020). Shortage designation scoring criteria. Retrieved April 30, 2020, from https://bhw.hrsa.gov/shortage-designation/hpsas

27.

Centers for Disease Control and Prevention. (2018). Behavioral Risk Factor Surveillance System 2018 English questionnaire. Retrieved April 30, 2020, from https://www.cdc.gov/brfss/questionnaires/pdf-ques/2018_BRFSS_English_Questionnaire.pdf

28.

Hartley, D., Quam, L., & Lurie, N. (1994). Urban and rural differences in health insurance and access to care. The Journal of Rural Health, 10(2), 98–108.CrossRef

29.

Schoen, C., & Osborn, R. (2011). The Commonwealth Fund 2011 international health policy survey of sicker adults in eleven countries. Chartpack: The Commonwealth Fund.

30.

Loftus, J., Allen, E. M., Call, K. T., & Everson-Rose, S. A. (2018). Rural urban differences in access to preventive health care among publicly insured Minnesotans. The Journal of Rural Health, 34(Suppl 1), s48–s55.CrossRef

31.

MacKinney, A. C., Coburn, A., Lundblad, J., McBride, T., Mueller, K., & Watson, S. (2014). Access to rural health care: A literature review and new synthesis. Retrieved April 30, 2020, from https://www.rupri.org/Forms/HealthPanel_Access_August2014.pdf#page=9

32.

Ohio Department of Health. (2017). Ohio Pregnancy Assessment Survey 2017 English questionnaire. Retrieved April 30, 2020, from https://odh.ohio.gov/wps/portal/gov/odh/know-our-programs/ohio-pregnancy-assessment-survey-opas/questionnaires/17-english-questionnaire

33.

U.S. Census Bureau. (2019). U.S. Census Bureau quick facts: Hardin County, Ohio. Retrieved April 30, 2020, from https://www.census.gov/quickfacts/hardincountyohio

34.

Fine, A., & Kotelchuck, M. (2010). Rethinking MCH: The life course model as an organizing framework. Retrieved April 30, 2020, from https://www.hrsa.gov/sites/default/files/ourstories/mchb75th/images/rethinkingmch.pdf

35.

Johnson, K., Posner, S. F., Biermann, J., et al. (2006). Recommendations to improve preconception health and health care—United States: a report of the CDC/ATSDR Preconception Care Work Group and the Select Panel on Preconception Care. MMWR Recomm Rep, 55(RR-6), 1–23.

36.

Johnson, K., Balluf, M., Abresh, C., Verbiest, S., & Atrash, H. (2015). Summary of findings from the reconvened Select Panel on Preconception Health and Health Care. Retrieved April 30, 2020, from https://beforeandbeyond.org/wp-content/uploads/2014/03/002192_Preconception-Health-Report-Booklet_5th.pdf.

37.

Centers for Disease Control and Prevention. (2020). Pregnancy Risk Assessment Monitoring System. Retrieved April 30, 2020, from https://www.cdc.gov/prams/index.htm

Title: Routine Healthcare Utilization Among Reproductive-Age Women Residing in a Rural Maternity Care Desert
Authors: Natalie A. DiPietro Mager
Terrell W. Zollinger
Jack E. Turman Jr
Jianjun Zhang
Brian E. Dixon
Publication date: 01-02-2021
Publisher: Springer US
Keyword: Care
Published in: Journal of Community Health / Issue 1/2021
Print ISSN: 0094-5145
Electronic ISSN: 1573-3610
DOI: https://doi.org/10.1007/s10900-020-00852-6

At a glance: The STEP trials

Springer Medicine

Routine Healthcare Utilization Among Reproductive-Age Women Residing in a Rural Maternity Care Desert

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 1/2021

Promoting Community Health Worker Leadership in Policy Development: Results from a Louisiana Workforce Study

Using Implementation Science to Disseminate a Lung Cancer Screening Education Intervention Through Community Health Workers

Socio-economic and Regional Differences in Walkability and Greenspace Around Primary Schools: A Census of Australian Primary School Neighbourhoods

Systematic Review of Interventions to Increase Stool Blood Colorectal Cancer Screening in African Americans

Prevalence of Vaping and Behavioral Associations of Vaping Among a Community of College Students in the United States

Mapping Food Insecurity-Related 2-1-1 Calls in a 10-County Area of Central Texas by Zip Code: Exploring the Role of Geographic Food Access, Urbanicity and Demographic Indicators