Peiyin Hung (
Carrie E. Henning-Smith is a research associate at the Rural Health Research Center, University of Minnesota School of Public Health.
Health Aff (Millwood). 2017 Sep 1;36(9):1663-1671. doi: 10.1377/hlthaff.2017.0338.
Recent closures of rural obstetric units and entire hospitals have exacerbated concerns about access to care for more than twenty-eight million women of reproductive age living in rural America. Yet the extent of recent obstetric unit closures has not yet been measured. Using national data, we found that 9 percent of rural counties experienced the loss of all hospital obstetric services in the period 2004-14. In addition, another 45 percent of rural US counties had no hospital obstetric services at all during the study period. That left more than half of all rural US counties without hospital obstetric services. Counties with fewer obstetricians and family physicians per women of reproductive age and per capita, respectively; a higher percentage of non-Hispanic black women of reproductive age; and lower median household incomes and those in states with more restrictive Medicaid income eligibility thresholds for pregnant women had higher odds of lacking hospital obstetric services. The same types of counties were also more likely to experience the loss of obstetric services, which highlights the challenge of providing adequate geographic access to obstetric care in vulnerable and underserved rural communities.
最近农村产科单位和整个医院的关闭，加剧了人们对美国农村地区超过 2800 万育龄妇女获得医疗服务的关注。然而，最近产科单位关闭的程度尚未得到衡量。利用国家数据，我们发现，在 2004 年至 2014 年期间，有 9%的农村县失去了所有医院的产科服务。此外，在研究期间，还有另外 45%的农村县根本没有医院产科服务。这使得超过一半的农村县没有医院产科服务。每个育龄妇女和每千人中妇产科医生和家庭医生较少的县；非西班牙裔黑人育龄妇女比例较高；以及中等家庭收入较低和在孕妇医疗补助收入资格门槛较严格的州的县，缺乏医院产科服务的可能性更大。同样类型的县也更有可能失去产科服务，这突显了在脆弱和服务不足的农村社区提供足够的地理上获得产科护理的挑战。
