Department of Sociology and Anthropology, Montana State University, Bozeman, Montana, USA.
Jake Jabs College of Business and Entrepreneurship, Montana State University, Bozeman, Montana, USA.
J Rural Health. 2022 Jan;38(1):151-160. doi: 10.1111/jrh.12572. Epub 2021 Mar 23.
Pregnant women across the rural United States have increasingly limited access to obstetric care, especially specialty care for high-risk women and infants. Limited research focuses on access for rural American Indian/Alaskan Native (AIAN) women, a population warranting attention given persistent inequalities in birth outcomes.
Using Montana birth certificate data (2014-2018), we examined variation in travel time to give birth and access to different levels of obstetric care (i.e., the proportion of individuals living within 1- and 2-h drives to facilities), by rurality (Rural-Urban Continuum Code) and race (White and AIAN people).
Results point to limited obstetric care access in remote rural areas in Montana, especially higher-level specialty care, compared to urban or urban-adjacent rural areas. AIAN women traveled significantly farther than White women to access care (24.2 min farther on average), even compared to White women from similarly rural areas (5-13 min farther, after controlling for sociodemographic characteristics, risk factors, and health care utilization). AIAN women were 20 times more likely to give birth at a hospital without obstetric services and had less access to complex obstetric care. Poor access was particularly pronounced among reservation-dwelling AIAN women.
It is imperative to consider racial disparities and health inequities underlying poor access to obstetric services across rural America. Current federal policies aim to reduce maternity care professional shortages. Our findings suggest that racial disparities in access to complex obstetric care will persist in Montana unless facility-level infrastructure is also expanded to reach areas serving AIAN women.
美国农村地区的孕妇获得产科护理的机会越来越有限，尤其是高危孕妇和婴儿的专科护理。针对农村美国印第安人/阿拉斯加原住民（AIAN）妇女的研究有限，鉴于在生育结果方面仍然存在不平等现象，这一人群值得关注。
利用蒙大拿州出生证明数据（2014-2018 年），我们根据农村-城市连续体代码（Rural-Urban Continuum Code）和种族（白人和 AIAN 人），研究了分娩旅行时间和获得不同水平产科护理的机会（即，居住在 1 至 2 小时车程内的个人比例）的差异。
结果表明，与城市或城市周边农村地区相比，蒙大拿州偏远农村地区的产科护理机会有限，尤其是高级专科护理。与来自类似农村地区的白人妇女相比，AIAN 妇女前往接受护理的路程明显更远（平均远 24.2 分钟），即使考虑到社会人口特征、风险因素和医疗保健利用情况也是如此。AIAN 妇女在没有产科服务的医院分娩的可能性是白人妇女的 20 倍，并且获得复杂产科护理的机会也较少。在保留地居住的 AIAN 妇女中，这种情况尤其明显。
必须考虑到美国农村地区产科服务机会不佳背后的种族差异和健康不平等问题。当前的联邦政策旨在减少产科护理专业人员的短缺。我们的研究结果表明，除非在为 AIAN 妇女提供服务的地区扩大设施基础设施以扩大获得复杂产科护理的机会，否则蒙大拿州的复杂产科护理机会的种族差异仍将持续存在。
