Division of Clinical Sciences, Northern Ontario School of Medicine, Marathon, Ontario, Canada.
Division of Clinical Sciences, Northern Ontario School of Medicine, Haileybury, Ontario, Canada.
Can J Rural Med. 2022 Apr-Jun;27(2):61-68. doi: 10.4103/cjrm.cjrm_4_21.
Rural maternity care services matter. Obstetrical care in rural Canada has seen concerning trends of service closures and decreasing numbers of family physicians who predominantly provide this service. Such reductions have been shown to have a serious impact on maternal/foetal well-being.
This study investigated the present state of obstetrical services in Northern Ontario, comparing results to those of the last similar survey in 1999. All 40 Northern Ontario communities with hospitals were surveyed, as were the 16 midwife practices in the region.
: Of the 35 rural and 5 urban hospitals surveyed, the number not offering obstetrical care has risen from 37.5% in 1999 to 60% in 2020, with all the closures having been rural sites. There have been no re-openings of obstetrics in hospitals that did not offer obstetrics in 1999. Women in the 9 communities that had offered maternity services in 1999, but no longer do in 2020, now travel an average of over 1.5 h to access these services. In those communities that continue obstetrics, but stopped offering caesarean sections, women now travel 2.5 h for this surgery. Although the total number of general physicians remains at the 1999 level, the number offering intrapartum care has dropped by 65% in urban centres and by 49% in rural ones still providing maternity care.
Like much of the rural United States, rural Northern Ontario is well on its way to becoming a maternity care desert. As proven in Southern Australia, supportive government policies and programmes should be established and education reform enacted to reverse this concerning trend.
农村产妇保健服务至关重要。加拿大农村地区的产科护理服务出现了令人担忧的关闭趋势，提供该服务的家庭医生人数也在减少。事实证明，这种减少对母婴/胎儿健康有严重影响。
本研究调查了安大略省北部的产科服务现状，将结果与 1999 年的上一次类似调查进行了比较。对安大略省北部所有 40 个拥有医院的社区以及该地区的 16 个助产士诊所进行了调查。
在所调查的 35 家农村医院和 5 家城市医院中，不提供产科服务的医院数量从 1999 年的 37.5%上升到 2020 年的 60%，所有关闭的医院均为农村医院。在 1999 年不提供产科服务的医院中，没有重新开设产科。在 1999 年提供产科服务但 2020 年不再提供的 9 个社区中，妇女现在平均要行驶超过 1.5 小时才能获得这些服务。在那些仍提供产科服务但停止提供剖腹产的社区，妇女现在要行驶 2.5 小时才能进行手术。尽管普通医生的总数仍保持在 1999 年的水平，但在城市中心提供分娩护理的医生数量下降了 65%，在仍提供产妇护理的农村地区下降了 49%。
与美国大部分农村地区一样，安大略省北部农村地区正在成为产妇保健服务的沙漠。正如在澳大利亚南部所证明的那样，应制定支持性的政府政策和方案，并进行教育改革，以扭转这一令人担忧的趋势。
