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Thorsen ML, Harris S, McGarvey R, et al. Evaluating disparities in access to obstetric services for American Indian women across Montana. J Rural Health. 2021;38(1):151-160doi: 10.1111/jrh.12572.
Thorsen, M. L., Harris, S., McGarvey, R., Palacios, J., & Thorsen, A. (2022). Evaluating disparities in access to obstetric services for American Indian women across Montana. The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association, 38(1), 151-160. https://doi.org/10.1111/jrh.12572
Thorsen, Maggie L, et al. "Evaluating disparities in access to obstetric services for American Indian women across Montana." The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association vol. 38,1 (2022): 151-160. doi: https://doi.org/10.1111/jrh.12572
Thorsen ML, Harris S, McGarvey R, Palacios J, Thorsen A. Evaluating disparities in access to obstetric services for American Indian women across Montana. J Rural Health. 2022 Jan;38(1):151-160. doi: 10.1111/jrh.12572. Epub 2021 Mar 23. PMID: 33754411; PMCID: PMC8458487.
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J Rural Health. 2022 Jan;38(1):151-160. doi: 10.1111/jrh.12572. Epub 2021 Mar 23.

Evaluating disparities in access to obstetric services for American Indian women across Montana.

The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association

Maggie L Thorsen, Sean Harris, Ronald McGarvey, Janelle Palacios, Andreas Thorsen

Affiliations

  1. Department of Sociology and Anthropology, Montana State University, Bozeman, Montana, USA.
  2. Jake Jabs College of Business and Entrepreneurship, Montana State University, Bozeman, Montana, USA.
  3. Department of Industrial and Manufacturing Systems Engineering and Truman School of Public Affairs, University of Missouri, Columbia, Missouri, USA.
  4. Department of Obstetrics and Gynecology, Kaiser Permanente Northern California, Oakland, California, USA.

PMID: 33754411 PMCID: PMC8458487 DOI: 10.1111/jrh.12572

Abstract

PURPOSE: 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.

METHODS: 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).

FINDINGS: 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.

CONCLUSIONS: 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.

© 2021 National Rural Health Association.

Keywords: American Indians; driving time; health care access; obstetrics; rural perinatal care

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