Maternity Care Deserts and Pregnancy-Associated Mortality in Louisiana
Maternal mortality is an issue of growing concern in the United States, where the incidence of death during pregnancy and postpartum seems to be increasing. The purpose of this analysis was to explore whether residing in a maternity care desert (defined as a county with no hospital offering obstetri...
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| Published in: | Women's health issues Vol. 31; no. 2; pp. 122 - 129 |
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| Main Authors: | , , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
United States
Elsevier Inc
01-03-2021
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| Subjects: | |
| Online Access: | Get full text |
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| Summary: | Maternal mortality is an issue of growing concern in the United States, where the incidence of death during pregnancy and postpartum seems to be increasing. The purpose of this analysis was to explore whether residing in a maternity care desert (defined as a county with no hospital offering obstetric care and no OB/GYN or certified nurse midwife providers) was associated with risk of death during pregnancy and up to 1 year postpartum among women in Louisiana from 2016 to 2017.
Data provided by the March of Dimes were used to classify Louisiana parishes by level of access to maternity care. Using data on all pregnancy-associated deaths verified by the Louisiana Department of Health (n = 112 from 2016 to 2017) and geocoded live births occurring in Louisiana during the same time period (n = 101,484), we fit adjusted modified Poisson regression models with generalized estimating equations and exploratory spatial analysis to identify significant associations between place of residence and risk of death.
We found that the risk of death during pregnancy and up to 1 year postpartum owing to any cause (pregnancy-associated mortality) and in particular death owing to obstetric causes (pregnancy-related mortality) was significantly elevated among women residing in maternity care deserts compared with women in areas with greater access (adjusted risk ratio [aRR] for pregnancy-associated mortality, 1.91; 95% confidence interval [CI], 1.15–3.18; aRR for pregnancy-related mortality, 3.37; 95% CI, 1.71–6.65). A large racial inequity in risk persisted above and beyond differences in geographic access to maternity care (non-Hispanic Black vs. non-Hispanic White aRR for pregnancy-associated mortality, 2.22; 95% CI, 1.39–3.56; aRR for pregnancy-related mortality, 2.66; 95% CI, 1.16–6.12).
Ensuring access to maternity care may be an important step toward maternal mortality prevention, but may alone be insufficient for achieving maternal health equity. |
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| Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Erica Felker-Kantor is a doctoral student at Tulane University School of Public Health and Tropical Medicine. Erica’s work applies innovative geospatial and network-centric methods to contextualize health outcomes. Dovile Vilda is a postdoctoral fellow with the Mary Amelia Community Women’s Health Education Center at Tulane University. She has expertise in qualitative and quantitative methods with interests in social policy and health and conducting ethical research with vulnerable populations. Jia Benno is a mortality surveillance epidemiologist at the Bureau of Family Health, Louisiana Department of Health. Emily Harville is a perinatal epidemiologist and associate professor at Tulane University School of Public Health and Tropical Medicine. Her research focuses on how pregnancy and reproduction relate to health throughout the life course, including the biological mechanisms underlying health disparities. Maeve Wallace is an assistant professor at Tulane University School of Public Health and Tropical Medicine. Her research interests include the social, structural, and policy determinants of maternal and child health and health inequities. Lauren Dyer is a research analyst with the Mary Amelia Community Women’s Health Education Center at Tulane University. She is interested in how on mass incarceration and criminal justice influence to maternal and child population health. Katherine Theall, the Cecile Usdin Professor and director of the Mary Amelia Community Women’s Health Education Center, at Tulane University School of Public Health and Tropical Medicine. Her research focuses on policy and community influences on population health disparities. |
| ISSN: | 1049-3867 1878-4321 |
| DOI: | 10.1016/j.whi.2020.09.004 |