Access to Obstetric Care and Perinatal Outcomes in the Rural United States: A Systematic Review

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  • July 18, 2019
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  • Myrick, Katie
    • Gillings School of Global Public Health
Abstract
  • Background: Women and infants who live in rural areas of the US experience higher rates of morbidity and mortality compared to their peers living urban areas. Limited availability of maternity care in non-metropolitan regions may contribute to this disparity. The present systematic review examined the relationship between access to care and maternal and infant outcomes in rural parts of the United States. Methods: A thorough search of PUBMED was conducted to identify articles addressing the association between access to obstetric care and outcomes in rural areas of the US. Study selection, data extraction, risk of bias assessment, and quality assessment were performed by a single reviewer. Results: Fourteen observational studies met inclusion criteria. Eleven of the studies reported an adverse relationship between poor access to care and perinatal outcomes in rural areas. Two studies reported no significant association. One study reported that a decline in locally available services was associated with better outcomes. Studies used heterogeneous measures for access to care and category of rural residence, and many studies had methodological limitations, such as inadequately addressing known confounders. As a result, conclusions about the true effects of access to care on outcomes were limited. Conclusion: The evidence from this review suggests that shortages or declines in obstetric care in the rural US are associated with poorer outcomes. While one article addressed this trend on the national level, further studies of such magnitude are needed to strengthen the evidence base.
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  • In Copyright
Advisor
  • Feltner, Cynthia
    • Gillings School of Global Public Health
  • Chetwynd, Ellen
    • School of Medicine, Department of Family Medicine
Degree
  • Master of Public Health
Graduation year
  • 2019
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