Recent research has shown that more than half of U.S. rural counties no longer have hospitals where women can give birth, leaving thousands of pregnant women in outlying areas with few options for obstetric care. Delving deeper into the issue, a new study from the School of Public Health shows that those women also often have to travel great distances for obstetric services, and mothers from vulnerable populations — such as those who are uninsured or on Medicaid — typically have to travel the furthest of all.

“Understanding residential proximity to obstetric care is particularly important among vulnerable populations,” says the study’s lead author, Peiyin Hung (PhD ’17). “Rural women and low-income families can have a harder time traveling to far away hospitals due to lack of local public transportation options. That travel burden can place them at risk for unnecessary obstetric procedures, like scheduled c-sections or inductions.”

The study was published in the Journal of Perinatology.

“Our study showed that, overall, the uneven geographic distribution of hospital obstetric care capacity in the United States increased from 2002 to 2013,” says Hung. “What is even more striking is that women who had to travel farther to reach the nearest hospital for obstetric care in 2002 faced disproportionate increasing distances between 2002-2013.”

According to Hung, by 2013, the distance from a rural pregnant woman’s home to the nearest hospital with an obstetric unit grew to as high as 143 miles — and the distance to the nearest advanced neonatal care unit was up to 190 miles. In contrast, most urban women lived within 10 miles of the nearest hospital offering obstetric care and less than one percent lived more than 30 miles away.

The problem was worst for women with Medicaid coverage at the time of childbirth and those who were uninsured, who the study showed lived farther from hospitals with obstetric care than privately insured women.

Hung said that state Medicaid programs and federal, state, and local public health agencies can — through coordinated efforts — ensure that these growing gaps in obstetric care proximity do not compromise maternal and child health.

“Policy measures may include efforts to identify obstetric care shortage areas, improve transportation options, and regionally coordinate perinatal services,” says Hung.

Hung also believes that the situation can be helped by providing pregnant women in rural areas with comprehensive pregnancy and birth information along with opportunities to develop well-rehearsed plans for labor and transport, and understand the capability of the nearest hospital to respond to emergencies.

Hung is continuing her exploration of this issue by examining how increases in the distance between rural communities and hospitals offering perinatal care relates to recent high-profile obstetric unit closures, and how the obstetric care proximity relates to maternal and birth outcomes.