Closure of Labor & Delivery units in rural counties is associated with reduced adequacy of prenatal care, even when prenatal care remains available

Stephanie M Radke; Laurel Smiens; Kelli K Ryckman; Thomas S Gruca

doi:10.1111/jrh.12758

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Closure of Labor & Delivery units in rural counties is associated with reduced adequacy of prenatal care, even when prenatal care remains available

Journal article

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Closure of Labor & Delivery units in rural counties is associated with reduced adequacy of prenatal care, even when prenatal care remains available

Stephanie M Radke, Laurel Smiens, Kelli K Ryckman and Thomas S Gruca

The Journal of rural health, Vol.39(4), pp.746-755

Autumn 2023

DOI: 10.1111/jrh.12758

PMID: 36999217

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Abstract

Closure of rural Labor & Delivery (L&D) units can impact timely access to hospital-based obstetrical care. Iowa has lost over a quarter of its L&D units in the previous decade. Assessing the effect of these closures on prenatal care in those rural communities is important to understanding the full effect of unit closures on maternal health care. Using birth certificate data in Iowa from 2017 to 2019, the initiation of prenatal care and adequacy of prenatal visits were assessed for 47 rural counties in Iowa. Of these, 7 experienced a closure of the only L&D unit between 1/1/2018 and 1/1/2019. The impact of these closures is modeled for all birthing parents and compared for Medicaid versus non-Medicaid recipients. All 7 counties that experienced the loss of their only L&D unit continued to have prenatal care services available. Experiencing a closure of an L&D unit was associated with a lower likelihood of overall adequate prenatal care but not significantly associated with a lower rate of first-trimester prenatal care utilization. Among Medicaid recipients of the communities where an L&D unit closed, there was an association of closure with both a lower likelihood of adequate prenatal care and entry to prenatal care after the first trimester. Utilization of prenatal care is lower in rural communities following L&D unit closure, especially among Medicaid recipients. This suggests that the overall maternal health systems were disrupted by the closure of the L&D unit, impacting the utilization of services that remained available to the community.

Prenatal Care

rural

birth certificate

labor and delivery closure

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Details

Title: Subtitle: Closure of Labor & Delivery units in rural counties is associated with reduced adequacy of prenatal care, even when prenatal care remains available
Creators: Stephanie M Radke - Department of Obstetrics & Gynecology, University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA
Laurel Smiens - Department of Internal Medicine, University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA
Kelli K Ryckman - University of Indiana School of Public Health, Iowa City, Iowa, USA
Thomas S Gruca - University of Iowa
Resource Type: Journal article
Publication Details: The Journal of rural health, Vol.39(4), pp.746-755
DOI: 10.1111/jrh.12758
PMID: 36999217
NLM abbreviation: J Rural Health
ISSN: 0890-765X
eISSN: 1748-0361
Publisher: Wiley
Language: English
Electronic publication date: 03/30/2023
Date published season: Autumn 2023
Date published: 2023
Academic Unit: Marketing; Epidemiology; Obstetrics and Gynecology
Record Identifier: 9984381026702771

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