Females in rural areas less likely to have OB/GYN appointments

Females aged 15 to 44 years living in rural areas were significantly less likely than their urban counterparts to have had an office visit with a physician, including OB/GYNs, a 10-year pooled analysis showed.

According to HHS, approximately 700 women in the United States die annually from a pregnancy-related complication. The CDC estimates that two out of three pregnancy-related deaths are preventable.

In the latest study, Hyunjung Lee, PhD, MS, MPP, MBA, a fellow at the Oak Ridge Institute for Science and Education in Tennessee, and colleagues reviewed data from the Medical Expenditure Panel Survey from 2006 to 2015. They merged these data with 2010 rural–urban commuting area codes for 52,190 females of reproductive age. Of that total, 4,817 lived in rural areas.

In an adjusted analysis, females in rural areas were more likely to report having a usual source of care (4.9 percentage points; 95% CI, 2.1-7.7 percentage points) and were slightly less likely to experience delayed care (–1.3 percentage points; 95% CI, –2.5 to –0.2 percentage points). The researchers did not observe any rural-urban differences in reports of uninsured status (2 percentage points; 95% CI, –0.2 to 4.1 percentage points) and unmet care needs (–0.2 percentage points; 95% CI, –1.1 to 0.8 percentage points).

However, Lee and colleagues said it is “unlikely” that females in rural areas have “equivalent or better access to care than urban women.” Results showed that females in rural areas were overall less likely to report having had any physician visits (–4.2 percentage points; 95% CI, -6.9 to –1.6 percentage points) and any OB/GYN visits (–3.3 percentage points; 95% CI, –5.9 to –0.8 percentage points).

“Clinicians serving women of reproductive age need to optimally engage these women in continuous prenatal and perinatal care, actively work to mitigate comorbidities putting these women at higher mortality risk and refer their patients as appropriate to specialized providers and facilities that are well-equipped to handle their complex health care needs,” Lee told Healio Primary Care.

“Rural providers in particular need to ensure that every visit they have with a woman considering pregnancy, or who is currently pregnant, is as meaningful and impactful as possible,” she continued.

Lee noted that since the study’s completion, the U.S. Surgeon General Jerome M. Adams, MD, MPH, released a call to action on ways to improve maternal health that outlines other clinical recommendations, such as:

• increasing knowledge, awareness and use of tools from organizations such as the U.S. Preventive Services Task Force and Women’s Preventive Services;
• enhancing self and situational awareness of and attention to disparities;
• listening to women and their family members’ concerns before, during and after delivery; and
• recording and monitoring patient’s vital signs across the lifespan.

“The health of our nation depends on the health of our mothers,” Adams said in a press release. “A mother or mother-to-be dies every 12 hours in the U.S. These tragedies are unacceptable.” 

References

HHS. The surgeon general’s call to action to improve maternal health. https://www.hhs.gov/sites/default/files/call-to-action-maternal-health.pdf. Accessed December 4, 2020.

HHS. HHS Outlines New Plans and a Partnership to Reduce U.S. Pregnancy-related Deaths. https://www.hhs.gov/about/news/2020/12/03/hhs-outlines-new-plans-to-reduce-us-pregnancy-related-deaths.html. Accessed December 14, 2020.