The urban and rural divide for women giving birth in NSW, 1990-1997.
OBJECTIVE
To examine trends in the pregnancy profile and outcomes of urban and rural women.


METHODS
Data were obtained from the NSW Midwives Data Collection on births in NSW, 1990-1997. Associations between place of residence (urban/rural) and maternal factors and pregnancy outcomes were examined, including changes over time.


RESULTS
From 1990 to 1997 there were 685,631 confinements in NSW and these mothers resided as follows: 76% metropolitan, 5% large rural centres, 8% small rural centres, 11% other rural areas and 1% remote areas. Rural mothers were more likely to be teenagers, multiparous, without a married or de facto partner, public patients and smokers. Births in rural areas declined, particularly among women aged 20-34 years. Infants born to mothers in remote communities were at increased odds of stillbirth and low Apgar scores (all women) and small-for-gestational- age (SGA) (Indigenous women only).


CONCLUSIONS
The profile of pregnant women in rural NSW is different from their urban counterparts and is consistent with relative socioeconomic disadvantage and possibly suboptimal maternity services in some areas. While increased risk of SGA is associated with environmental factors such as smoking and nutrition, the reasons the increased risk of stillbirth are unclear. Although there does not appear to be an increase d risk of preterm birth for rural women this may be masked by transfer of high risk pregnancies interstate.


CONCLUSIONS
Maternity services need to be available and accessible to all rural women with targeting of interventions known to reduce low birthweight and perinatal death.
New South Wales Centre for Perinatal Health Service Research, University of Sydney. christine.roberts@perinatal.usyd.edu.au
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Algert
D000293:Adolescent; D000328:Adult; D001723:Birth Rate; D005260:Female; D006801:Humans; D009517:New South Wales / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011256:Pregnancy Outcome; D011295:Prenatal Care; D012111:Residence Characteristics; D012307:Risk Factors; D012423:Rural Health / Q000145:classification / Q000706:statistics & numerical data*; D019035:Rural Health Services / Q000600:supply & distribution; D012959:Socioeconomic Factors; D014504:Urban Health / Q000145:classification / Q000706:statistics & numerical data*