title: Distance matters: a population based study examining access to maternity services for rural women.
abstract: BACKGROUND
  In the past fifteen years there has been a wave of closures of small maternity services in Canada and other developed nations which results in the need for rural parturient women to travel to access care. The purpose of our study is to systematically document newborn and maternal outcomes as they relate to distance to travel to access the nearest maternity services with Cesarean section capability.
  
  
  METHODS
  Study population is all women carrying a singleton pregnancy beyond 20 weeks and delivering between April 1, 2000 and March 31, 2004 and residing outside of the core urban areas of British Columbia. Maternal and newborn data was linked to specific geographic catchments by the B.C. prenatal Health Program. Catchments were stratified by distance to nearest maternity service with Cesarean section capability if greater than 1 hour travel time or level of local service. Hierarchical logistic regression was used to test predictors of adverse newborn and maternal outcomes.
  
  
  RESULTS
  49,402 cases of women and newborns resident in rural catchments were included. Adjusted odds ratios for prenatal mortality for newborns from catchments greater than 4 hours from services was 3.17 (95% CI 1.45-6.95). Newborns from catchments 2 to 4 hours, and 1 to 2 hours from services generated rates of 179 and 100 NICU 3 days per thousand births respectively compared to 42 days for newborns from catchments served by specialists.
  
  
  CONCLUSIONS
  Distance matters: rural parturient women who have to travel to access maternity services have increased rates of adverse prenatal outcomes.
authors.affiliation: Centre for Rural Health Research, Department of Family Practice, University of British Columbia, Vancouver, Canada. sgrzybow@interchange.ubc.ca
authors.forename: Stefan
authors.initials: S
authors.lastname: Grzybowski
authors.forename: Kathrin
authors.initials: K
authors.lastname: Stoll
authors.forename: Jude
authors.initials: J
authors.lastname: Kornelsen
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001955:British Columbia; D016001:Confidence Intervals; D005260:Female; D005843:Geography; D006291:Health Policy; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D009774:Obstetrics / Q000706:statistics & numerical data*; D016017:Odds Ratio; D011247:Pregnancy; D012424:Rural Population / Q000706:statistics & numerical data*; D016387:Women's Health