title: Perinatal health inequalities and accessibility of maternity services in a rural French region: closing maternity units in Burgundy.
abstract: Maternity unit closures in France have increased travel time for pregnant women in rural areas. We assessed the impact of travel time to the closest unit on perinatal outcomes and care in Burgundy using multilevel analyses of data on deliveries from 2000 to 2009. A travel time of 30min or more increased risks of fetal heart rate anomalies, meconium-stained amniotic fluid, out-of-hospital births, and pregnancy hospitalizations; a positive but non-significant gradient existed between travel time and perinatal mortality. The effects of long travel distances on perinatal outcomes and care should be factored into closure decisions.
authors.affiliation: Centre d'épidémiologie et de santé publique Bourgogne (EA4184). Faculté de Médecine, Dijon, France. Electronic address: evelyne.combier@orange.fr.
authors.forename: Evelyne
authors.initials: E
authors.lastname: Combier
authors.forename: Hélène
authors.initials: H
authors.lastname: Charreire
authors.forename: Marc
authors.initials: M
authors.lastname: Le Vaillant
authors.forename: Francis
authors.initials: F
authors.lastname: Michaut
authors.forename: Cyril
authors.initials: C
authors.lastname: Ferdynus
authors.forename: Jeanne-Marie
authors.initials: JM
authors.lastname: Amat-Roze
authors.forename: Jean-Bernard
authors.initials: JB
authors.lastname: Gouyon
authors.forename: Catherine
authors.initials: C
authors.lastname: Quantin
authors.forename: Jennifer
authors.initials: J
authors.lastname: Zeitlin
mesh_terms: D000293:Adolescent; D000328:Adult; D016208:Databases, Factual; D005260:Female; D005602:France / Q000453:epidemiology; D006271:Health Facility Closure; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D008427:Maternal Health Services / Q000600:supply & distribution*; D008499:Medical Records; D008875:Middle Aged; D018743:Perinatal Care; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D019035:Rural Health Services / Q000600:supply & distribution; D055815:Young Adult
keywords: Accessibility; Maternity services; Perinatal health; Rural region; Travel time