The distribution of maternity services across rural and remote Australia: does it reflect population need?

Rolfe, Margaret I., Donoghue, Deborah Anne, Longman, Jo M., Pilcher, Jennifer, Kildea, Sue, Kruske, Sue, Kornelsen, Jude, Grzybowski, Stefan, Barclay, Lesley and Morgan, Geoffrey Gerard (2017) The distribution of maternity services across rural and remote Australia: does it reflect population need?. BMC Health Services Research, 17 1: . doi:10.1186/s12913-017-2084-8

Author Rolfe, Margaret I.
Donoghue, Deborah Anne
Longman, Jo M.
Pilcher, Jennifer
Kildea, Sue
Kruske, Sue
Kornelsen, Jude
Grzybowski, Stefan
Barclay, Lesley
Morgan, Geoffrey Gerard
Title The distribution of maternity services across rural and remote Australia: does it reflect population need?
Journal name BMC Health Services Research   Check publisher's open access policy
ISSN 1472-6963
Publication date 2017-02-23
Sub-type Article (original research)
DOI 10.1186/s12913-017-2084-8
Open Access Status DOI
Volume 17
Issue 1
Total pages 13
Place of publication London, United Kingdom
Publisher BioMed Central
Language eng
Formatted abstract
Background: Australia has a universal health care system and a comprehensive safety net. Despite this, outcomes for Australians living in rural and remote areas are worse than those living in cities. This study will examine the current state of equity of access to birthing services for women living in small communities in rural and remote Australia from a population perspective and investigates whether services are distributed according to need.

Methods: Health facilities in Australia were identified and a service catchment was determined around each using a one-hour road travel time from that facility. Catchment exclusions: metropolitan areas, populations above 25,000 or below 1,000, and a non-birthing facility within the catchment of one with birthing. Catchments were attributed with population-based characteristics representing need: population size, births, demographic factors, socio-economic status, and a proxy for isolation - the time to the nearest facility providing a caesarean section (C-section). Facilities were dichotomised by service level - those providing birthing services (birthing) or not (no birthing). Birthing services were then divided by C-section provision (C-section vs no C-section birthing). Analysis used two-stage univariable and multivariable logistic regression.

Results: There were 259 health facilities identified after exclusions. Comparing services with birthing to no birthing, a population is more likely to have a birthing service if they have more births, (adjusted Odds Ratio (aOR): 1.50 for every 10 births, 95% Confidence Interval (CI) [1.33-1.69]), and a service offering C-sections 1 to 2 h drive away (aOR: 28.7, 95% CI [5.59-148]). Comparing the birthing services categorised by C-section vs no C-section, the likelihood of a facility having a C-section was again positively associated with increasing catchment births and with travel time to another service offering C-sections. Both models demonstrated significant associations with jurisdiction but not socio-economic status.

Conclusions: Our investigation of current birthing services in rural and remote Australia identified disparities in their distribution. Population factors relating to vulnerability and isolation did not increase the likelihood of a local birthing facility, and very remote communities were less likely to have any service. In addition, services are influenced by jurisdictions.
Keyword Catchment area (health)
Geographic information systems
Health services research
Healthcare disparities
Maternity Hospitals
Rural health services
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Mater Research Institute-UQ (MRI-UQ)
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School of Nursing, Midwifery and Social Work Publications
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Citation counts: TR Web of Science Citation Count  Cited 2 times in Thomson Reuters Web of Science Article | Citations
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Created: Tue, 14 Mar 2017, 00:24:17 EST by System User on behalf of Learning and Research Services (UQ Library)