OB/GYN Accessibility and Maternal-Infant Health Outcomes

Kalamazoo County, Michigan is an urban-rural county with high rates of gestational diabetes among expectant mothers and high disparities in the quality of birth outcomes among its population segments. Analysis of health outcomes in the county has primarily focused on densely populated areas of low socioeconomic status.  However, Kalamazoo County, as well as 77% of counties in the US, has a clear urban to rural continuum. Because women without appropriate access to healthcare during particular stages of pregnancy have poorer outcomes than women with regular access to care, this paper examines the disparities in transportation network accessibility by public transit and private vehicle in terms of travel time. Cases of gestational diabetes, hypertension, sexually transmitted infection, low birthweight infants and premature births for Kalamazoo County, were retrieved from 2011-13 Michigan birth records. Open Trip Planner and Google Maps JavaScript API were used to estimate travel time from census block centroids to obstetric/gynecological (OB/GYN) and family health center services by both public vehicle and private transit.  Principal components analysis was used to reduce 36 accessibility variables into 9 components for each census block, 5 representing accessibility to OB/GYNs and 4 to family health centers.  30 minute transit access and rural-ness of the block were components comment to both types of facilities. Perinatal outcomes were consistently related to transportation accessibility.  This study has implications for Kalamazoo County health, but also the health of other urban-rural counties across the country with similar vulnerable populations.