Effects of Obstetric Unit Closures on Maternity Care Access and Delivery Outcomes

• In Event: Access to Health Care

Abstract

Wide disparities exist in maternity care access and in maternal and infant health outcomes, and closures of obstetric units may exacerbate these disparities. Existing estimates of maternity care access and effects of obstetric unit closures frequently use county-level data, which mask heterogeneity within counties, including among different racial and ethnic populations. In Illinois, non-Hispanic Black and Hispanic individuals are more likely to experience nearby obstetric unit closures than non-Hispanic White individuals. We first show that local measures of maternity care access at the ZIP Code level more precisely capture changes in birthing hospital access -- such as among racial and ethnic populations in the City of Chicago -- than county-level birthing hospital access measures. We then investigate the causal effects of Illinois obstetric unit closures using event study methods. Nearby obstetric unit closures increase travel times to chosen delivery hospitals on average for these three racial and ethnic groups. After nearby obstetric unit closures, individuals are more likely to deliver at obstetric units offering higher levels of perinatal care on average. Finally, we do not find significant effects of nearby obstetric unit closures on maternal and infant health outcomes at delivery, including preterm births, low-risk Cesarean deliveries, and severe maternal morbidity, on average. While obstetric unit closures increase disparities in maternity care access, our results suggest that reducing or preventing obstetric unit closures alone might not substantially improve delivery health outcomes and underscore the need for other types of policies to address disparities in maternal and infant health outcomes.

Author

• Jennifer Helen Kwok, University of Illinois, Chicago
  Presenting Author