Does Better Spatial Access Lead to Better Use of Prenatal Care? A Population Study in Georgia

Abstract

Understanding the effect of spatial accessibility on service utilization is essential to facilitate prenatal care delivery. Previous studies suggest that mothers with better spatial access are more likely to receive adequate prenatal care. Their conclusions, however, are limited by use of small samples and inappropriate spatial accessibility measurements. This article examines the role of spatial accessibility in explaining the variation of prenatal care utilization among 202,377 mothers in Georgia from 2009 to 2011. Specifically, we use geographic information systems and spatial analysis methods to explore the spatial pattern of inadequate prenatal care utilization. A two-transportation-mode, two-step floating catchment area method is used to measure the spatial access to prenatal care by census tract. The effects of spatial accessibility, combined with the influences of demographic, socioeconomic, behavioral, and medical factors, on the adequacy of prenatal care utilization are investigated with statistical models at the individual level. The results show that mothers with better spatial access are less likely to have adequate prenatal care. The inconsistency of this finding with other existing evidence suggests that the effects of spatial accessibility on health service utilization could be complicated and context specific.