Relation of infant mortality to the availability of maternity care in rural Florida.

Abstract

This cross-sectional study was designed to explore the impact of the availability of maternity care services on the infant mortality rates in nonmetropolitan (rural) counties in Florida. We evaluated the sufficiency of physicians providing maternity care in each rural county. We then constructed a mathematical model to compare physician availability with the infant mortality rates for each county, while controlling for socioeconomic variables. Thirty-one family physicians and 974 obstetrician-gynecologists were delivering babies in Florida in 1991. Forty-seven counties were lacking in maternity care services; 45 of these counties had family physicians who practiced in the county but did not provide maternity care services. There was a negative correlation in rural counties between availability of maternity care services and infant mortality (R = -0.42, R2 = 0.176, P = 0.012), implying that 17.6 percent of the variation in rural Florida's infant mortality was explained by a ranking in physician availability. Multivariate analysis revealed that increasing infant death rates can be predicted by decreasing physician availability (P = 0.003). A multiplicative risk model developed for this study demonstrated that the loss of 1 family physician delivering babies would predict the increase of infant mortality by 2.3 percent, and the loss of 1 obstetrician-gynecologist increased infant mortality by 9.6 percent. Access to maternity care for women in rural Florida is a problem that could be hampering Florida's ability to reduce its infant mortality rate. Family physicians appear to be the most geographically distributed health care providers in Florida; therefore, strategies should be developed to recruit Florida's rural family physicians into maternity care.