Urban–rural inequalities in spatial accessibility to prenatal care: a GIS analysis of Georgia, USA, 2000–2010

Abstract

Understanding inequalities in spatial accessibility to prenatal care over space and time is critical for policymakers to plan a more effective distribution of health resources, improve access to prenatal care, and promote maternal and infant health. However, urban–rural inequalities in spatial accessibility to prenatal care have not been well studied. Using geographic information systems and the two-transportation-mode two-step floating catchment area method, we first assess and compare the spatial variation and urban–rural inequalities of spatial accessibility to prenatal care in Georgia for years 2000 and 2010. Then we designate census-tract-based prenatal care shortage areas that have both poor spatial accessibility and high demand population in each year. The results show that, for both years 2000 and 2010, spatial accessibility to prenatal care was best in urban core areas and decreased as rurality increases. However, the differences among suburban, urban influence, and rural areas were reduced over the decade. A total of eight census tracts, most located on the fringe of metropolitan Atlanta, had a prenatal care shortage in both years. According to the results, we suggest that spatial accessibility to prenatal care in non-urban-core areas in Georgia needs more attention from policymakers.