Health care use and health consequences of geographic lack of access to abortion and maternity care.

BACKGROUND: Recent years have brought substantial declines in geographic access to abortion facilities and maternity care across the US. The purpose of this study was to identify the reproductive health consequences of living in a county without access to comprehensive reproductive health care services. METHODS: We analyzed National Center for Health Statistics data on all live births occurring in the US in 2020. We used data on locations of abortion facilities and availability of maternity care in order to classify counties by level of access to comprehensive reproductive health care services and defined comprehensive reproductive health care deserts as counties that did not have an abortion facility in the county or in any neighboring county and did not have any maternity care practitioners. We fit modified Poisson regression models with generalized estimating equations to estimate the degree to which living in a comprehensive reproductive health care desert was associated with receipt of timely and adequate prenatal care and risk of preterm birth, controlling for individual-level and county-level characteristics. RESULTS: In 2020, one third of counties in the US were comprehensive reproductive health care deserts (n = 1082), and 136,272 births occurred in these counties. In adjusted models, there was no difference in prenatal health care use (timeliness or adequacy of care) between persons in comprehensive reproductive health care deserts and those with full access to care, but the risk of preterm birth was significantly elevated (aRR =1.09, 95% CI = 1.06, 1.13). CONCLUSIONS: Lack of access to comprehensive reproductive health care services may increase the incidence of preterm birth.

Association between smoking cessation interventions during prenatal care and postpartum relapse: results from 2004 to 2008 multi-state PRAMS data.

Cigarette smoking is a serious global public health issue, and is particularly harmful to the maternal and child population. The study aimed to determine if there was an association between smoking cessation intervention during pregnancy and postpartum smoking relapse, and to define a time trend of postpartum smoking relapse after delivery. Data from the 2004-2008 pregnancy risk assessment monitoring systems of Colorado, Maine, Ohio, and Washington were analyzed. Logistic regression was used to define the association between smoking cessation intervention and postpartum smoking relapse, and to identify trend of postpartum smoking relapse. Analyses were done using SAS-Callable SUDAAN v.10.0 and Mplus v.6.0. Among the 2,938 women in the study the relapse rate was 48 %. It was 45 % among those without intervention, 58 % among those who received only counseling, and 57 % among those who received both counseling with treatment and/or referral. The rate was 42, 61, and 67 % among women whose infants were at 2-3, 4-5, and 6 months or more, respectively. Adjusted logistic regression models showed a trend of increased smoking relapse, but did not indicate an association between smoking cessation intervention and smoking relapse. Rates of smoking relapse were high and increased by time after delivery. Smoking cessation intervention during pregnancy may not be successful at preventing postpartum smoking relapse.

Infant secondhand smoke exposure in Louisiana, 1998-2004: trend and high risk population.

PURPOSES: To evaluate the trend of infant secondhand smoke exposure (ISHSE) at home from 1998 to 2004 and define high risk infants exposed to secondhand smoke. METHODS AND SUBJECTS: 1998-2004 Louisiana Pregnancy Risk Assessment Monitoring System data were used. Logistic regression was applied to determine the trend of ISHSE and define variables associated with ISHSE. RESULTS: Adjusted annual percent increase of odds of ISHSE was 9.0% (p = .0020) among blacks. Adjusted annual percent decrease of odds of ISHSE was 5.0% (p = .0084) among whites. Adjusted odds of ISHSE was higher among women with characteristics as follows: currently smoked, age < 20 years, < high school education, unmarried, never breastfed their infants, had term delivery or deliveries paid for by Medicaid. CONCLUSIONS: Prevalence of ISHSE increased in blacks and decreased in whites between 1998 and 2004. Smoking status, maternal age, education, marital status, delivery payment source, delivery status, and breastfeeding status were associated with ISHSE.