Higher-Level Neonatal and Obstetric/Well-Infant Care Access in Rural Communities

This project will build on our dataset on maternity care access, which now includes neonatal care at U.S. hospitals. It will describe access to childbirth-related care for families living in rural communities, with a focus on neonatal care for infants with acute clinical needs. While basic well-infant care is routinely provided in conjunction with basic obstetric care, this project will examine access to higher-level neonatal care, which provides specialty care to infants with unexpected complications or conditions immediately after birth. Understanding the availability of higher-level neonatal care for rural communities compared with urban communities is not yet known. Additionally, recognizing the factors that predict whether a rural community has access to higher-level neonatal care can help inform clinical and policy efforts to ensure availability and access to essential, life-saving infant care at the time of childbirth.

This project seeks to identify and describe:

1. Characteristics of rural and urban counties with and without access to higher-level neonatal care
2. Mapping rural and urban counties with a) no obstetric/well-infant and no higher-level neonatal care, b) obstetric/well-infant but no higher-level neonatal care, or c) both obstetric/well-infant and higher-level neonatal care
3. Independent predictors of discordance in level of obstetric/well-infant and neonatal care available in rural counties

Despite the interdependence of neonatal and obstetric services, a comprehensive examination of access to basic and/or specialty childbirth-related hospital-based care is lacking. This project's goal is to describe access to childbirth-related care for families living in rural and urban communities, including attention to rural communities without access to either neonatal or obstetric services, and those communities with obstetric and well-infant care, but without higher-level neonatal care.