J Korean Med Sci.
2019 Jan;34(1):e8. 10.3346/jkms.2019.34.e8.
Accessibility of Prenatal Care Can Affect Inequitable Health Outcomes of Pregnant Women Living in Obstetric Care Underserved Areas: a Nationwide Population-Based Study
- Affiliations
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- 1Center for Public Health, National Medical Center, Seoul, Korea.
- 2Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.
- 3Department of Preventive Medicine, Chungnam National University School of Medicine, Daejeon, Korea.
- 4Public Health Medical Service, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea. jylee2000@gmail.com
- 5Institute of Health Policy and Management, Medical Research Center, Seoul National University, Seoul, Korea.
- 6Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea.
- KMID: 2447047
- DOI: http://doi.org/10.3346/jkms.2019.34.e8
Abstract
- BACKGROUND
As of 2011, among 250 administrative districts in Korea, 54 districts did not have obstetrics and gynecology clinics or hospitals providing prenatal care and delivery services. The Korean government designated 38 regions among 54 districts as "Obstetric Care Underserved Areas (OCUA)." However, little is known there are any differences in pregnancy, prenatal care, and outcomes of women dwelling in OCUA compared to women in other areas. The purposes of this study were to compare the pregnancy related indicators (PRIs) and adequacy of prenatal care between OCUA region and non-OCUA region.
METHODS
Using National Health Insurance database in Korea from January 1, 2012 to December 31, 2014, we constructed the whole dataset of women who terminated pregnancy including delivery and abortion. We assessed incidence rate of 17 PRIs and adequacy of prenatal care. All indicators were compared between OCUA group and non-OCUA group.
RESULTS
The women dwelling in OCUA regions were more likely to get abortion (4.6% in OCUA vs. 3.6% in non-OCUA) and receive inadequate prenatal care (7.2% vs. 4.4%). Regarding abortion rate, there were significant regional differences in abortion rate. The highest abortion rate was 10.3% and the lowest region was 1.2%. Among 38 OCUA regions, 29 regions' abortion rates were higher than the national average of abortion rate (3.56%) and there were 10 regions in which abortion rates were higher than 7.0%. In addition, some PRIs such as acute pyelonephritis and transfusion in obstetric hemorrhage were more worse in OCUA regions compared to non-OCUA regions.
CONCLUSION
PRIs are different according to the regions where women are living. The Korean government should make an effort reducing these gaps of obstetric cares between OCUA and non-OCUA.
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