Distance as a barrier to obstetric care among indigenous women in Panama: a cross-sectional study

ObjectivesWe assess the relationship between distance to a woman’s assigned health clinic and obstetric care utilisation.DesignWe employ a cross-sectional study design using baseline data from the evaluation of a conditional cash transfer programme to promote greater utilisation of maternal and infa...

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Bibliographic Details
Published in:BMJ open 2020-03, Vol.10 (3), p.e034763-e034763
Main Authors: Acevedo, Paloma, Martinez, Sebastian, Pinzon, Leonardo, Sanchez-Monin, Emmanuelle, Winters, Solis
Format: Article
Language:English
Subjects:
Abortion, Spontaneous - epidemiology
Adult
Babies
Births
Censuses
Childbirth & labor
Children & youth
Childrens health
Cross-Sectional Studies
Developing countries
Female
health economics
Health facilities
Health services
Health Services Accessibility - statistics & numerical data
Households
Humans
Indigenous Peoples - statistics & numerical data
Infant mortality
international health services
LDCs
Low income groups
Maternal & child health
Maternal mortality
Mothers
Native peoples
Obstetrics
Panama - epidemiology
Postnatal Care - statistics & numerical data
Postpartum period
Poverty Areas
Pregnancy
Prenatal care
Prenatal Care - statistics & numerical data
Public Health
Stillbirth - epidemiology
tropical medicine
Womens health
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Summary:ObjectivesWe assess the relationship between distance to a woman’s assigned health clinic and obstetric care utilisation.DesignWe employ a cross-sectional study design using baseline data from the evaluation of a conditional cash transfer programme to promote greater utilisation of maternal and infant health services. Data were collected between December 2016 and January 2017.SettingThe study is conducted in Ngäbe Buglé, the largest of Panama’s three indigenous territories, where maternal mortality is three times the national average.ParticipantsWe analyse a representative sample of 1336 indigenous women with a birth in the 12 months prior to the survey.Primary and secondary outcome measuresPrimary outcomes include obstetric care utilisation measures for prenatal, childbirth and postpartum events. Secondary outcomes include reasons for not receiving prenatal care, alarming symptoms, child weight at birth and stillbirths or miscarriages.ResultsCompared with women in closest geographic proximity to a health centre (top quintile, Q1), women who lived farthest from a health centre (bottom quintile, Q5) had significantly lower obstetric care utilisation outcomes for critical prenatal, childbirth and postpartum events. Mothers in Q5 were 36 percentage points less likely to have had at least one prenatal care appointment in a hospital, health centre or clinic compared with mothers in Q1 (p
ISSN:2044-6055
2044-6055
DOI:10.1136/bmjopen-2019-034763