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In the United States, maternal mortality rates remain higher than in comparable countries and racial disparities persist. While many countries have seen improvements in maternal mortality rates, US rates have increased to approximately 16.9 pregnancy-associated deaths per 100,000 live births between 2006 and 2016 and currently have a higher maternal mortality rate. than more than 50 other countries. Longer travel times to access obstetric care are associated with poorer outcomes for mothers and babies, and only about 61.6% of the US population has timely emergency access (in 30 minutes) to obstetrical care. A new study by researchers at Brigham and Women’s Hospital assesses a potential solution that could improve access: a partnership with military medical treatment facilities (MTFs), which could provide high-quality obstetric care, including cesarean section emergency. The researchers identified 17 facilities with the capacity to provide care in underserved areas, particularly in rural communities.

“Providing emergency caesarean sections in underserved areas has the potential to not only improve care for pregnant patients requiring emergency access, but it also has the potential to address inequities and support military readiness, said lead author Molly Jarman, PhD, MPH, of Brigham’s Center for Surgery and Public Health (CSPH). “We have health care resources that need more patients, and we have patients that need health care. Although the needs and abilities maps do not overlap perfectly, when they do, we have the opportunity to open the door. »

“This could be a win-win situation for both military and civilian MTFs,” said corresponding author Tarsicio Uribe-Leitz, MD, MPH, also of CSPH. “There is much to be gained for both parties by reducing disparities, improving maternal care and providing training and experience for military health professionals.

Uribe-Leitz, Jarman and their colleagues studied access to obstetric care across the United States. They looked at areas within a 30-minute drive of a medical facility capable of providing emergency cesarean section care. The team identified 3 MTFs that were the only facility within a 30-minute drive and 14 additional MTFs that could improve access to care.

“Better access to emergency obstetric care could save lives,” Jarman said. “We see this work as bringing together a solution to two separate problems – the reduction of preventable maternal mortality in rural areas of the United States and the ongoing policy discussions about ‘right sizing’ the US military healthcare system.”

Disclosures: Uribe-Leitz said he received grants from the US Department of Defense while conducting the study. Jarman said he received DOD grants while conducting the study. Additional information can be found in the document.

Funding: This work was supported by grant 108334 from the Comparative Effectiveness and Provider Induced Demand Collaboration of the DOD Defense Health Agency

Article quoted: Uribe-Leitz T et al. “Geospatial Analysis of Access to Emergency Cesarean Section for Military and Civilian Populations in the United States” Open JAMA Network DOI: 10.1001/jamanetworkopen.2021.42835


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