Maternity Care In Rural Florida

Background: This cross-sectional study was designed to explore the impact of the availability of maternity care services on the int~Ult mortality rates in nonmetropolitan (rural) counties in Florida. Methods: We evaluated the sufficiency of physicians providing maternity care in each rural county. We then constructed a mathematical model to compare physician availability with the infant mortality rates for each county, while controlling for socioeconomic variables. Results: Thirty-one family physicians and 974 obstetrician-gynecologists were delivering babies in Florida in 1991. Forty-seven counties were lacking in maternity care services; 45 ofthese counties had family physicians who practiced in the county but did not provide maternity care services. There was a negative correlation in rural counties between availability of maternity care services and infant mortality (R = -0.42, H2 = 0.176, P= 0.012), implying that 17.6 percent of the variation in rural Florida's infant mortality was explained by a ranking in physician availability. Multivariate analysis revealed that increasing infant death rates can be predicted by decreasing physician availability (P = 0.003). A multiplicative risk model developed for this study demonstrated that the loss of 1 family physician delivering babies would predict the increase of infant mortality by 2.3 percent, and the loss of 1 obstetrician-gynecologist increased infant mortality by 9.6 percent. Conclusions: Access to maternity care for women in rural Florida is a problem that could be hampering Florida's ability to reduce its infant mortality rate. Family physicians appear to be the most geographically distributed health care providers in Florida; therefore, strategies should be developed to recruit Florida's rural family physicians into maternity care. (J Am Board Fam Pract 1995; 8:392-9.)