Need a womans opinion

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Read terms. Reaffirmed Replaces Committee OpinionMarch This information should not be construed as dictating an exclusive course of treatment or procedure to be followed. Rural America is heterogeneous where problems vary depending on the region and state. Health care professionals should be aware of this issue and advocate for reducing health disparities in rural women.

ificant health disparities exist between rural and urban women. Rural communities are heterogeneous, with substantial regional differences in ethnic and racial composition 3 4.

Need a womans opinion

Whereas General health conditions and behavior that U. Other comparisons show that death rates from ischemic heart disease in rural women exceed that for all U. In some regions of the country, women in nonmetropolitan areas have higher rates of heavy alcohol consumption 4. Proportionately fewer rural women receive recommended preventive screening services for breast and cervical cancer.

Rural African American, Hispanic, Asian, and white women are less likely to have cervical cancer screening. African American, Hispanic, and white women are less likely than their urban counterparts to have mammograms 7. National level data show relatively little difference between metropolitan and nonmetropolitan women for a of obstetric outcomes 9. In contrast, risks vary by levels of rurality in many parts of the country. Prenatal care initiation in the first trimester was lower for mothers in more rural areas compared with suburban areas Relative to women living in large fringe metropolitan and medium to small metropolitan areas, rural women experienced slightly higher rates of hospitalizations with complications during pregnancy in With respect to adverse birth outcomes, a study in Pennsylvania found that women residing in the two most rural types of communities experienced risks of low birth weight LBW and preterm birth similar to those identified for women living in urban areas, even after controlling for pertinent maternal variables Calculations of 5-year average — infant mortality rates for the United States and its counties indicated a rate of 6.

A survey of women aged 18—44 years in Colorado found that women in small towns or rural areas indicated that they plan for contraceptive use less and were more likely to have had an unintended pregnancy than women in more urban areas Access to health care for rural residents is complicated by patient factors as well as those related to the delivery of care.

Rural residents are more likely to be poor, lack health insurance, or rely substantially on Medicaid and Medicare; they also travel longer distances to receive care or to access a range of medical, dental, and mental health specialty services Less than one half of rural women live within a minute drive to the nearest hospital offering perinatal services. Within a minute drive, the proportion increases to During —, rural women aged 18—64 years reported the highest rates of delayed care or no medical care due to cost According to birth certificate data, home births were higher in counties with a population size less than0.

Regional organization of perinatal services is an important strategy to improve outcomes for underserved women and their infants in rural communities. One outcome indicator is the percentage of very LBW less than 1, g deliveries that take place in subspecialty hospitals. Based on this indicator, 9 of the 12 lowest ranked states have rural populations that exceed one third of the state population 20 Some studies that examined deliveries of very LBW infants suggest that residing in more distant areas from a subspecialty facility, as well as inadequate prenatal care, increases the likelihood of delivery in a Need a womans opinion level facility 22 23 Inonly 6.

These predominantly rural counties exist in all states, but are particularly prevalent in the central and mountain west states. The ratio of obstetrician—gynecologists per 10, women is highest in metropolitan areas, and decreases in less populated and rural counties 18 Even so, practice data show that obstetric services provided by family physicians is decreasing, with only At the same time, an increasing proportion of women are entering obstetrics and family practice; however, substantially fewer females compared with males in both specialties choose to practice in rural areas 26 29 These trends could contribute to a potential decrease in the rural workforce.

Obstetric and gynecologic health services, including family planning, are limited in many nonmetropolitan Need a womans opinion. Substantial decreases in the availability of vaginal birth after cesarean delivery VBAC services from through reported for hospitals in Colorado, Montana, Oregon, and Wisconsin disproportionately affected smaller and more isolated or rural hospitals Local availability of abortion services also is a concern.

Eighty-seven percent of U. Obstetrician—gynecologists with rural mailing addresses were ificantly less likely to perform abortions 6. Rural women seeking abortions in traveled substantially greater distances than nonrural women. Thirty-one percent traveled more than miles and an additional In Colorado, where almost three-quarters of the counties are considered rural, substantial s of reproductive-aged women live in counties where there is no identified pharmacy or health clinic that either prescribes or fills prescriptions for contraceptives Despite concern about access to emergency contraception, data on current over-the-counter availability of emergency contraception in U.

A variety of initiatives have been established to address the difficulties in providing care to rural women, funded by a Need a womans opinion of state and federal programs and medical school department budgets. Examples of recent or current approaches include: Wyoming, a state with no tertiary care centers for pregnant women or infants and few pediatric specialists, approves out-of-state health care providers and facilities as state Medicaid providers, allowing the state to reimburse transport to and care and delivery in an out-of-state subspecialty hospital when medically necessary The program addresses culturally relevant services and transportation needs, and uses electronic medical records Need a womans opinion facilitate continuity of care.

It also provides housing in its Regional Perinatal Residence for high-risk women and family members living in distant locations to facilitate their access to regional center care when hospitalization is not necessary The system uses telemedicine and clinic networks to facilitate access to maternal—fetal medicine consultation services, and to provide continuing education for practitioners Oregon enacted legislation to offer financial incentives, such as a state income tax credit for rural practitioners and assistance with medical liability insurance, for obstetricians practicing in rural areas.

An evaluation of the program 2 years after full implementation found that the subsidy had not halted the overall decrease in rural clinicians who performed deliveries in that time frame. Clinicians receiving the subsidy, however, indicated that it was an important reason that they were able to continue maternity care Twenty-four family medicine residency programs have incorporated a rural training track.

Graduates of these programs are two to three times more likely to practice in rural areas than graduates of family medicine residencies overall. The majority of those physicians initially selecting rural sites remained in rural locations 2 years after graduation Obstetricians and gynecologists in every region of the United States can work to reduce rural health disparities.

The diversity of rural communities necessitates local solutions to local problems. The American College of Obstetricians and Gynecologists encourages obstetrician—gynecologists to do the following: Collaborate with maternal—child and rural health agencies in their state to identify the health needs of rural women and barriers to health care. Share professional expertise as a member of an advisory committee or task force focused on improving the health of rural women.

Promote state initiatives offering financial incentives to rural health care practitioners and providers of rural obstetric care and reproductive health services. Encourage graduates of obstetric—gynecologic residency programs to participate in loan repayment programs that require practicing in rural locations for a specific length of time.

Foster and participate in efforts to utilize effective telemedicine technologies in accordance with state regulations to expand and improve services for rural women. Advocate for comprehensive professional liability reform to facilitate the practice of health care providers in rural areas. Promote research to determine factors and conditions that support the retention of obstetrician—gynecologists in rural communities. Conduct further research to understand acceptable conditions for performance of VBAC in rural areas and to study the effect of VBAC policies on access to care for rural women.

Advocate for increased access for rural women to contraceptive methods and emergency contraception. Include place of residence in the collection of data for health-related databases and their analyses to ensure improved understanding of rural—urban health disparities among women. Encourage research on the education, employment, and poverty disparities that affect the health of rural women. All rights reserved.

Need a womans opinion

Health disparities in rural women. Committee Opinion No. American College of Obstetricians and Gynecologists. Obstet Gynecol ;—8.

Need a womans opinion

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Need a womans opinion

For additional quantities, please contact sales acog. Patient Education Materials For Patients. Featured Clinical Topics. Jump to Jump to Close. Search. Resources Close. Replaces Committee OpinionMarch Committee on Health Care for Underserved Women This information should not be construed as dictating an exclusive course of treatment or procedure to be followed. Obstetric and Reproductive Health Outcomes National level data show relatively little difference between metropolitan and nonmetropolitan women for a of obstetric outcomes 9. Health Services Access Access to health care for rural residents is complicated by patient factors as well as those related to the delivery of care.

Current Initiatives to Improve Services for Rural Women A variety of initiatives have been established to address the difficulties in providing care to rural women, funded by a range of state and federal programs and medical school department budgets. Recommendations Obstetricians and gynecologists in every region of the United States can work to reduce rural health disparities.

Need a womans opinion

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