Navigating geographical disparities: access to obstetric hospitals in maternity care deserts and across the United States.

BACKGROUND: Access to maternity care in the U.S. remains inequitable, impacting over two million women in maternity care "deserts." Living in these areas, exacerbated by hospital closures and workforce shortages, heightens the risks of pregnancy-related complications, particularly in rural regions. This study investigates travel distances and time to obstetric hospitals, emphasizing disparities faced by those in maternity care deserts and rural areas, while also exploring variances across races and ethnicities. METHODS: The research adopted a retrospective secondary data analysis, utilizing the American Hospital Association and Centers for Medicaid and Medicare Provider of Services Files to classify obstetric hospitals. The study population included census tract estimates of birthing individuals sourced from the U.S. Census Bureau's 2017-2021 American Community Survey. Using ArcGIS Pro Network Analyst, drive time and distance calculations to the nearest obstetric hospital were conducted. Furthermore, Hot Spot Analysis was employed to identify areas displaying significant spatial clusters of high and low travel distances. RESULTS: The mean travel distance and time to the nearest obstetric facility was 8.3 miles and 14.1 minutes. The mean travel distance for maternity care deserts and rural counties was 28.1 and 17.3 miles, respectively. While birthing people living in rural maternity care deserts had the highest average travel distance overall (33.4 miles), those living in urban maternity care deserts also experienced inequities in travel distance (25.0 miles). States with hotspots indicating significantly higher travel distances included: Montana, North Dakota, South Dakota, and Nebraska. Census tracts where the predominant race is American Indian/Alaska Native (AIAN) had the highest travel distance and time compared to those of all other predominant races/ethnicities. CONCLUSIONS: Our study revealed significant disparities in obstetric hospital access, especially affecting birthing individuals in maternity care deserts, rural counties, and communities predominantly composed of AIAN individuals, resulting in extended travel distances and times. To rectify these inequities, sustained investment in the obstetric workforce and implementation of innovative programs are imperative, specifically targeting improved access in maternity care deserts as a priority area within healthcare policy and practice.

The Mental Health of the Organic Farmer: Psychosocial and Contextual Actors.

Despite the large body of research and literature on the health and mental health of farmers, we should not assume that research findings necessarily apply to the organic farmer. The limited literature on the mental health of the organic farmer points to potential differences. Research has found that workers on organic farms may be happier than their counterparts; others have identified added sources of stress related to the perceived need of organic farmers to embrace concepts linked to the organic movement. However, further research is needed to identify both risk and protective factors for mental health among organic farmers. The purpose of this qualitative descriptive study was to explore the psychosocial and contextual factors that may relate to the mental health of the organic farmer. Key informant interviews were conducted with 10 farm producers and 20 farm workers. The findings indicated that respondents recognized mental health as influential in the workplace and the future of organic practices (e.g., the mental, financial, physical stress). Some of the risk factors mentioned by participants reflected those experienced by conventional, nonorganic farmers. Participants also reported contentment with farming as an occupation, the benefits of being connected to the land, feelings of social and environmental responsibility, and engagement in social activities that may promote human and social capital. These feelings and activities ultimately benefit the farmer, contribute to social cohesion, and may have positive implications for mental health. Results suggest that there may be protective mental health factors unique to the organic farmer.