Obstetric units: a stable access time despite clOsures

Abstract

Nearly 790 000 births occurred in 2010 in France, 5 % more than in 2001. At the same time, one in five obstetric departments closed. These closures are the result of a movement that began in the 1970s, whose aim was to make deliveries safer for both mothers and babies by closing obstetric units with low activity. This study allows us to observe the impact of obstetric unit closures on the time needed by mothers to reach the maternity unit. To do so, we use births as recorded in the PMSI. Women’s localization is available in the PMSI bases whereas obstetric departments’ localization is obtained thanks to the “Statistique annuelle des établissements de santé” (SAE). Distances in time are then calculated using the software Odomatrix. The study shows that despite the closures of many units and the supply contraction, median access time remained stable between 2001 and 2010: half of women need less than 17 minutes to get to the obstetric department. Disparities between areas still remain important, and eight of them have a median access time exceeding 30 minutes. Finally, the overall access time stability is mainly due to a more frequent use of the nearest obstetric unit from home. However, these results do not allow a full assessment of all maternal and perinatal birth outcomes. Indeed, many factors such as quality of care, obstetrician/midwife’s responsiveness, safety feeling or postnatal care influence women’s satisfaction.