Relationship of infant mortality to the availability of obstetrical care in Indiana.

BACKGROUND: Projects that are currently under way in Indiana to improve access to obstetrical care have not addressed the availability of these services in nonmetropolitan areas. This study was designed to identify all physicians who were providing obstetrical services in every county throughout the state to determine if there is a correlation between the availability of these services and the infant mortality rate in nonmetropolitan counties.
METHODS: A state-wide physician profile maintained by the Indiana Academy of Family Physicians was cross-referenced with a telephone survey of all hospitals in the state to identify those physicians providing obstetrical services within each county in Indiana. The number of physicians in each county was then compared with the number of births per year by mothers from that county to determine whether nonmetropolitan counties had sufficient physicians to provide obstetrical services. Finally, these findings were compared with the most recent infant mortality rate for each nonmetropolitan county.
RESULTS: A total of 610 family physicians, 311 obstetricians, and 75 general practitioners were providing obstetrical care in Indiana. There were 10 counties that did not have a physician who delivered babies practicing in that county. Thirty-two counties had more women who needed obstetrical care than the current number of physicians could serve. There was a negative correlation between physician availability and infant mortality in Indiana's nonmetropolitan counties (r = -.38; P less than .02).
CONCLUSIONS: Access to care for pregnant patients is a major problem in rural Indiana and hampers Indiana's ability to reduce its current infant mortality rate.