Health policy: outcomes for rural residents’ access to\ud maternity care

Regular health care during pregnancy, birthing and the postnatal period is recommended for improving maternal and neonatal outcomes and accessing such care has become a common expectation for Australian families. Studies have highlighted the relative safety of birthing in rural hospitals even though these units are typically associated with low volumes of deliveries. Yet, in Queensland, the location and number of public maternity units shows a clear trend towards centralisation of services. During 1995-\ud 2005, 43% of Queensland public maternity units closed, with the remaining units predominantly located in coastal and more populated locations. The closure of rural maternity units is not restricted to Queensland: the National Rural Health Alliance estimated 130 rural maternity units had closed across Australia throughout the decade 1996-20065. Growing numbers of closed rural maternity units raises considerable questions regarding the care accessed by rural residents. This paper presents findings from research\ud conducted in north Queensland which examined the impact of health policy on an issue that is of central importance to rural communities—access to birthing services.\ud \ud A multi-dimensional understanding of access to maternity services was adopted in this study, a view which goes beyond measuring access only in terms of geographic distance. Gulliford et al have provided a constructive discussion of the multifaceted nature of access, particularly the differentiation between ‘having access’ and ‘gaining access’ to health care. Having access implies that a person has the\ud opportunity to use a health service if they need or want it. This type of access is often measured in terms of doctors or hospital beds per capita and is dependent on the provision, and geographical allocation of resources, as well as the actual configuration of the network of health services. The authors draw attention to Mooney’s proposition that equal costs in using a service (eg costs of care, costs of travel, lost work) indicates equal access to services. On the other hand, gaining access to health care can be complicated by a variety of barriers including those of a personal nature (eg patients recognising their need to access health care); financial (that is, costs to be borne by the potential patient) or organisational (eg waiting lists)