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Choice in maternity care: associations with unit supply, geographic accessibility and user characteristics.
Pilkington H., Blondel B., Drewniak N., Zeitlin J.
International Journal of Health Geographics 11, 1 (2012) 35 - http://www.hal.inserm.fr/inserm-00762305
Choice in maternity care: associations with unit supply, geographic accessibility and user characteristics.
Hugo Pilkington () 1, 2, Béatrice Blondel1, Nicolas Drewniak1, Jennifer Zeitlin1
1 :  Recherche Epidémiologique en Santé Périnatale et Santé des Femmes et des Enfants
INSERM : U953 – Université Paris V - Paris Descartes – Université Pierre et Marie Curie (UPMC) - Paris VI – Université Paris XI - Paris Sud – Hôpital Cochin – Hôpital Tenon – Assistance publique - Hôpitaux de Paris (AP-HP)
Maternité de Port Royal - 6ème étage 53, avenue de l'Observatoire 75014 Paris
2 :  LADYSS - Laboratoire dynamiques sociales et recomposition des espaces
CNRS : UMR7533 – Université Paris I - Panthéon-Sorbonne – Université Paris VII - Paris Diderot – Université Paris VIII - Vincennes Saint-Denis – Université Paris X - Paris Ouest Nanterre La Défense
Université Paris Ouest Nanterre La Défense Bâtiment T 200 avenue de la République 92001 Nanterre cedex
ABSTRACT: BACKGROUND: Despite national policies to promote user choice for health services in many European countries, current trends in maternity unit closures create a context in which user choice may be reduced, not expanded. Little attention has been paid to the potential impact of closures on pregnant women's choice of maternity unit. We study here how pregnant women's choices interact with the distance they must travel to give birth, individual socioeconomic characteristics and the supply of maternity units in France in 2003. RESULTS: Overall, about one-third of women chose their maternity units based on proximity. This proportion increased steeply as supply was constrained. Greater distances between the first and second closest maternity unit were strongly associated with increasing preferences for proximity; when these distances were [greater than or equal to] 30 km, over 85 % of women selected the closest unit (revealed preference) and over 70 % reported that proximity was the reason for their choice (expressed preference). Women living at a short distance to the closest maternity unit appeared to be more sensitive to increases in distance between their first and second closest available maternity units. The preference for proximity, expressed and revealed, was related to demographic and social characteristics: women from households in the manual worker class chose a maternity unit based on its proximity more often and also went to the nearest unit when compared with women from professional and managerial households. These sociodemographic associations held true after adjusting for supply factors, maternal age and socioeconomic status. CONCLUSIONS: Choice seems to be arbitrated in both absolute and relative terms. Taking changes in supply into consideration and how these affect choice is an important element for assessing the real impact of maternity unit closures on pregnant women's experiences. An indicator measuring the proportion of women for whom the distance between the first and second maternity unit is greater than 30 km can provide a simple measure of choice to complement indicators of geographic accessibility in evaluations of the impact of maternity unit closures.
Sciences du Vivant/Santé publique et épidémiologie

Articles dans des revues avec comité de lecture
International Journal of Health Geographics
Publisher BioMed Central
ISSN 1476-072X 

Health services accessibility – Distance – Hospital planning – Perinatal care
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