NEWS

New UNC study reveals N.C. obstetrics care supply decent, but disparities contribute to infant problems

By DAVID WILLIAMSON
UNC News Services

CHAPEL HILL -- Between 1994 and 1998, the number of North Carolina doctors grew by almost 18 percent, but the number who helped women give birth declined, according to a new University of North Carolina at Chapel Hill study. The total state decrease in physicians attending births -- from 896 to 839 -- was most acutely felt in non-metropolitan counties, which lost 12 percent of their obstetric care providers.

Such numbers interest and concern health planners because North Carolina continues to rank in the lowest fifth in the nation in infant mortality and low birth weight, said Erin Fraher, assistant director of UNC’s Cecil G. Sheps Center for Health Services Research.

"We looked at data from throughout the state to see whether there were any trends in the provision of obstetric care, meaning prenatal care as well as birthing," Fraher said. "For the first time, we combined what was available on physicians with information on non-physician providers such as certified nurse midwives, physician assistants and nurse practitioners.

"We did that because non-physician providers play an important role in offering obstetric care, and their numbers are growing faster than any other health professions. By combining data, we get a much better sense of what is really going on in the state."

When doctors and others are considered as a group, the supply of such providers is relatively good, she said. Twelve counties, however, had no one attending births within the county, and eight of those were in the east. They were Alexander, Currituck, Davie, Gates, Graham, Hyde, Jones, Madison, Northampton, Pamlico, Pender and Tyrrell.

Also, nine counties had no physician or certified nurse midwife offering prenatal care. They were Alexander, Currituck, Gates, Graham, Hyde, Pamlico, Pender, Polk and Tyrrell.

"In 1998, some kind of obstetric care, including that provided at county health departments, was available in all but two counties, Pamlico and Gates," Fraher said. "What this suggests is that North Carolina’s poor rankings in this important area of health care may be more complicated than a lack of access to obstetric care providers."

Fraher and N.C. Health Professions Data System staff conducted the study under the direction of Dr. Thomas C. Ricketts, associate professor of public health leadership and deputy director of the Sheps center.

Other findings were that:

The number of certified nurse midwives offering obstetric care in North Carolina more than quadrupled between 1984 and 1998.

Over the last decade, the supply of physician assistants doubled and nurse practitioners increased by 166 percent.

In 1998, 6.1 percent of the former and 15.5 percent of the latter treated pregnant women.

"We think our study reveals that simply having access to a provider is not necessarily going to lower infant mortality, and so we have to look beyond access," Fraher said. "If a woman comes in with more complex problems such as domestic violence, alcoholism or substance abuse, she can get the best prenatal care in the world and still have a low birth weight baby."

The researchers would like to get more information about what services the practitioners can and can’t offer, she said.

"Can they communicate effectively with Spanish-speaking mothers?" Fraher said. "Do they have access to referral services? How much support are county health departments, which are very important, getting, and what else do they need to be able to do a better job?"

The data system is funded by the UNC School of Medicine-based N.C. Area Health Education Centers (AHEC) and UNC’s Office of the Provost for Health Affairs. An electronic copy of the report can be downloaded at http://www.shepscenter.unc.edu/hp.

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Note: Ricketts, who can answer questions, can be reached at (919) 966-5541. Fraher’s number is 966-5012, but she will not be available until July 9.

Sheps center contact: Carolyn Busse, 966-3847
News Services contact: David Williamson, 962-8596