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Public Health/Global Health

Poster Session 1

(366) Investigating the impact maternity care access and social vulnerability on short-interval birth in Tennessee

Tuesday, February 13, 2024

10:30 AM – 12:00 PM

Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

Primary & Presenting Author(s)

Megan L. Young, MPH

University of Tennessee Graduate School of Medicine
Knoxville, TN, United States

Coauthor(s)

AM

Alicia Mastronardi, MPH

University of Tennessee Graduate School of Medicine
Knoxville, TN, United States
JM

Jill Maples, PhD

University of Tennessee Medical Center
Knoxville, TN, United States
ZS

Zach Shelton, BS

University of Tennessee Medical Center
Knoxville, TN, United States
NZ

Nikki B. Zite, MD, MPH

Vice Chair of Education and Advocacy
University of Tennessee Graduate School of Medicine
Knoxville, TN, United States

Objective: Maternity Care Access (MCA) and levels of community vulnerability can impact contraception access and health outcomes for pregnant-capable individuals. The relationship between maternity care access based on county of residence and short-interval birth (SIB) rates across Tennessee was analyzed.

Study Design: Tennessee birth certificate data for 2015-2021 from the Tennessee Department of Health was obtained. Maternal county of residence was coded using the March of Dimes 2018 definitions of MCA (full-access, moderate-access, low-access, or maternity desert) and CDC/ATSDR 2020 social vulnerability index (SVI). Birth intervals of 6-23 months were coded as short-interval birth (SIB). Births were excluded if they were nulliparous or had missing birth interval information. Analysis was completed in SPSS 29.0 and Pearson chi-square tests, Kruskal-Wallis tests, and binary logistic were conducted.

Results: Overall, 319,600 births were included in analysis. SIB was highest in maternity care deserts (24.5%; p< .001). There was a statistically significant difference in SVI between MCA levels (p < 0.001). Logistic regression was used to analyze the relationship between SIB and SVI. SIB was significantly higher among reported household incomes < $25,000 (27.6%; p< .001) and those with a high school diploma or GED (26.8%; p< .001). SVI was higher among groups experiencing SIB 2015-2020 (p < .001) and remained statistically significant after controlling for age, education, race/ethnicity, and household income (AOR:1.048; 95%;CI:1.010-1.087, p< .001).

Conclusion: Measures of high vulnerability and low healthcare access are associated with higher rates of SIB. County-level data may not be the best indication of health access and outcomes in Tennessee as it is likely patient-level factors vary widely within counties. Future work should investigate MCA and community vulnerability on rates of prenatal contraceptive counseling and obtaining desired contraception.