More than Just Bus Fare: Critical Theory and GIS to Deconstruct Prenatal Care Travel among Low-income Urban Mothers

Background: Having had preterm birth is most predictive of having another. Racial disparities in preterm birth (PTB) rates in urban areas overlap in socio-economically disadvantaged neighborhoods. Challenged to meet maternal self-care needs, unintended pregnancies with inadequate spacing often result. This study, guided by critical theory, deconstructs travel to public-funded prenatal care (PNC) using public transit.

 Methods:  GIS ‘ground truthing’ method was used. The first step was to use GIS to identify Philadelphia neighborhoods with the highest PTB rates using 2003-2005 geocoded Philadelphia birth records. Then, expert panel simulated case vignettes for a  plausible residential location. Service locations (WIC, prenatal clinic, antenatal testing center and SNAP) for required components of prenatal were geocoded. Time and money spent traveling with public transit ere modeled using ArcMap’s Network Analyst.

 Results: Among 381 census tracts, 36 had PTB rates between 25 -36.9%. Modeling travel time to for routine PNC took 25 visits to different geographically located facilities, 19 hours, 24 minutes to travel 179.6 miles at the personal cost of $69.60. For medically high-risk mothers, this burden increased to 34 visits, 27 hours, 20 minutes to travel 259.6 miles at the personal cost of $98.60 for bus fare.

 Conclusions and Public Health Implications:  This simulation model of travel does not account for the other related  hassles of getting and waiting for care with frail children in tow. Improving pregnancy outcomes among the most at risk requires innovative approaches in research to translate to new models of MCH services.