ACCESS TO HEALTH-CARE AND TRAVEL FOR BIRTHING - NATIVE AMERICAN-WHITEDIFFERENTIALS IN MONTANA

The location of medical services critically affects access to health c are. We examine the extent to which the spatial distribution of health carl resources allows expectant mothers to give birth in the county w here they live or forces them to travel elsewhere for obstetrical care . We focus on native American-white differentials in access and travel because little is known about inter-racial differences involving nati ve American Indians. Montana birth records for the period 1980-1989 ar e used to identify the degree to which women leave the county of resid ence to give birth. Thirty-seven percent of births to native American mothers involved travel, compared to 19% of births to whites. Sixty-on e percent of births to whites were to mothers residing in counties wit h relatively high levels of obstetrical care (Level II hospitals), whi le that proportion for native Americans was only 18%. Of women who tra veled, 65% of whites gave birth in counties with a Level II hospital, compared to 40% of native Americans. Results of logistic regression su ggest that the distribution of health care facilities in the county of residence largely explains travel for birthing. Inter-racial differen ces in travel turn out to be minimal when the spatial distribution of health care resources is taken into consideration, and both groups act similarly when faced with the same level of health care resources. Su ggestions to improve the delivery of health care in rural areas are of fered.