The urban and rural divide for women giving birth in NSW, 1990-1997

OBJECTIVE: To examine trends in the pregnancy profile and outcomes of urban and rural women. METHODS: Data were obtained Rom the NSW Midwives Data Collection on births in NSW, 1990-1997. Associations between place of residence (urban/rural) an d maternal factors and pregnancy outcomes were examined, including changes over time. RESULTS: From 1990 to 1997 there were 685,631 confinements in NSW and these mothers resided as follows: 76% metropolitan. 5% large rural centres, 8% s mall rural centres, 11% other rural areas and 1% remote areas. Rural mother s were more likely to be teenagers, multiparous, without a married or de fa cto partner. public patients and smokers. Births in rural areas declined, p articularly among women aged 20-34 years. Infants born to mothers in remote communities were at increased odds of stillbirth and low Apgar scores (all women) and small-for-gestational-age (SGA) (Indigenous women only). CONCLUSIONS: The profile of pregnant women in rural NSW is different from t heir urban counterparts and is consistent with relative socioeconomic disad vantage and possibly suboptimal maternity services in some areas. While inc reased risk of SGA is associated with environmental factors such as smoking and nutrition, the reasons for increased risk of stillbirth are unclear. A lthough there does not appear to be an increased risk of preterm birth for rural women this may be masked by transfer of high-risk pregnancies interst ate. IMPLICATIONS: Maternity services need to be available and accessible to all rural women with targeting of interventions known to reduce low birthweigh t and perinatal death.