Obstetric care by family physicians and infant mortality in rural Alabama

Background: The closure of obstetrics (OB) units at rural hospitals is thought to have implications for access to prenatal care (PNC) and infant mortality rate (IMR). The objective of this study was to determine whether local availability of PNC and OB services, specifically as provided by family physicians (FPs), would be associated with a lower IMR in 1 rural Alabama county. Methods: Data from 1986 to 2013 from Pickens County was compared with data from 2 sets of control counties: Clarke/Monroe (full OB care) and Coosa/Conecuh (no local OB care). Results: From 1986 to 1991 (no local OB services; period 1), Pickens County’s IMR was 17.9, which fell to 7.2 from 1993 to 2001 (with local services; period 2). After the county’s OB unit closed, IMR rose to 16.0 from 2005 to 2013 (period 3). In Clarke/Monroe (continuous OB service), the IMR fell from 14.5 to 9.9 from period 1 to period 3. Coosa/Conecuh (no OB service) exhibited a consistent IMR ranging from 10.9 to 14.4. Conclusion: OB services provided by FPs in Pickens County resulted in improvement of the county’s IMR. Local PNC was associated with a lower IMR.