Mapping the Distances From Prisons to Hospitals Providing Obstetric and Neonatal Intensive Care.

Abstract

To evaluate the driving distance from U.S. prisons housing women to hospitals providing obstetric care and advanced neonatal intensive care. Using the Google Distance Matrix API, we conducted a cross-sectional analysis to calculate driving distances from state and federal prisons housing women to the closest in-state obstetric hospitals and level III or IV neonatal intensive care units (NICUs). The primary outcome was obstetric hospital distance (driving distance from each prison to the closest hospital providing obstetric care). The secondary outcome was NICU hospital distance (driving distance from each prison to the closest level III or IV NICU). We calculated state-level descriptive statistics and assessed regional differences using the Kruskal-Wallis test. Of 136 prisons, 134 (98.5%) had an in-state driving route to an obstetric hospital. There were 1,920 obstetric hospitals and 836 level III or IV NICUs. The median (IQR) obstetric hospital distance was 11.4 miles (4.5-22.8) (range 0.6-139.8). The farthest obstetric hospital distances were in Wyoming (139.8 miles), North Dakota (122.4 miles), and Georgia (69.6 miles). Twelve prisons (9.0%) were located more than 37.2 miles from the closest obstetric hospital, including two in both Wyoming and Georgia. Of the 130 prisons with driving routes to an in-state level III or IV NICU, the median (IQR) NICU hospital distance was 19.5 miles (7.7-39.6) (range 0.4-357.9). The farthest NICU hospital distances were in Alaska (357.9 miles), New Mexico (187.0 miles), and South Dakota (175.8 miles). Distances to the closets NICU were significantly longer in the South and Midwest than in the Northeast ( P =.025). Although most prisons housing women were located near hospitals providing obstetric and neonatal intensive care, there were state and regional disparities. For some prisons, distance could pose a substantial barrier to timely perinatal care and may exacerbate existing inequities in maternal and neonatal morbidity and mortality.