Beyond bus fare: Deconstructing prenatal care travel among low-income urban mothers through a mix methods GIS study

Objective: Guided by critical theory, this study illustrates the value of interpretative mapping to deconstruct bus travel to publicly funded prenatal care in a city marked by health and social inequities.
Design: Using geographical information systems (GIS) approach, this mixed methods study delves deeper into the known barrier of transportation to prenatal care among urban mothers most at risk for preterm birth by employing iterative processes among data, analysis, and interpretation.
Methods: GIS maps developed based on 61,305 births directed neighborhood field excursions for which researchers and key informants created a ‘typical case vignette.’ Multiple service locations for required components of prenatal care were geocoded. Time and money spent traveling with public transit were modeled using ArcMap’s Network Analyst.
Results: Among 350 census tracts, 36 census tracts had preterm rates between 25 −36.9%. Modeling travel time for the case vignette for routine prenatal care took 21 visits to different geographically located facilities. This burden increased to 32 visits if the case vignette was high-risk.
Conclusions: Interpretative GIS mapping is an important tool to ground truth spatially linked data into real world meaning to promote deeper understandings of complex problems. Time and cost traveling by bus to prenatal care that entailed various locations travel did not account for other related hassles of getting and waiting for care for mothers with young toddlers in tow. Promoting optimal health outcomes among the most at risk mothers requires innovative and feasible approaches that take into consideration daily maternal functioning as pregnant mothers care for their children and themselves.
Impact Statement: Ground truthing data-driven GIS maps with key informant community-based nurses is an important method to consider globally to garner deeper community and family health understandings for future actions. (author abstract) #P4HEwebinarOctober2024