Understanding the maternity care desert: A qualitative study on factors contributing to the closure of obstetrical programmes in rural northern Ontario
Bibliographic record
Abstract
INTRODUCTION: Northern Ontario continues to experience closures of rural obstetric programmes, forcing pregnant persons to travel for care. This reduced access is associated with poorer maternal and newborn health outcomes and creates logistical and financial barriers to care. Despite closures, factors underlying this trend are not well understood. Administrators, nurses and physicians involved in rural obstetrics at the time of programme closure are well positioned to identify factors contributing to service attrition. This qualitative study aimed to explore their perspectives regarding factors contributing to closure. METHODS: Semi-structured interviews were conducted with administrators, nurses and physicians involved in rural obstetric programmes in northern Ontario at the time of closure. Interview questions were developed from a literature scan and refined by an experienced practitioner to identify factors influencing closures. Thematic analysis of interviews identified common themes regarding factors perceived to contribute to programme closure. RESULTS: Twelve administrators, 6 nurses and 10 doctors were interviewed. Analysis revealed several perceived factors contributing to programme closures: (1) a decline in obstetric competence and confidence among healthcare workers attributable to inadequate obstetric exposure in schooling, low birth volumes and limited ongoing training opportunities; (2) shortage of health human resources providing obstetric care due to lack of provider reluctance and recruitment challenges and (3) limited support from the provincial government and tertiary referral centres. CONCLUSIONS: Closure of rural obstetric programmes in northern Ontario is seen as a result of complex, multifaceted challenges. Understanding these factors can better inform strategies to sustain rural obstetric programmes and prevent further attrition of care. INTRODUCTION: Le nord de l'Ontario continue de subir des fermetures de programmes obstétriques ruraux, ce qui oblige les femmes enceintes à SE déplacer pour obtenir des soins. Cet accès réduit est associé à de moins bons résultats en matière de santé pour la mère et le nouveau-né et crée des obstacles logistiques et financiers aux soins. Malgré les fermetures, les facteurs qui sous-tendent cette tendance ne sont pas bien compris. Les administrateurs, infirmières et médecins impliqués dans l'obstétrique rurale au moment de la fermeture du programme sont bien placés pour identifier les facteurs contribuant à l'attrition des services. Cette étude qualitative avait pour but d'explorer leurs points de vue sur les facteurs contribuant à la fermeture. MTHODES: Des entretiens semi-structurés ont été menés avec des administrateurs, des infirmières et des médecins participant à des programmes d'obstétrique en milieu rural dans le nord de l'Ontario au moment de la fermeture. Les questions ont été élaborées à partir d'une analyse documentaire et affinées par un praticien expérimenté afin d'identifier les facteurs influençant les fermetures. L'analyse thématique des entretiens a permis d'identifier des thèmes communs concernant les facteurs perçus comme contribuant à la fermeture d'un programme. RSULTATS: Douze administrateurs, six infirmières et dix médecins ont été interrogés. L'analyse a révélé plusieurs facteurs perçus comme contribuant à la fermeture des programmes: 1) un déclin des compétences obstétricales et de la confiance des travailleurs de la santé, attribuable à une exposition insuffisante à l'obstétrique au cours des études, à de faibles volumes de naissances et à des possibilités limitées de formation continue; 2) une pénurie de ressources humaines en santé fournissant des soins obstétricaux en raison de la réticence des prestataires et des difficultés de recrutement; et 3) un soutien limité du gouvernement provincial et des centres de référence tertiaires. CONCLUSIONS: La fermeture des programmes d'obstétrique en milieu rural dans le nord de l'Ontario est considérée comme le résultat de défis complexes et à multiples facettes. La compréhension de ces facteurs peut permettre de mieux informer les stratégies destinées à soutenir les programmes d'obstétrique en milieu rural et à prévenir l'attrition des soins.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.009 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.015 | 0.009 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.004 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".