SynthesisBMJ open2020
Impact of obstetric unit closures, travel time and distance to obstetric services on maternal and neonatal outcomes in high-income countries: a systematic review.
Synthesis in BMJ open, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
16 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Impact of travel time to health facilities on perinatal outcomes: a systematic review with narrative synthesis and meta-analysis.Journal of global health · 2026Pooled it
- Association between socioeconomic disadvantage and severe maternal morbidity and mortality in high-income countries: a systematic review.Journal of epidemiology and community health · 2025Pooled it
- Spatial and Temporal Trends of Access to Birthing Hospitals in Illinois, 2016-2021.Preventing chronic disease · 2026Article
- 'I pack two birth bags': women's accounts of preparing for hospital or roadside birth during maternity unit closures in rural northern Sweden.BMC health services research · 2026Article
- Regional correlation study of obstetrician maldistribution and its impact on pregnancy loss outcomes in Japan amid declining fertility.BMJ public health · 2026Article
- Norms for scaling up small and sick newborn care: an overview of reviews.Journal of global health · 2025Review
- Hospital birth volume and rurality: Associations with pregnancy outcomes among individuals with chronic hypertension.Pregnancy (Hoboken, N.J.) · 2025Article
- Determining what matters: data resources for examining maternal health equity.Frontiers in public health · 2025Article
- Does the reduction in obstetric hospitals result in an unintended decreased in-hospital delivery utilisation? A causal multilevel analysis in China.BMJ public health · 2025Article
- Mapping Geographic Access to Illinois Birthing Hospitals, 2016-2023.Preventing chronic disease · 2024Article
- Article
- Factors associated with antepartum pilgrimage at a reference maternity hospital in Ceará.Revista da Escola de Enfermagem da U S P · 2024Article
- Dual Barriers: Examining Digital Access and Travel Burdens to Hospital Maternity Care Access in the United States, 2020.The Milbank quarterly · 2023Article
- Article
- Centralisation of acute obstetric care in the Netherlands: a qualitative study to explore the experiences of stakeholders with adaptations in organisation of care.BMC health services research · 2021Article
- Association between ambulance prehospital time and maternal and perinatal outcomes in Sierra Leone: a countrywide study.BMJ global health · 2021Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo systematically review (1) The effect of obstetric unit (OU) closures on maternal and neonatal outcomes and (2) The association between travel distance/time to an OU and maternal and neonatal outcomes.
designSystematic review of any quantitative studies with a comparison group. DATA SOURCES: Embase, MEDLINE, PsycINFO, Applied Social Science Index and Abstracts, Cumulative Index to Nursing and Allied Health and grey literature were searched.
methodsEligible studies explored the impact of closure of an OU or the effect of travel distance/time on prespecified maternal or neonatal outcomes. Only studies of women giving birth in high-income countries with universal health coverage of maternity services comparable to the UK were included. Identification of studies, extraction of data and risk of bias assessment were undertaken by at least two reviewers independently. The risk of bias checklist was based on the Cochrane Effective Practice and Organisation of Care criteria and the Newcastle-Ottawa scale. Heterogeneity across studies precluded meta-analysis and synthesis was narrative, with key findings tabulated.
results31 studies met the inclusion criteria. There was some evidence to suggest an increase in babies born before arrival following OU closures and/or associated with longer travel distances or time. This may be associated with an increased risk of perinatal or neonatal mortality, but this finding was not consistent across studies. Evidence on other maternal and neonatal outcomes was limited but did not suggest worse outcomes after closures or with longer travel times/distances. Interpretation of findings for some studies was hampered by concerns around how accurately exposures were measured, and/or a lack of adjustment for confounders or temporal changes.
conclusionIt is not possible to conclude from this review whether OU closure, increased travel distances or times are associated with worse outcomes for the mother or the baby. PROSPERO REGISTRATION NUMBER: CRD42017078503.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.