Degree

Doctor of Philosophy (PhD)

Department

Department of Geography and Anthropology

Document Type

Dissertation

Abstract

Access to obstetric care is essential for safe childbirth, yet obstetric hospitals (OBHOS) are unevenly distributed across space. Conventional access measures often rely on proximity-based assumptions, such as distance to the nearest hospital or fixed catchment areas. These measures may overlook how patients actually use OBHOS, how hospital capacity interacts with population demand, and how accessibility relates to delivery hospital choice. This dissertation examines obstetric care utilization, spatial accessibility, and delivery hospital choice in Florida through an integrated spatial and statistical framework. Using Florida birth records and obstetric hospital data, this dissertation addresses three objectives. First, it characterizes observed OBHOS utilization patterns using patient–hospital flows, including travel burden, bypass behavior, hospital destination diversity, and excess travel. Secondly, it develops a data-driven extension of the variable two-step floating catchment area (V2SFCA) method to measure spatial accessibility to obstetric hospitals. Empirical distance decay functions are derived from observed patient–hospital flows and incorporated into area-specific accessibility models to account for geographic heterogeneity in care-seeking behavior. Thirdly, it evaluates whether ZIP Code Tabulation Area (ZCTA)-level obstetric hospital accessibility is associated with individual delivery hospital choice using multilevel logistic regression. The results show that OBHOS utilization in Florida was spatially heterogeneous. Many patients did not use the nearest obstetric hospital, and ZCTAs varied in whether hospital choices were localized, concentrated, diversified, or fragmented. The data-driven accessibility measure revealed substantial inequality in access to OBHOS and showed that area-specific distance decay functions provide a more behaviorally informed representation than uniform catchment assumptions. Multilevel logistic regression results showed that one-standard-deviation increase in ZCTA-level accessibility of OBHOS was associated with higher odds of delivering there, while random effects indicated geographic variation in both baseline use and the accessibility–choice relationship. These findings demonstrate that obstetric care access is both a spatial resource distribution issue and a behavioral-contextual process. Accessibility matters for delivery hospital choice, but utilization is also shaped by patient behavior, regional healthcare markets, and local spatial contexts. This dissertation provides a behaviorally informed framework for evaluating obstetric care accessibility and planning obstetric hospital resources.

Date

5-15-2026

Committee Chair

Fahui Wang

LSU Acknowledgement

1

LSU Accessibility Acknowledgment

1

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Available for download on Monday, May 14, 2029

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