Poster Presentation Australasian Diabetes in Pregnancy Society and Society of Obstetric Medicine Australia and New Zealand Joint Scientific Meeting 2021

Drawing the line: The impact of border closures on maternity care, a case report  (#85)

Grace Prentice 1 , Joseph Suttie 1
  1. Wagga Wagga Base Hospital, Wagga Wagga, NSW, Australia

The impact of COVID-19 in Australia reached far beyond the actual number of cases1. Policy restricting travel and the way patients interacted with health systems, altered the face of maternity care2. These effects were felt to be more profound amongst rural communities, as unpredictable and inconsistent state border closures disrupted standard processes of accessing healthcare3,4.

In July 2020, New South Wales (NSW) closed the border to Victoria following a daily total of 124 new cases of COVID-19. At this time, our case, a 37-year-old gravida 7 para 5, was 12+5 weeks pregnant. Her pregnancy was high risk (insulin dependent gestational diabetes, IgA nephropathy and Graves’ disease), therefore requiring management in a level 5 obstetric centre. The closest facility that could provide this care and offer the recommended fortnightly obstetrician review, was one 1 hour by road, across state lines in Victoria. Therefore, she was faced with the prospect of spending the remainder of her pregnancy in isolation, or, alternatively, travelling greater than 2.5 hours to access equivalent care in NSW4.  

The relationship between rural residence, travel time and poor perinatal outcomes is well established5. This case demonstrates that border closures, while successful in attenuating the spread of COVID-19, have the potential to exacerbate known health inequalities by enforcing new remoteness on rural communities3;5. Moreover, pregnancy is a time of traditionally increased medical observation, and the psychological impact of uncertain access to antenatal care during COVID-19 has been well documented2,3. Changing border policies, and their variation when implemented by different governments, serves as a reminder of the vulnerability of rural populations to access health systems that were not designed around state lines5.  Thus, we propose solutions including compassionate travel exemptions or negotiated cross-border “bubbles”, which take into consideration the ongoing need for border residents to access healthcare during COVID-19 outbreaks.  

 References:

  1. Sutherland, K. et al. Impact of COVID-19 on healthcare activity in NSW. J Public Health Rese, 2020, 30(4).
  2. Bradfield, Z. et al. Experiences of receiving and providing maternity care during the COVID-19 pandemic in Australia: A five-cohort cross-sectional comparison. PLOSONE, 16(3)
  3. Jones, V. Border closure: Maternity concern as letters become permits for patients, https://www.bordermail.com.au/story/6822909/maternity-concern-as-letters-become-permits-for-border-patients/ (2020, accessed 7 April 2021).
  4. NSW Health. Restrictions tightened for entry to NSW from Victoria, https://www.health.nsw.gov.au/news/Pages/20200724_04.aspx (2020, accessed 7 April 2021).
  5. Rolfe, M. et al. The distribution of maternity services across rural and remote Australia: does it reflect population need? BMC Health Serv Res, 163(2017).