Maternal and Child Health Journal

, Volume 22, Issue 1, pp 101–110 | Cite as

Travel Time to Hospital for Childbirth: Comparing Calculated Versus Reported Travel Times in France

  • Hugo PilkingtonEmail author
  • Caroline Prunet
  • Béatrice Blondel
  • Hélène Charreire
  • Evelyne Combier
  • Marc Le Vaillant
  • Jeanne-Marie Amat-Roze
  • Jennifer Zeitlin


Objectives Timely access to health care is critical in obstetrics. Yet obtaining reliable estimates of travel times to hospital for childbirth poses methodological challenges. We compared two measures of travel time, self-reported and calculated, to assess concordance and to identify determinants of long travel time to hospital for childbirth. Methods Data came from the 2010 French National Perinatal Survey, a national representative sample of births (N = 14 681). We compared both travel time measures by maternal, maternity unit and geographic characteristics in rural, peri-urban and urban areas. Logistic regression models were used to study factors associated with reported and calculated times ≥30 min. Cohen’s kappa coefficients were also calculated to estimate the agreement between reported and calculated times according to women’s characteristics. Results In urban areas, the proportion of women with travel times ≥30 min was higher when reported rather than calculated times were used (11.0 vs. 3.6%). Longer reported times were associated with non-French nationality [adjusted odds ratio (aOR) 1.3 (95% CI 1.0–1.7)] and inadequate prenatal care [aOR 1.5 (95% CI 1.2–2.0)], but not for calculated times. Concordance between the two measures was higher in peri-urban and rural areas (52.4 vs. 52.3% for rural areas). Delivery in a specialised level 2 or 3 maternity unit was a principal determinant of long reported and measured times in peri-urban and rural areas. Conclusions for Practice The level of agreement between reported and calculated times varies according to geographic context. Poor measurement of travel time in urban areas may mask problems in accessibility.


Accessibility Travel time Hospital planning Perinatal care France 



National Institute for Statistics and Economic Studies


National Perinatal Survey


Zonage en aires urbaines et aires d’emploi de l’espace rural



Grant from the French Institute for Public Health Research programme “Territories and Health 2008”. This source of funding had no involvement in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.

Compliance with Ethical Standards

Conflict of interest

No conflict of interest for any of the contributors.

Ethical Approval

The National Council on Statistical Information (Comité du Label) and the French Commission on Information Technology and Liberties (CNIL) approved this survey (Registration No. 909003).

Supplementary material

10995_2017_2359_MOESM1_ESM.docx (89 kb)
Supplementary material 1 (DOCX 88 KB)


  1. Attar, M. A., Hanrahan, K., Lang, S. W., Gates, M. R., & Bratton, S. L. (2006). Pregnant mothers out of the perinatal regionalization’s reach. Journal of Perinatology, 26(4), 210–214. doi: 10.1038/ Scholar
  2. Baillot, A., & Evain, F. (2012). Les maternités : un temps d’accès stable malgré les fermetures (Etudes et Résultats No. 814) (p. 8). Drees.Google Scholar
  3. Blondel, B., Drewniak, N., Pilkington, H., & Zeitlin, J. (2011). Out-of-hospital births and the supply of maternity units in France. Health and Place, 17(5), 1170–1173. doi: 10.1016/j.healthplace.2011.06.002.CrossRefPubMedGoogle Scholar
  4. Blondel, B., Lelong, N., Kermarrec, M., Goffinet, F., & National Coordination Group of the National Perinatal Surveys. (2012). Trends in perinatal health in France from 1995 to 2010. Results from the French National Perinatal Surveys. Journal De Gynécologie, Obstétrique Et Biologie De La Reproduction, 41(4), e1–e15. doi: 10.1016/j.jgyn.2012.04.014.CrossRefPubMedGoogle Scholar
  5. Clanché, F., & Rascol, O. (2011). Le découpage en unités urbaines de 2010. Insee Première, (1364).Google Scholar
  6. Combier, E., Charreire, H., Le Vaillant, M., Michaut, F., Ferdynus, C., Amat-Roze, J.-M., … Zeitlin, J. (2013). Perinatal health inequalities and accessibility of maternity services in a rural French region: Closing maternity units in Burgundy. Health and Place, 24, 225–233.CrossRefPubMedGoogle Scholar
  7. Coulm, B., Blondel, B., Alexander, S., Boulvain, M., Le Ray, C. (2016). Elective induction of labour and maternal request: a national population-based study. BJOG, 123, 2191–2197. doi: 10.1111/1471-0528.13805.CrossRefPubMedGoogle Scholar
  8. Crompton, A. (2006). Perceived distance in the city as a function of time. Environment and Behavior, 38(2), 173–182. doi: 10.1177/0013916505276743.CrossRefGoogle Scholar
  9. Crompton, A., & Brown, F. (2006). Distance estimation in a small-scale environment. Environment and Behavior, 38(5), 656–666. doi: 10.1177/0013916505281571.CrossRefGoogle Scholar
  10. Ebener, S., Guerra-Arias, M., Campbell, J., Tatem, A. J., Moran, A. C., Johnson, F. A., Fogstad, H., Stenberg, K., Neal, S., Bailey, P., Porter, R., & Matthews, Z. (2015). The geography of maternal and newborn health: the state of the art. International Journal of Health Geographics, 14, 19. doi: 10.1186/s12942-015-0012-x.CrossRefPubMedPubMedCentralGoogle Scholar
  11. Fleischman, R. J., Lundquist, M., Jui, J., Newgard, C. D., & Warden, C. (2013). Predicting ambulance time of arrival to the emergency department using global positioning system and Google maps. Prehospital emergency care: Official Journal of the National Association of EMS Physicians and the National Association of State EMS Directors, 17, 458–465. doi: 10.3109/10903127.2013.811562.CrossRefGoogle Scholar
  12. Floch, J.-M., & Lévy, D., (2011). Le nouveau zonage en aires urbaines de 2010. Poursuite de la périurbanisation et croissance des grandes aires urbaines. Insee Première.Google Scholar
  13. Grzybowski, S., Stoll, K., & Kornelsen, J. (2011). Distance matters: a population based study examining access to maternity services for rural women. BMC Health Services Research, 11, 147. doi: 10.1186/1472-6963-11-147.CrossRefPubMedPubMedCentralGoogle Scholar
  14. INSEE. Définitions et méthodes—Zonage en aires urbaines/ZAU. (2013). Retrieved June 6, 2015 from
  15. Kornelsen, J., Moola, S., & Grzybowski, S. (2009). Does distance matter? Increased induction rates for rural women who have to travel for intrapartum care. Journal of Obstetrics and Gynaecology Canada: JOGC (Journal D’obstétrique et Gynécologie Du Canada: JOGC), 31(1), 21–27.CrossRefGoogle Scholar
  16. Papiernik, E., & Keith, L. G. (1995). The regionalization of perinatal care in France—description of a missing policy. European Journal of Obstetrics and Gynecology and Reproductive Biology, 61(2), 99–103. doi: 10.1016/0301-2115(95)02107-I.CrossRefPubMedGoogle Scholar
  17. Pilkington, H., Blondel, B., Drewniak, N., & Zeitlin, J. (2014). Where does distance matter? Distance to the closest maternity unit and risk of foetal and neonatal mortality in France. The European Journal of Public Health, 24(6), 904–909.CrossRefPubMedCentralGoogle Scholar
  18. Pilkington, H., Blondel, B., Carayol, M., Breart, G., & Zeitlin, J. (2008). Impact of maternity unit closures on access to obstetrical care: The French experience between 1998 and 2003. Social Science and Medicine (1982), 67(10), 1521–1529. doi: 10.1016/j.socscimed.2008.07.021.CrossRefGoogle Scholar
  19. Pilkington, H., Blondel, B., Drewniak, N., & Zeitlin, J. (2012). Choice in maternity care: associations with unit supply, geographic accessibility and user characteristics. International Journal of Health Geographics, 11, 35. doi: 10.1186/1476-072X-11-35.CrossRefPubMedPubMedCentralGoogle Scholar
  20. Poeran, J., Maas, A. F. G., Birnie, E., Denktas, S., Steegers, E. A. P., & Bonsel, G. J. (2013). Social deprivation and adverse perinatal outcomes among Western and non-Western pregnant women in a Dutch urban population. Social Science and Medicine (1982), 83, 42–49. doi: 10.1016/j.socscimed.2013.02.008.CrossRefGoogle Scholar
  21. Quantin, C., Cottenet, J., Vuagnat, A., Prunet, C., Mouquet, M.-C., Fresson, J., & Blondel, B. (2014). Quality of perinatal statistics from hospital discharge data: Comparison with civil registration and the 2010 National Perinatal Survey. Journal de Gynécologie Obstétrique et Biologie de la Reproduction, 43, 680–690. doi: 10.1016/j.jgyn.2013.09.004.CrossRefGoogle Scholar
  22. Ravelli, A. C. J., Jager, K. J., de Groot, M. H., Erwich, J. J. H. M., Rijninks-van Driel, G. C., Tromp, M., … Mol, B. W. J. (2011). Travel time from home to hospital and adverse perinatal outcomes in women at term in the Netherlands. BJOG: An International Journal of Obstetrics and Gynaecology, 118(4), 457–465. doi: 10.1111/j.1471-0528.2010.02816.x.CrossRefGoogle Scholar
  23. Samra, H. A., McGrath, J. M., Wey, H., Bette, S., Sheri, F., & Beverly, J. (2013). The influence of geographic isolation on late preterm infant and mother outcomes. Advances in Neonatal Care: Official Journal of the National Association of Neonatal Nurses, 13(3), 205–215. doi: 10.1097/ANC.0b013e318285fd58.CrossRefGoogle Scholar
  24. Stetson, C., Fiesta, M. P., & Eagleman, D. M. (2007). Does time really slow down during a frightening event?. PLoS ONE, 2(12), e1295. doi: 10.1371/journal.pone.0001295.CrossRefPubMedPubMedCentralGoogle Scholar
  25. Wang, F., & Xu, Y. (2011). Estimating O–D travel time matrix by Google Maps API: Implementation, advantages, and implications. Annals of GIS, 17(4):199–209.Google Scholar
  26. Zeitlin, J., Charreire, H., Combier, É., Pilkington, H., & Topuz, B. (2008). Le choix d’une maternité dépend-il de contraintes sociales et géographiques? In De la pilule au bébé-éprouvette: choix individuels ou stratégies médicales? INED.Google Scholar
  27. Zeitlin, J., Mortensen, L., Cuttini, M., Lack, N., Nijhuis, J., Haidinger, G., … Hindori-Mohangoo, A. (2015). Declines in stillbirth and neonatal mortality rates in Europe between 2004 and 2010: Results from the Euro-Peristat project. Journal of Epidemiology and Community Health. doi: 10.1136/jech-2015-207013.PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Hugo Pilkington
    • 1
    Email author
  • Caroline Prunet
    • 2
  • Béatrice Blondel
    • 2
  • Hélène Charreire
    • 3
  • Evelyne Combier
    • 4
  • Marc Le Vaillant
    • 5
  • Jeanne-Marie Amat-Roze
    • 3
  • Jennifer Zeitlin
    • 2
  1. 1.Département de Géographie, Université Paris 8 Vincennes-Saint-Denis, UMR7533 LadyssSaint-DenisFrance
  2. 2.INSERM U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Research on Epidemiology and Statistics Sorbonne Paris Cité (CRESS)Paris Descartes UniversityParisFrance
  3. 3.Université Paris-Est, LabUrba, Ecole d’urbanisme de ParisCréteilFrance
  4. 4.Centre d’épidémiologie des populations (CEP)University of Burgundy, EA4184 CHU, Hôpital du BocageDijonFrance
  5. 5.Centre de Recherche, médecine, sciences, santé, santé mentale, société (CERMES3) INSERM U988 - CNRS UMR 8211Villejuif CedexFrance

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