Geographic variation of reproductive health indicators and outcomes in the United States: place matters

The social determinants of health are the circumstances in which people are born, grow up, live, work, and age and the systems put in place to deal with illness. These circumstances, in turn, are shaped by a wider set of forces: economics, social policies, and politics. Reproductive health indicators and conditions that are germane to obstetricians and gynecologists vary across states and regions in the United States as well as within regions and states. The aim of this article is to illustrate this variation with the use of examples of gynecologic malignancies, sexually transmitted infections, teen birth rates, preterm birth rates, and infant mortality rates. Using the example of infant death, the difficulties in "unpacking" the construct of place will be discussed, and a special emphasis is placed on the interaction of race, place, and disparities in shaping perinatal outcomes. Finally, readily available and easy-to-use online data resources will be provided so that obstetricians and gynecologists will be able to assess geographic variation in health indicators and outcomes in their own localities.