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Poster Session 4

Category: Health Equity/Community Health

Poster Session 4

(1070) Geographic and Social Burden of InterIsland Travel for Obstetric Delivery in Hawai’i

Thursday, February 12, 2026

3:30 PM - 5:00 PM

Submitting Author(s)

Elizabeth Mercer, MD, MS (she/her/hers)

MFM Fellow
University of Hawaii
Honolulu, Hawaii, United States

Coauthor(s)

KI

Kyle M. Ishikawa, MS

Biostatistical Analyst
University of Hawaii
Honolulu, Hawaii, United States
AB

April Binari, MBA

Healthcare Project Manager
University of Hawaii
Honolulu, Hawaii, United States
AG

Ashley Graham

Project Director
Pacific Basin Telehealth Resource Center
Honolulu, Hawaii, United States
Corrie Miller, DO

Assistant Professor
University of Hawaii
Honolulu, Hawaii, United States

Presenting Author(s)

Hyeong Jun Ahn, PhD

Associate Professor
University of Hawaii John A Burns School of Medicine Department of Quantitative Health Sciences
Honolulu, Hawaii, United States

Coauthor(s)

Men-Jean Lee, MD (she/her/hers)

Associate Chair
University of Hawaii
Honolulu, Hawaii, United States

Objective:
The objective of this study was to quantify the rate of pregnant patients in Hawai’i who must travel from neighbor islands to O’ahu for delivery and to measure the average distance traveled from their home ZIP code to the delivery hospital.

Study Design:
We conducted a population-based analysis using Hawai‘i birth registry data from 2014 to 2024, including all hospital deliveries statewide. For each ZIP code, we calculated the rate of interisland deliveries per 1,000 births and measured the driving and flight distance between the patient’s home and the delivery hospital.

Results:
As shown in Figure 1, the highest rates of interisland travel for delivery originated from Hawai’i Island (Big Island), followed by Maui and Kaua’i. Ni’ihau and Lana’i do not have delivery hospitals and only low risk, midwife attended deliveries occur on Moloka’i. Figure 2 demonstrates a wide distribution of travel distances among the 124,535 patients. On O’ahu, travel distances to delivery hospitals were comparable between short (31.5%), medium (32.5%) and long (32.9%) distances. Patients traveling from remote islands (Ni’ihau, Lana’i, and Moloka’i) accounted for 0.8% (1024), while those from other neighbor islands accounted for 2.3% (2851). Common reasons for interisland delivery included desire for trial of labor after cesarean, anticipated delivery before 35 weeks (due to the lack of NICU services on neighbor islands), and requirement for IV insulin during labor.

Conclusion:
Patients traveling from neighbor islands to O’ahu for delivery face significant geographic and social barriers, including housing insecurity, transportation logistics, and limited family support. Many patients must remain on O’ahu for extended periods if a NICU stay is required. Identifying ZIP codes with the highest burden of travel can inform targeted support services to reduce maternal stress, financial burden, and health inequities.