Accessibility to delivery care in Hubei Province, China.

Accessibility to delivery care is crucial for improving maternal health, which is an important policy goal to ensure healthy lives and promote well-being in China and worldwide, especially with the change of the family planning policy in China in 2016. This study develops a set of methods to project the population of women of child-bearing age and birth population and assess the accessibility to delivery care services in Hubei Province. The Cohort-Component projection method with various scenarios was applied to project the population of women of children-bearing age in 2030. A Gravity-based Variable Two-Step Floating Catchment Area (GV2SFCA) method is developed, which takes into account the heterogeneous catchment areas and distance decay effects for different regions and various levels of delivery care services. The parameters are calibrated by using medical records with patients' addresses. The traditional Supply-Demand Ratio method is also applied. The results demonstrate an overall decreasing trend of birth population in Hubei in all scenarios, but with significant disparities across regions. In 2016, 28% of districts fail to reach the policy goal with 17 beds per thousand births. In 2030, accessibility to delivery care is projected to increase in 98% of districts, while there are still 22% of districts that fail to reach the policy goal. The accessibility scores are further combined with the densities of birth population to identify shortage areas of delivery care. 7% and 6% of districts are classified as Major Shortage Areas in 2016 and 2030, respectively. The findings shed lights on the distributions and future changes of accessibility to and shortage areas of delivery care in Hubei, which can provide evidence-based recommendations for planning and policymaking. It also provides innovative methods for more accurately assessing accessibility to delivery care.