Institute of Geography and Geology, University of Wuerzburg, Wuerzburg, Germany.
Institute of Psychology, Friedrich-Schiller-University of Jena, Jena, Germany.
PLoS One. 2022 Jul 6;17(7):e0270834. doi: 10.1371/journal.pone.0270834. eCollection 2022.
While the place of birth plays a crucial role for women's birth experiences, the interest in out-of-hospital births has increased during the Covid-19 pandemic. Related to this, various international policies recommend enabling women to choose where to give birth. We aimed to analyze Swiss women's choice between birth hospitals and birth centers. Employing spatial accessibility analysis, we incorporated four data types: highly disaggregated population data, administrative data, street network data, addresses of birth hospitals and birth centers. 99.8% of Swiss women of childbearing age were included in the analysis (N = 1.896.669). We modelled car travel times from a woman's residence to the nearest birth hospital and birth center. If both birth settings were available within 30 minutes, a woman was considered to have a true choice. Only 58.2% of women had a true choice. This proportion varied considerably across Swiss federal states. The main barrier to a true choice was limited accessibility of birth centers. Median travel time to birth hospitals was 9.8 (M = 12.5), to birth centers 23.9 minutes (M = 28.5). Swiss women are insufficiently empowered to exercise their reproductive autonomy as their choice of place of birth is significantly limited by geographical constraints. It is an ethical and medical imperative to provide women with a true choice. We provide high-resolution insights into the accessibility of birth settings and strong arguments to (re-)examine the need for further birth centers (and birth hospitals) in specific geographical areas. Policy-makers are obligated to improve the accessibility of birth centers to advance women's autonomy and enhance maternal health outcomes after childbirth. The Covid-19 pandemic offers an opportunity to shift policy.
虽然出生地对女性的分娩经历起着至关重要的作用，但在 COVID-19 大流行期间，人们对非医院分娩的兴趣有所增加。与此相关的是，各种国际政策都建议让女性能够选择在哪里分娩。我们旨在分析瑞士女性在分娩医院和分娩中心之间的选择。我们采用空间可达性分析，纳入了四种数据类型：高度细化的人口数据、行政数据、街道网络数据、分娩医院和分娩中心的地址。分析包括了 99.8%的瑞士育龄妇女（N=1896669）。我们模拟了从女性住所到最近的分娩医院和分娩中心的汽车旅行时间。如果这两种分娩环境都在 30 分钟内，那么女性就被认为有真正的选择。只有 58.2%的女性有真正的选择。这种比例在瑞士各州之间差异很大。真正选择的主要障碍是分娩中心的可达性有限。前往分娩医院的平均旅行时间为 9.8 分钟（M=12.5），前往分娩中心的平均旅行时间为 23.9 分钟（M=28.5）。瑞士女性行使生育自主权的能力不足，因为她们选择分娩地点的自由受到地理限制的严重限制。为女性提供真正的选择是一种伦理和医疗上的必要。我们提供了有关分娩环境可达性的高分辨率见解，并提供了强有力的论据来（重新）审视在特定地理区域进一步开设分娩中心（和分娩医院）的必要性。政策制定者有义务改善分娩中心的可达性，以提高女性自主权，并改善产后产妇健康状况。COVID-19 大流行提供了一个改变政策的机会。
