Department of Epidemiology and Biostatistics, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China.
Nanning Center for Disease Control and Prevention, Nanning, Guangxi, China.
BMC Health Serv Res. 2024 Aug 15;24(1):934. doi: 10.1186/s12913-024-11415-z.
China's family planning policies have experienced stages of one-child policy, partial two-child policy, and universal two-child policy. However, the impact of these policy shifts on the spatial accessibility to maternal and child health (MCH) services for women and children remains uncertain. This study aimed to evaluate the spatiotemporal trends and geographic disparities in spatial accessibility to MCH services in the context of two-child polices.
This study was conducted in Nanning prefecture, China, from 2013 to 2019. Data on the transportation networks, MCH institutes, the annual number of newborns, and the annual number of pregnant women in Nanning prefecture were collected. Gaussian two-step floating catchment area (Ga2SFCA) method was employed to measure the spatial accessibility to MCH services at county, township, and village levels. Temporal trends in spatial accessibility were analyzed using Joinpoint regression analysis. Geographic disparities in spatial accessibility were identified using geographic information system (GIS) mapping techniques.
Overall, the spatial accessibility to MCH services showed an upward trend from 2013 to 2019 at county, town, and village levels, with the average annual percent change (AAPC) being 5.04, 4.73, and 5.39, respectively. Specifically, the spatial accessibility experienced a slight downward trend during the period of partial two-child policy for both parents only children (i.e., 2013-2014), a slight upward trend during the period of partial two-child policy for either parent only child (i.e., 2014-2016) and the early stages of universal two-child policy (i.e., 2016-2018), and a large upward trend in the later stages of universal two-child policy (i.e., 2018-2019). Spatial accessibility to MCH services gradually decreased from central urban areas to surrounding rural areas. Regions with low spatial accessibility were predominantly located in remote rural areas.
With the gradual opening of the two-child policies, the spatial accessibility to MCH services for women and children has generally improved. However, significant geographic disparities have persisted throughout the stages of the two-child policies. Comprehensive measures should be considered to improve equity in MCH services for women and children.
中国的计划生育政策经历了独生子女政策、部分二孩政策和普遍二孩政策三个阶段。然而，这些政策变化对妇女和儿童获得妇幼保健（MCH）服务的空间可达性的影响尚不确定。本研究旨在评估二孩政策背景下 MCH 服务空间可达性的时空趋势和地理差异。
本研究在中国南宁市进行，时间范围为 2013 年至 2019 年。收集了南宁市交通网络、MCH 机构、新生儿年数量和孕妇年数量的数据。采用高斯两步浮动集水区（Ga2SFCA）方法测量县、乡、村各级 MCH 服务的空间可达性。使用 Joinpoint 回归分析方法分析空间可达性的时间趋势。使用地理信息系统（GIS）制图技术确定空间可达性的地理差异。
总体而言，2013 年至 2019 年，县、乡、村各级 MCH 服务的空间可达性呈上升趋势，平均年变化百分比（AAPC）分别为 5.04%、4.73%和 5.39%。具体而言，在只有父母一方是独生子女的部分二孩政策期间（即 2013-2014 年），空间可达性略有下降；在只有父母一方是独生子女的部分二孩政策期间（即 2014-2016 年）和普遍二孩政策的早期阶段（即 2016-2018 年），空间可达性略有上升；在普遍二孩政策的后期阶段（即 2018-2019 年），空间可达性大幅上升。MCH 服务的空间可达性从城市中心逐渐向周边农村地区递减。空间可达性较低的地区主要位于偏远农村地区。
随着二孩政策的逐步放开，妇女和儿童获得 MCH 服务的空间可达性总体上有所提高。然而，在二孩政策的各个阶段，仍然存在显著的地理差异。应考虑采取综合措施，提高妇女和儿童的 MCH 服务公平性。
