PDF(Pubmed)
Abstract：
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
摘要：
背景:中国的计划生育政策经历了独生子女政策阶段,部分二胎政策，和普遍的二胎政策。然而,这些政策变化对妇女和儿童获得妇幼保健(MCH)服务的空间可及性的影响仍然不确定。这项研究旨在评估在二胎政策背景下对MCH服务的空间可达性的时空趋势和地理差异。
方法：本研究在南宁市进行，中国,从2013年到2019年。交通网络上的数据，妇幼保健机构，每年的新生儿数量，收集了南宁市每年的孕妇人数。采用高斯两步浮动集水区（Ga2SFCA）方法来测量县对MCH服务的空间可达性，乡镇，和村庄层面。使用Joinpoint回归分析分析了空间可达性的时间趋势。使用地理信息系统（GIS）制图技术确定了空间可达性的地理差异。
结果：总体而言，2013年至2019年，县级妇幼保健服务的空间可达性呈上升趋势，镇,和村庄层面，年平均百分比变化(AAPC)分别为5.04、4.73和5.39。具体来说,在父母双方独生子女的部分二胎政策期间，空间可达性经历了轻微的下降趋势(即，2013-2014),在父母一方独生子女的部分二胎政策期间略有上升趋势(即，2014-2016)和普遍二胎政策的早期阶段(即，2016-2018），以及普遍二胎政策后期的大幅上升趋势(即，2018-2019年）。从中心城区到周边农村，妇幼保健服务的空间可达性逐渐下降。空间可达性低的地区主要位于偏远的农村地区。
结论：随着二胎政策的逐步开放，妇女和儿童获得妇幼保健服务的空间可及性总体上有所改善。然而,在二胎政策的整个阶段，显著的地理差异一直存在。应考虑采取综合措施，提高妇幼保健服务对妇女和儿童的公平性。
方法：本研究在南宁市进行，中国,从2013年到2019年。交通网络上的数据，妇幼保健机构，每年的新生儿数量，收集了南宁市每年的孕妇人数。采用高斯两步浮动集水区（Ga2SFCA）方法来测量县对MCH服务的空间可达性，乡镇，和村庄层面。使用Joinpoint回归分析分析了空间可达性的时间趋势。使用地理信息系统（GIS）制图技术确定了空间可达性的地理差异。
结果：总体而言，2013年至2019年，县级妇幼保健服务的空间可达性呈上升趋势，镇,和村庄层面，年平均百分比变化(AAPC)分别为5.04、4.73和5.39。具体来说,在父母双方独生子女的部分二胎政策期间，空间可达性经历了轻微的下降趋势(即，2013-2014),在父母一方独生子女的部分二胎政策期间略有上升趋势(即，2014-2016)和普遍二胎政策的早期阶段(即，2016-2018），以及普遍二胎政策后期的大幅上升趋势(即，2018-2019年）。从中心城区到周边农村，妇幼保健服务的空间可达性逐渐下降。空间可达性低的地区主要位于偏远的农村地区。
结论：随着二胎政策的逐步开放，妇女和儿童获得妇幼保健服务的空间可及性总体上有所改善。然而,在二胎政策的整个阶段，显著的地理差异一直存在。应考虑采取综合措施，提高妇幼保健服务对妇女和儿童的公平性。
