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. 2024 Aug 15;24(1):934.
doi: 10.1186/s12913-024-11415-z.

Spatiotemporal trends and geographic disparities in spatial accessibility to maternal and child health services in Nanning, China: impact of two-child policies

Qinglian Qin #  1 , Bin Xu #  2 , Xinxuan Hu #  1 , Xue Wei  3 , Yulu Su  3 , Xianyan Tang  4
Affiliations

Spatiotemporal trends and geographic disparities in spatial accessibility to maternal and child health services in Nanning, China: impact of two-child policies

Qinglian Qin et al. BMC Health Serv Res. .

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.

Conclusion: 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.

Keywords: Geographic disparities; Maternal and child health services; Spatial accessibility; Spatiotemporal trends; Two-child policies.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Geographical location of Nanning prefecture in China
Fig. 2
Fig. 2
Temporal trends of spatial accessibility to MCH services in Nanning prefecture from 2013 to 2019. A At county level; (B) At town level; (C) At village level
Fig. 3
Fig. 3
County-level geographic disparities in spatial accessibility to MCH services in Nanning prefecture. A 2013, (B) 2014, (C) 2016, (D) 2019
Fig. 4
Fig. 4
Township-level geographic disparities in spatial accessibility to MCH services in Nanning prefecture. A 2013, (B) 2014, (C) 2016, (D) 2019
Fig. 5
Fig. 5
Village-level geographic disparities in spatial accessibility to MCH services in Nanning prefecture. A 2013, (B) 2014, (C) 2016, (D) 2019
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