The Research On The Obstetric Service Provision And The Obstetric Health Resources Allocation In Key Monitoring Areas Under The New Adjusted Family Planning Policy

ObjectiveTo analyze the situation of the obstetric service provision,the obstetric health resources allocation and utilization,and the fairness and efficiency of the obstetric health resources allocation and its changing trends in key monitoring areas before and after the new adjusted family planning policy,discover the problems in the obstetric health resources allocation,and provide references and policy suggestions for further optimizing the obstetric health resources allocation.MethodBased on the monitoring data collected from three continued surveillance projects which were founded by China-WHO Biennial Collaborative Projects.Descriptive analysis was used on the obstetric service provision,the obstetric health resources allocation and utilization and its changing trends.Lorenz curve,Gini coefficient were used to evaluate the fairness of the obstetric health resources allocation.Data Envelopment Analysis was used to evaluate the efficiency of obstetric health resources allocation.ResultsFrom 2013 to 2019,the number of obstetric outpatient clinics and live births in key monitoring areas showed a gradual increase,and peaked in 2014 and 2016,and then the growth trend slowed down and gradually approached the level before the new adjusted family planning policy.The proportion of "policy second-child" live births from 2014 to 2017 had shown an increase,reaching 33.9%in 2017.The proportion of high-risk pregnant women from 2016 to 2019 had shown an increase,reaching 66.4%in 2019.The proportion of obstetric outpatient clinics and live births in public tertiary midwifery medical institutions had shown an increase,reaching 72.1%and 72.8%in 2019,respectively.The obstetric services provided by other types of midwifery medical institutions had shown a decrease.From 2013 to 2019,the obstetric beds in key monitoring areas showed an increase,with an average growth rate of 2.1%,mainly in public tertiary and private midwifery medical institutions.The utilization rate of obstetric beds in public tertiary midwifery medical institutions was the highest(above 90%),and exceeded 100%in 2014 and 2016.The utilization rate of obstetric beds in public secondary midwifery medical institutions ranged from 59.6%to 80.9%,and that in private midwifery medical institutions and public primary midwifery medical institutions ranged from 42.7%to 63.5%.Before and after the new adjusted family planning policy,the proportion of obstetricians in public tertiary midwifery institutions showed an increase,reaching 57.9%in 2019,but the number of obstetricians per 1,000 live births showed a decrease.With the new adjusted family planning policy,the obstetrician’s work load had decreased except for public tertiary midwifery medical institutions.The obstetricians in public tertiary midwifery institutions had the highest work load of outpatient and inpatient,followed by public secondary midwifery institutions,public primary and private midwifery institutions.Based on the distribution of permanent population,the Gini coefficients of obstetric beds and obstetricians were less than 0.3.Based on the distribution of population density,the Gini coefficients of obstetric beds and obstetricians were between 0.4 and 0.5.Based on the distribution of geographical area,the Gini coefficients of obstetric beds and obstetricians were above 0.6.The efficiency of obstetric health resources allocation had improved with the new adjusted family planning policy,but there were still some problems,such as excessive input or insufficient output,and excessive or undersize health resources scale.ConclusionIn the initial stage of the new birth policy adjustment,the obstetric beds and obstetrician in the key monitoring areas were inadequacy,but were supplemented in time to meet the increasing demand for live births.After 2017,the utilization rate of obstetric beds and the obstetrician’s work load have been significantly reduced except for public tertiary midwifery medical institutions,and the imbalance of obstetric health resources utilization was becoming more and more obvious.There were a series of problems in the geographical distribution and the allocation efficiency of the obstetric health resources.At the same time,there were also great challenges in the management of high-risk pregnant women in key monitoring areas.It is suggested that the monitoring areas should reasonably plan obstetric health resources based on actual conditions,strengthen the construction of the obstetric service capacity and quality of midwifery medical institutions,and encourage pregnant women to select reasonable types of midwifery medical institutions based on their pregnancy risk levels.