Impacts of low birth rates on the geographical distribution of obstetricians and accessibility of obstetrics resources for parturient women

Abstract

© 2018 Chinese Public Health Association of Taiwan. All rights reserved. Objectives: Low birth rates can have substantial social impacts and comprise a challenge for the health care sector, especially obstetrics. To understand their influence on obstetrics services, this study aimed to quantify the impacts of low birth rates on the geographical distribution of obstetricians and the accessibility of obstetrics services for parturient women by using representative empirical data. Methods: Using Nationwide Health Insurance Database, we observed trends in childbirth and the mean number of deliveries per obstetrician from 2005 to 2009. Theoretical frameworks and spatial analysis were employed to analyze the changes in the geographical distribution of obstetricians and the accessibility of obstetrics services for parturient women. Finally, we used a gravity model to analyze the parturient women's trade-off of between the accessibility and availability of obstetrics services. Results: During the study period, childbirth decreased by 6.7%, and the number of obstetricians decreased by 5.4%. Meanwhile, the mean number of deliveries per obstetrician decreased by 1.6%. The changes in the aforementioned indicators were worse in rural areas than in urban areas. Some obstetricians withdrew from the market, some changed their practice location, especially to areas with a higher carrying capacity. Consequently, parturient women who lived in areas with a low urbanization level had to travel longer distances to obtain obstetrics services; thus, they preferred to obtain services in areas with better accessibility rather than better availability. Conclusions: This study demonstrated that low birth rates can lead to the geographical redistribution of obstetricians, which worsen accessibility for parturient women, particularly those living in rural areas. (Taiwan J Public Health. 2018;37(5):554-564).