Spatial Access Matters: An Analysis of Policy Change and Its Effects on Avoidable Infant Mortality in Portugal

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Abstract

In 2006, a policy reform restructured the maternal and perinatal healthcare system, including closing smaller maternity units, to further improve care in Portugal. This study aimed to investigate the effects of the 2006 National Program of Maternal and Neonatal Health policy on spatial inequalities in access to care and consequently avoidable infant mortality. A thematic analysis of qualitative data including interviews and surveys and a quantitative spatial analysis using Geographic Information Systems was applied. Spatial inequalities were found which may lead to avoidable infant mortality. Inequalities exist in freedom of choice and autonomy in care, within a medicalized system. Changes in approach to and organization of care would further enhance equitable spatial access to care in maternal health and reduce avoidable infant mortality.

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Most cited references 52

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Financial crisis, austerity, and health in Europe.

Marina Karanikolos, Marina Karanikolos, Johan P Mackenbach … (2013)

The financial crisis in Europe has posed major threats and opportunities to health. We trace the origins of the economic crisis in Europe and the responses of governments, examine the effect on health systems, and review the effects of previous economic downturns on health to predict the likely consequences for the present. We then compare our predictions with available evidence for the effects of the crisis on health. Whereas immediate rises in suicides and falls in road traffic deaths were anticipated, other consequences, such as HIV outbreaks, were not, and are better understood as products of state retrenchment. Greece, Spain, and Portugal adopted strict fiscal austerity; their economies continue to recede and strain on their health-care systems is growing. Suicides and outbreaks of infectious diseases are becoming more common in these countries, and budget cuts have restricted access to health care. By contrast, Iceland rejected austerity through a popular vote, and the financial crisis seems to have had few or no discernible effects on health. Although there are many potentially confounding differences between countries, our analysis suggests that, although recessions pose risks to health, the interaction of fiscal austerity with economic shocks and weak social protection is what ultimately seems to escalate health and social crises in Europe. Policy decisions about how to respond to economic crises have pronounced and unintended effects on public health, yet public health voices have remained largely silent during the economic crisis. Copyright © 2013 Elsevier Ltd. All rights reserved.

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Method of delivery and pregnancy outcomes in Asia: the WHO global survey on maternal and perinatal health 2007-08.

Pisake Lumbiganon, Malinee Laopaiboon, A Gülmezoglu … (2010)

There has been concern about rising rates of caesarean section worldwide. This Article reports the third phase of the WHO global survey, which aimed to estimate the rate of different methods of delivery and to examine the relation between method of delivery and maternal and perinatal outcomes in selected facilities in Africa and Latin America in 2004-05, and in Asia in 2007-08. Nine countries participated in the Asia global survey: Cambodia, China, India, Japan, Nepal, Philippines, Sri Lanka, Thailand, and Vietnam. In each country, the capital city and two other regions or provinces were randomly selected. We studied all women admitted for delivery during 3 months in institutions with 6000 or fewer expected deliveries per year and during 2 months in those with more than 6000 deliveries. We gathered data for institutions to obtain a detailed description of the health facility and its resources for obstetric care. We obtained data from women's medical records to summarise obstetric and perinatal events. We obtained data for 109 101 of 112 152 deliveries reported in 122 recruited facilities (97% coverage), and analysed 107 950 deliveries. The overall rate of caesarean section was 27.3% (n=29 428) and of operative vaginal delivery was 3.2% (n=3465). Risk of maternal mortality and morbidity index (at least one of: maternal mortality, admission to intensive care unit [ICU], blood transfusion, hysterectomy, or internal iliac artery ligation) was increased for operative vaginal delivery (adjusted odds ratio 2.1, 95% CI 1.7-2.6) and all types of caesarean section (antepartum without indication 2.7, 1.4-5.5; antepartum with indication 10.6, 9.3-12.0; intrapartum without indication 14.2, 9.8-20.7; intrapartum with indication 14.5, 13.2-16.0). For breech presentation, caesarean section, either antepartum (0.2, 0.1-0.3) or intrapartum (0.3, 0.2-0.4), was associated with improved perinatal outcomes, but also with increased risk of stay in neonatal ICU (2.0, 1.1-3.6; and 2.1, 1.2-3.7, respectively). To improve maternal and perinatal outcomes, caesarean section should be done only when there is a medical indication. US Agency for International Development (USAID); UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), WHO, Switzerland; Ministry of Health, Labour and Welfare of Japan; Ministry of Public Health, China; and Indian Council of Medical Research. Copyright 2010 Elsevier Ltd. All rights reserved.

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Maternal age and risk of labor and delivery complications.

Patricia A Cavazos-Rehg, Melissa J Krauss, Edward L. Spitznagel … (2015)

We utilized an updated nationally representative database to examine associations between maternal age and prevalence of maternal morbidity during complications of labor and delivery. We used hospital inpatient billing data from the 2009 United States Nationwide Inpatient Sample, part of the Healthcare Cost and Utilization Project. To determine whether the likelihood that maternal morbidity during complications of labor and delivery differed among age groups, separate logistic regression models were run for each complication. Age was the main independent variable of interest. In analyses that controlled for demographics and clinical confounders, we found that complications with the highest odds among women, 11-18 years of age, compared to 25-29 year old women, included preterm delivery, chorioamnionitis, endometritis, and mild preeclampsia. Pregnant women who were 15-19 years old had greater odds for severe preeclampsia, eclampsia, postpartum hemorrhage, poor fetal growth, and fetal distress. Pregnant women who were ≥35 years old had greater odds for preterm delivery, hypertension, superimposed preeclampsia, severe preeclampsia, and decreased risk for chorioamnionitis. Older women (≥40 years old) had increased odds for mild preeclampsia, fetal distress, and poor fetal growth. Our findings underscore the need for pregnant women to be aware of the risks associated with extremes of age so that they can watch for signs and symptoms of such complications.

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Author and article information

Contributors

Paul B. Tchounwou: Role: Academic Editor

Journal

Journal ID (nlm-ta): Int J Environ Res Public Health

Journal ID (iso-abbrev): Int J Environ Res Public Health

Journal ID (publisher-id): ijerph

Title: International Journal of Environmental Research and Public Health

Publisher: MDPI

ISSN (Print): 1661-7827

ISSN (Electronic): 1660-4601

Publication date (Electronic): 30 January 2021

Publication date (Print): February 2021

Volume: 18

Issue: 3

Electronic Location Identifier: 1242

Affiliations

[1 ]Department of Health, Ethics and Society, Faculty of Health, Medicine and Life Sciences (FHML), Care and Public Health Research Institute (CAPHRI), Maastricht University, 6220 MD Maastricht, The Netherlands; morganweiland@ 123456btinternet.com (M.W.); julia.nadine.doetsch@ 123456gmail.com (J.D.)

[2 ]Centre of Studies in Geography and Spatial Planning (CEGOT), University of Coimbra, 3004-531 Coimbra, Portugal; paulasantana@ 123456uc.pt (P.S.); claudiampcosta@ 123456uc.pt (C.C.)

[3 ]EPIUnit–Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n° 135, 4050-600 Porto, Portugal

Author notes

[* ]Correspondence: Eva.pilot@ 123456maastrichtuniversity.nl ; Tel.: +31-43-3881144

Author information

Morgan Weiland https://orcid.org/0000-0002-1779-7162

Paula Santana https://orcid.org/0000-0002-7658-8475

Claudia Costa https://orcid.org/0000-0002-7422-6139

Eva Pilot https://orcid.org/0000-0003-3112-4447

Article

Publisher ID: ijerph-18-01242

DOI: 10.3390/ijerph18031242

PMC ID: 7908299

PubMed ID: 33573190

SO-VID: 41b18113-c37a-4327-ab39-f1cbe944260f

License:

Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

Spatial Access Matters: An Analysis of Policy Change and Its Effects on Avoidable Infant Mortality in Portugal

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Most cited references 52

Financial crisis, austerity, and health in Europe.

Method of delivery and pregnancy outcomes in Asia: the WHO global survey on maternal and perinatal health 2007-08.

Maternal age and risk of labor and delivery complications.

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