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

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  • Morgan Weiland

    (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
    Centre of Studies in Geography and Spatial Planning (CEGOT), University of Coimbra, 3004-531 Coimbra, Portugal)

  • Paula Santana

    (Centre of Studies in Geography and Spatial Planning (CEGOT), University of Coimbra, 3004-531 Coimbra, Portugal)

  • Claudia Costa

    (Centre of Studies in Geography and Spatial Planning (CEGOT), University of Coimbra, 3004-531 Coimbra, Portugal)

  • Julia Doetsch

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

  • Eva Pilot

    (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
    Centre of Studies in Geography and Spatial Planning (CEGOT), University of Coimbra, 3004-531 Coimbra, Portugal)

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.

Suggested Citation

  • Morgan Weiland & Paula Santana & Claudia Costa & Julia Doetsch & Eva Pilot, 2021. "Spatial Access Matters: An Analysis of Policy Change and Its Effects on Avoidable Infant Mortality in Portugal," IJERPH, MDPI, vol. 18(3), pages 1-18, January.
    • Handle: RePEc:gam:jijerp:v:18:y:2021:i:3:p:1242-:d:489961
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    References listed on IDEAS

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    1. Adriana Castelli & Olena Nizalova, 2011. "Avoidable mortality: what it means and how it is measured," Working Papers 063cherp, Centre for Health Economics, University of York.
    2. Anna Dixon & Elias Mossialos, 2000. "Has the Portuguese NHS Achieved its Objectives of Equity and Efficiency?," International Social Security Review, John Wiley & Sons, vol. 53(4), pages 49-78, November.
    3. Santana, Paula, 2002. "Poverty, social exclusion and health in Portugal," Social Science & Medicine, Elsevier, vol. 55(1), pages 33-45, July.
    4. Alexandre Morais Nunes & Diogo Cunha Ferreira, 2019. "The health care reform in Portugal: Outcomes from both the New Public Management and the economic crisis," International Journal of Health Planning and Management, Wiley Blackwell, vol. 34(1), pages 196-215, January.
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