Extent of legal status-defined support on maternal health care system in Beijing and Shanghai

Abstract

Objective To explore the extent of legal status-defined support on maternal health care system and the relationship between the support and maternal mortality in Beijing and Shanghai and to verify appropriate legal status of maternal health care system and its significance. Methods We systematically collect all normative legal documents related to maternal health issued by governmental agencies of the two cities and assessed extent of support of the legal documents on maternal health care system quantitatively based on the documents′ type and definition for legal status of maternal health care system. We adopted Spearman rank correlation and one-way linear regression to analyze the relationship between the extent of legal support on maternal health care and maternal mortality in the two cities. Results The appropriateness of the legal status of maternal health care system in Beijing and Shanghai showed an increasing trend year by year. The overall proportion of the maternal health programs with definite legal guarantees increased from 81.5% in 1990 to 96.3% in 2017 for the two cities. There was an inverse correlation between the appropriateness of maternal health care system and maternal mortality in both the cities, with the correlation coefficients of greater than 0.65. The results of fitted regression analysis demonstrated that 46.3% and 68.5% of the variation in the maternal mortality for the women in Beijing and Shanghai could be interpreted by the appropriateness of the legal status of maternal health care system. Conclusion Appropriate maternal health care system should clearly define the status, purpose, behavioral norms and the rights and responsibilities of all parties in the form of legal provisions. The implementation of maternal health care in Beijing and Shanghai has been guaranteed by relevant law regulations gradually but the responsibilities of various institutions for the implementation needs to be further clarified to strengthen the support of relevant law regulations. 【摘 要】 目的 评价京沪两地妇女保健法律地位保障程度及其与孕产妇死亡率的关系，验证适宜妇保体系的法律地位定位及其于京沪的意义。 方法 系统收集两地所有妇女保健相关的规范性法律文件，摘录“文件类型”“地位表述”等内容，量化计算法律地位的保障程度，并使用 Spearman 秩相关和线性回归模型分析妇女保健法律地位保障程度与孕产妇死亡率的关系。 结果 京沪两地妇女保健法律地位保障程度均呈现逐步上升的趋势，均从 1990 年的 81.5 % 上升至 2017 年的 96.3 %，并且与孕产妇死亡率均呈负相关（相关系数均大于 0.65）。拟合回归方程显示，京沪法律地位保障程度对孕产妇死亡率变化的解释程度分别为 46.3 % 和 68.5 %。 结论 适宜的妇女保健体系，应以法律的形式明确规定体系的地位、目的、行为规范和各方的权责关系等。两地妇保工作均已逐步得到法律规制的保障，但尚需通过明确职责、增强约束来充分发挥保障作用。