저출생시대 육아인프라 추이분석 및 대응 방안(Ⅰ): 임신・출산 관련 인프라 중심으로

Metadata Downloads
Title
저출생시대 육아인프라 추이분석 및 대응 방안(Ⅰ): 임신・출산 관련 인프라 중심으로
Alternative Title
An Analysis of Childcare Infrastructure Trend and the Responsive Policy in the Era of Low Fertility: Focusing on the Pregnancy and Childbirth Infrastructure
Author(s)
이재희김동훈김종근엄지원윤소정
Keyword
fertilitychild care and education infrastructureregional balance
Issued Date
2022-12-31
Publisher
육아정책연구소
URI
https://repo.kicce.re.kr/handle/2019.oak/5394
Abstract
This study intends to investigate the state and trend of the childcare infrastructure in the country experiencing rapid decrease in birthrate, and to suggest responsive measures in the both aspects of human and material infrastructure of the future through diagnosis of regional imbalances and demand forecasting of childcare infrastructure. For this objectives, first it examined the current state and trend of pregnancy and childbirth, as well as the changes in the population structure in Korea by longitudinal approach. Secondly, it investigated the state of pregnancy and childbirth infrastructure in Korea, including obstetrics and gynecology (ob/gyn), and pediatric hospitals, and conducted a geographic information system (GIS) analysis. Thirdly, it reviewed the relevant policies that support the regions that are lacking such infrastructure, both at the central and local government levels, and diagnosed issues and challenges to overcome. Fourthly, it conducted a survey to determine the demands of pregnancy and childbirth infrastructure by the households that just have or are expecting a child. Finally, it suggested a policy direction and improvement measure for the future pregnancy and childbirth infrastructure to meet the needs in the low birthrate era drew.
The examination of the fertility rate trend from 2012 to 2020 revealed that the rate has continuously declined to the extent that the total fertility rate was 0.84 in 2020. Accordingly, the number of ob/gyn and pediatric department in hospitals has been reduced drastically, so has the number of obstetrician and gynecologist, and pediatrician, gradually. As a result, the lack of pregnancy and childbirth infrastructure becomes increasingly serious in smaller cities and towns such as eup and myeon.
To resolve the lack of pregnancy and childbirth infrastructure, the central government is carrying out a support project for obstetrically underserved areas. The support project for obstetrically underserved areas is that for the purpose of the said objectives, the government provides or arranges provision of ob/gyn facility and equipment expenses to those areas which have no ob/gyn facility. hospitals or facility to assist childbirth. The support project is divided largely into labor ob/gyn support project (new establishment, and support for potentially vulnerable area), maternity outpatients ob/gyn support project, and mobile ob/gyn support project. At the same time, local governments are providing public postpartum care centers, transportation expenses support for the pregnant, mobile clinic buses, and healthcare support for new mothers and newborn babies, etc.
Also examined in this study was the state of pregnancy and childbirth infrastructure in the areas where women who gave birth within the last two years reside. As for the state of infrastructure, while most of the large cities, or mid-or small sized cities have ob/gyn clinics that assist childbirth, only about 37% of town and rural areas, or ‘eup/myeon’, have such facility therein. As for the emergency rooms, while about 90% of the large or mid- or small-sized city residents responded that they have one in their area, the eup and myeon residents who said that they have such their area were only a half of the former. The research has also found out that the average traveling time to the labor facility was approximately 27 minutes. More specifically, it takes about 24 minutes in large cities, about 29 minutes in mid-or small-sized cities, and about 36 minutes in eup and myeon, indicating that it takes relatively longer to get to a labor facility in eup and myeon level.
This study, then, conducted a hot/cold spot analysis with 2SFCA access scores on ob/gyn, pediatrics, and pediatric emergency care units, and calculated the scores. The analysis of the accessibility to available medical centers has revealed that labor and delivery facility hot spots include Seoul-Incheon, southern Gyeonggi-do, Busan and vicinity, Daejeon and Sejong and their vicinity, and Gangneung-si and Donghae-si in Gangwon-do. Pediatric hot spots include Seoul-Incheon, southern-Gyeonggi-do, Daegu, western Daejeon, and Sejong. Hot spots of pediatric emergency care include Seoul-Incheon and nearby Gyeonggi region, Gwangju and vicinity, Jeonju-si and vicinity in Jeollabuk-do, Wonju-si and vicinity, Gangneung-si and Donghae-si in Gangwon-do, Andong-si and Yongju-si and its vicinity in Gyeongsangbuk-do.
In addition, this study assessed the demands of pregnancy and childbirth policies through various methods. Based on the research results of the pregnancy and childbirth infrastructure state, the study conducted a logistic regression analysis to determine the influence of the pregnancy and childbirth infrastructure level over the people’s intentions to have any additional pregnancy and to relocate to specific locations. The results have showed that the younger the age and the higher the income is, the stronger the intention to have an additional pregnancy becomes, and that of the pregnancy and childbirth infrastructure, only the level of pediatrics service would affect the intention to have another pregnancy. As for the intention to relocate or move to another locations, the results have shown that such intention tends to decline where there are overall sufficient and good pregnancy and childbirth infrastructure in place.
The results of in-depth interviews on the pregnant women in obstetrically underserved areas have revealed that most of these women travel to an ob/gyn clinic located in a city far away from their own residence due to an absolute lack of ob/gyn clinic. More difficulties have been found in the availability of pediatric clinics. Many areas have no pediatric clinics at all, and even if a medical service exists, the residents find the level of service and expertise unsatisfactory and therefore are not willing to use the service. In addition, this study held a pregnancy and childbirth policy contest, and collected various policy suggestions from both prospective users and professionals in the field. Consequently, it has suggested a use of smartphone application which will be available in any areas of the country.
Based on the results of the research and analysis, this study suggests the following policy measures. First, we need to expand the essential public health infrastructure (ob/gyn, pediatrics, and pediatric emergency units). For this, it should be mandatory to establish ob/gyn, pediatrics, and pediatric emergency units in public healthcare facilities, and medical expenditure support for medically underserved areas and essential healthcare service must be implemented. Moreover, introduction of the national responsibility system for childbirth-related medical malpractice should be considered. Secondly, accommodation and transportation support for the households in the pregnancy, as well as the EMS transport system for mothers and newborns should be improved. Thirdly, provision of general postpartum care voucher and establishment of public postpartum care centers should be realized at a reasonable level. Finally, an integrated smartphone application for pregnancy and childbirth care should be developed to improve and assist various policy activities that are carried out by both the central and local governments in this regard.
Table Of Contents
요약 1

Ⅰ. 서론 13
1. 연구의 필요성 및 목적 15
2. 연구내용 18
3. 연구방법 19
4. 선행연구 30

Ⅱ. 임신·출산 실태 및 관련 인프라 현황 37
1. 지역별 임신・출산 현황 39
2. 임신・출산 건강 수준 43
3. 지역별 임신・출산 인프라 현황 50
4. 소결 56

Ⅲ. 임신・출산 인프라 지원 정책과 사례 59
1. 중앙정부의 임신・출산 인프라 지원 정책 61
2. 지자체의 임신・출산 인프라 지원 정책 및 사례 84
3. 소결 99

Ⅳ. 임신・출산 인프라 이용 실태 103
1. 지역 내 임신・출산 관련 인프라 현황 105
2. 임신・출산 인프라 이용 및 관련 정책 수혜 현황 113
3. 지역내 육아인프라 인식 159
4. 소결 174


Ⅴ. 임신・출산 인프라 지역별 구조와 진단 181
1. 임신・출산 및 육아 의료 서비스 수요와 공급지 분포 183
2. 임신・출산 인프라 군집 현황 195
3. 출산 및 영유아 의료서비스 접근성 206
4. 소결 222

Ⅵ. 임신・출산 정책 수요 225
1. 임신・출산인프라 수준이 출산 및 거주지 이전 의사에 미치는 효과 227
2. 심층면담 결과 230
3. 임신・출산 정책 공모전 결과 243
4. 소결 246

Ⅶ. 정책제언 249
1. 연구결과 종합 및 임신・출산 인프라 진단 251
2. 정책개선 방향 255

참고문헌 271
Abstract 283
부록 287
1. 설문지 287
2. 부표 302
3. 정책공모전 제안서 398
Appears in Collections:
연구보고서 > 2. 일반연구보고서
파일 목록
GR2205.pdf Download

qrcode

twitter facebook

Items in OAK are protected by copyright, with all rights reserved, unless otherwise indicated.

BROWSE