분만취약지 지원사업 정책 평가: 더 평등한 미래를 위한 제언

Abstract

Purpose: Although the government has promoted the Maternity Care Underserved Area Support program to ensure equitable access to safe maternity care, its expansion has stagnated, raising concerns about its sustainability and effectiveness. This study examined the status of the program over 14 years from a gender impact perspective, evaluated its achievements and limitations in improving maternal and child health and access to obstetric services, and proposed directions for improvement. Methods: This policy review employed a mixed-methods approach, combining a comprehensive literature review, quantitative analysis of administrative program data, and qualitative interviews with health providers, service users, and health policy experts. Results: As of 2024, the Maternity Care Underserved Area Support program operates in only 54 of the 108 designated underserved areas. The program demonstrated limited effectiveness in improving access to delivery services and reducing regional maternal health disparities, accounting for only 1.1% of total births in 2023. Key barriers to program effectiveness include fixed budgets since the program’s inception, restrictions on regional participation, an unstable workforce supply, inefficient performance indicators focused solely on within-district delivery rates, and a selective, delivery-centered support model. Conclusion: Overcoming these challenges requires transforming obstetric facilities in underserved areas into comprehensive women’s health hubs offering life course care. Priority policy reforms include broadening services beyond maternal care to encompass women’s health across all life stages, strengthening public health system integration, tailoring strategies to regional contexts, and empowering community governance. These structural changes are critical to establish an equitable and sustainable maternal and reproductive healthcare system at the community level.