{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,4]],"date-time":"2026-04-04T21:24:44Z","timestamp":1775337884273,"version":"3.50.1"},"reference-count":52,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2021,1,30]],"date-time":"2021-01-30T00:00:00Z","timestamp":1611964800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.3390\/ijerph18031242","type":"journal-article","created":{"date-parts":[[2021,1,30]],"date-time":"2021-01-30T06:22:20Z","timestamp":1611987740000},"page":"1242","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Spatial Access Matters: An Analysis of Policy Change and Its Effects on Avoidable Infant Mortality in Portugal"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1779-7162","authenticated-orcid":false,"given":"Morgan","family":"Weiland","sequence":"first","affiliation":[{"name":"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"},{"name":"Centre of Studies in Geography and Spatial Planning (CEGOT), University of Coimbra, 3004-531 Coimbra, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7658-8475","authenticated-orcid":false,"given":"Paula","family":"Santana","sequence":"additional","affiliation":[{"name":"Centre of Studies in Geography and Spatial Planning (CEGOT), University of Coimbra, 3004-531 Coimbra, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7422-6139","authenticated-orcid":false,"given":"Claudia","family":"Costa","sequence":"additional","affiliation":[{"name":"Centre of Studies in Geography and Spatial Planning (CEGOT), University of Coimbra, 3004-531 Coimbra, Portugal"}]},{"given":"Julia","family":"Doetsch","sequence":"additional","affiliation":[{"name":"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"},{"name":"EPIUnit\u2013Instituto de Sa\u00fade P\u00fablica, Universidade do Porto, Rua das Taipas, n\u00b0 135, 4050-600 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3112-4447","authenticated-orcid":false,"given":"Eva","family":"Pilot","sequence":"additional","affiliation":[{"name":"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"},{"name":"Centre of Studies in Geography and Spatial Planning (CEGOT), University of Coimbra, 3004-531 Coimbra, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2021,1,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1002\/hpm.2613","article-title":"The health care reform in Portugal: Outcomes from both the New Public Management and the economic crisis","volume":"34","author":"Nunes","year":"2019","journal-title":"Int. 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