Maternity Hospital Accessibility in parts of Northern Sweden : Analyzing accessibility change from 2013 to 2019 using GIS Network Analysis

Abstract: Since the Swedish health care system is mostly organized at a regional level and the population density across the Swedish regions are variating, the supply of health care differs among the regions. Population density and the centralization of care is also affecting the distribution of health care facilities since most opportunities for care will be found where population density is high, such as larger cities. In northern Sweden where the larger parts of the area are sparsely populated and the main cities are mostly located along the coast, accessibility to health care for the rural population and their urban counterparts are therefore very different. The level of accessibility to health care can be more crucial in some situations than in other, one of these is childbirth. Since the labour process can develop quickly, the need to get the right care at the right time can be vital for both mother and child.  In the past years there have been changes to the maternity hospital distribution in northern Sweden. This is due to the closure of Sollefteå maternity hospital and the temporal closing of Lycksele maternity hospital. The aim of this thesis is to analyse the change in accessibility between 2013 and 2019 as a result of these shutdowns. This is done using service area analysis through the ArcGIS network analyst extension. The result show that the closures have had large impact on the spatial accessibility, increasing travel times to maternity hospitals for the inland population. Those who are mostly affected are people who already had poor accessibility, these are also places who have a small population. The result also shows that around 90 % of the women could reach their closest maternity hospital within one hour in 2013 compared to around 80 % in 2019. Around 40 % of the women are at higher risk of childbirth complications since they exceed 20 minutes travel time, this was the same value in 2013 as for 2019. As conclusion, closures have decreased accessibility for women in the inland of northern Sweden but the largest part of the population remain having good accessibility to their closest maternity hospital.