Objective To analyze the enforceability of maternal health care-related law system and its variation in Beijing and Shanghai municipality and to explore the effect of the enforceability on maternal health care services and quantitative method to evaluate the enforceability.
Methods We systematically collected all normative legal documents related to maternal health care issued by municipal administrations of the two cities. The rigid constraint of the legal documents was quantitatively assessed by identifying responsible governmental agencies designated by the documents and penalty for illegal acts specified in the documents. Spearman correlation and linear regression were used to analyze the relationship between the enforceability of the legal documents and the maternal mortality in the two cities.
Results The overall proportion of the legal documents with enforceability increased gradually from 0 in 1990 to 44.4% in 2017 but the enforceability to key responsible departments was not strong enough in the two cities. Significant correlations between the degree of the legal documents′ enforceability and the vairations in maternal mortality were observed, with the correlation coefficients of – 0.640 for Beijing and – 0.788 for Shanghai, respectively. The ratio of variation in maternal mortality which could be explained by the enforceability of the legal documents was higher in Shanghai than that in Beijing (64.4% vs. 44.6%).
Conclusion The law system should have a rigid constraint on all aspects of maternal health care. The enforceability of legal documents related to maternal health care have been gradually improved in Beijing and Shanghai the effect of the improvement in the enforceability is greater in Shanghai than that in Beijing. The study result indicates that the quantitative evaluation method is feasible in assessing the enforceability of maternal health care-related law system.
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