Neonatal mortality rate reduction by improving geographic accessibility to perinatal care centers in Japan.

OBJECTIVES To assess reducing travel time to perinatal care centers, and to examine whether reducing travel time influences the neonatal mortality rate (NMR). METHODS The travel time from a population centroid in each municipality to the nearest perinatal care center was measured using the Geographic Information System at two time points, 2002 and 2006. Areas with and without reductions in travel time were compared for changes in the NMR. The Difference-In-Difference Estimation was used to examine whether the NMR decreased in areas with reducing travel times. RESULTS The median travel time was reduced from 66.99 minutes in 2002 to 39.09 minutes in 2006, and the mean NMR decreased from 1.72 (2002) to 1.33 (2006). The travel time showed great disparities. Of the areas that in 2002 had travel times longer than 60 minutes, by 2006 some areas that had improved accessibility by reducing travel time also had significant reductions in the NMR compared with regions that did not reduce travel time by 2006. CONCLUSIONS Reducing travel time to perinatal care centers by reconsidering the location of such centers is an effective strategy to reduce the NMR in Japan.