From 2010 to 2019, neonatal visit rate and system management rate of under-three children increase generally, and perinatal mortality rate decreases generally, indicating that child health services are gradually improving. Neonatal visit is the regular health check of the newborns by community medical staff, early detection of abnormalities and diseases, and popularization of scientific parenting knowledge to the mothers and their families during the visits. According to the case of each newborn and parturient, individualized guidance is given to the parturient to do well in newborn feeding, nursing and disease prevention, which has a positive effect on reducing the morbidity and mortality of the newborn and promoting the healthy growth of the newborn7,8. System management of under-three children is that under-three children receive growth testing or physical examination, common disease prevention and other health management systems, which promotes the early intelligent physical development and reduce common diseases9. Perinatal death refers to stillbirths and neonatal deaths from 28 weeks of pregnancy to the 7th day after birth10. According to Fig. 1, it can be found that the mortality rate of under-five children declines slower than that of the perinatal infants. This suggests that the reduction in the deaths of children under 5 in China is more due to the decrease in children aged 1 to 4, and there is still a large room for perinatal deaths to decline. Therefore, vigorously conduct neonatal visit and child system management services to reduce perinatal mortality can reduce the mortality rate of under-five children.
Previous studies11 have found that the death of perinatal infants is closely related to perinatal health care, the quality of obstetrics and pediatric diagnosis and treatment services, regional economic levels, social and cultural background, and geographical transportation. The perinatal health care system in the western region is imperfect, and the economic level has affected the accessibility of maternal health services, resulting in a low proportion of pregnant women receiving prenatal education and prenatal examinations. Pregnant women in these areas have higher pregnancy risks and lack of health care awareness, which affects the safety of mothers and babies. The reduction of perinatal mortality is closely related to the development of maternal health services, which requires relevant departments to improve maternal health care, and strengthen the screening and management of high-risk pregnant women and birth defects12. The neonatal visit rate and the system management rate of under-three children in the central region are lower than the eastern and western regions. The eastern region has richer material foundation and talent advantages than the central region, and western region have more policy support compared with the central region. And it is difficult to implement projects with a large population base in the central region. The gap between the three regions has gradually narrowed which is related to the change of national policies. The government has provided support in the medical and economic development of the central and western regions, such as National Child Development Plan for Poor Areas promulgated by the State Council in 2014.
From CI, there is an unfair phenomenon that child health services concentrate in provinces with high economic levels. The absolute value of CI of their three indicators are all showing a downward trend, indicating that the fairness of child health services continues to improve. This is related to policy of increasing capital and human input and promoting the equalization of basic public health services. However, the index increased slightly from 2014 to 2019, and the absolute value of CI of perinatal mortality rate in 2017 even reached the highest value in a decade, indicating that the fairness of child health services from 2014 to 2019 has not been further improved. This is related to the implementation of the separate two-child policy in 2013 and the implementation of the comprehensive two-child policy in 201513.The two-child policy has increased the number of children the demand for child health services. However, nowadays resources of child care health are insufficient and high-quality resources are inclined to developed areas, resulting in inequality14. After the implementation of the two-child policy, the incidence of high-risk pregnant women has increased significantly in both developed areas and undeveloped areas15, which puts forward higher requirements for child health services. Developed areas have abundant medical service resources, which can still cushion the impact of the two-child policy, but undeveloped areas lack medical resources, and the contradiction between supply and demand brought about by the two-child policy is more prominent, which lead to increased unfairness of child health services between regions. Therefore, government should allocate health resources based on the needs of maternal and child health care, and appropriately tilt to the central and western regions. It is also found that the unfairness of perinatal mortality is the highest. The reason is that the perinatal mortality rate will be affected by the quality of maternal health care services, and the influencing factors are difficult to control, such as birth defects and preterm birth factors, will lead to death of the perinatal infant. One of the keys to preventing perinatal death lies in the level of diagnosis and treatment technology in obstetrics and pediatrics. Areas with high economic levels have high medical standards and effective prevention and treatment, which keeps the perinatal mortality rate at a low level, while areas with low economic levels are just the opposite, which further highlights the unfairness of perinatal mortality.