Objective. We investigated the effects of the centralization of obstetricians and obstetric care facilities on the perinatal mortality rate in Japan. Methods. We used the Gini coefficient as an index to represent the centralization of obstetricians and obstetric care facilities. The Gini coefficients were calculated for the number of obstetricians and obstetric care facilities of 47 prefectures using secondary medical care zones as units. To measure the effects of the centralization of obstetricians and obstetric care facilities on the outcomes (perinatal mortality rates), we performed multiple regression analysis using the perinatal mortality rate as the dependent variable. Results. Obstetric care facilities were more evenly distributed than obstetricians. The perinatal mortality rate was found to be significantly negatively correlated with the number of obstetricians per capita and the Gini coefficient of obstetric care facilities. The latter had a slightly stronger effect on the perinatal mortality rate. Conclusion. The centralization of obstetric care facilities can improve the perinatal mortality rate, even when increasing the number of obstetricians is difficult. 1. Background and Objective In Japan, obstetric care facilities and the number of obstetricians are decreasing [1]. One of the reasons for this could be the risks in delivery system, and sometime lawsuits could be held between obstetrician and pregnant women. And the other is that obstetricians usually are working for a long time. It is debatable whether this shortage can be attributed to the decrease in the absolute number of obstetricians or a maldistribution. A theory proposed by Newhouse JP insisted that an increase in the number of obstetricians will result in the uniformity of their distribution [2]. The Japanese Ministry of Health, Labor, and Welfare, the Japan Medical Association, and the Japan Society of Obstetrics and Gynecology recommended the centralization of obstetric care facilities [3]. As a result, many small obstetric care facilities have been closed in the rural areas. Centralization is expected to increase the number of medical facilities with multiple full-time obstetricians and ensure safe childbearing care. Previous studies have shown that obstetric care outcomes are favorable in communities with large obstetric care facilities [4, 5]. On the other hand, the closure of nearby medical facilities due to centralization is expected to result in pregnant women having to travel longer distances to seek the care they need in the event of an emergency [6]. Thus, the
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