背景與目的：近年來，台灣地區因為少子化與醫療市場化的浪潮，導致婦產科醫師人力出現短缺與分佈不均的情況。目前更有部分的婦產科醫師僅提供婦科醫療服務，使得產檢與接生的醫師更為缺乏。在這樣產科照護不足之下，都將加劇地區孕產婦與胎兒醫療照護可近性的困難。過去研究指出，當孕產資源的可近性降低，可能導致孕產婦缺乏產前保健利用，並影響新生兒的不良出生結果，如：週產期死亡率與加護病房住院率。然而，在我國目前現行的執業醫療統計中，不但無法實質呈現產科醫師人力的困境，且綜觀國內研究也沒有深入探討產科醫師資源對於新生兒出生結果的健康影響。因此，本研究欲探討產科醫師人力資源分佈情形與年代趨勢，並進一步瞭解地區不同產科醫師資源與新生兒不良出生結果間的關係。
　　方法：使用1997-2008年全民健保資料庫特殊需求百萬抽樣檔，以及2001-2011單數年間國健署出生通報資料庫。將「產科醫師」定義為能提供婦女產前檢查與接生的醫師人力；出生人口包含出生通報內大於20週或500克以上活產與死產新生兒。以描述性統計與地理資訊系統繪圖，呈現我國產科醫師人力資源的數量趨勢與地理分佈情形。再進一步計算鄉鎮市區產科醫師資源數量，利用趨勢檢定與迴歸模型，檢視在鄉鎮市區不同產科醫師資源下，對本國籍婦女單胞胎新生兒的不良出生結果影響。
　　結果：第一，研究發現我國產科醫師人力正逐年降低，產科醫療負擔量也相同降低。第二，目前將近五成以上的鄉鎮市區缺乏產科醫師可提供醫療照護，影響出生人數約18.24~23.75%，且產科醫師多集中於高度都市化地區。第三，產科醫師資源愈低的鄉鎮市區，將影響到孕產婦女新生兒早產、低出生體重、胎兒小於妊娠週數(SGA)、死產及晚期死產的發生，產科資源距離影響顯著，且多影響到適齡與高齡婦女之新生兒。
　　結論：目前我國提供產科的醫師人力呈現地理分佈不均現況，且產科醫師資源將影響到地區間新生兒的不良出生結果增加。本研究藉由利用大型健保資料與出生通報資料在我國首次進行相關分析研究，建議衛生當局未來可針對產科醫師人力政策考量，並為地區新生兒不良出生結果的差異帶來一部分貢獻性。

　　In recent years, obstetricians / gynecologists (OB/GYN) in Taiwan has been unevenly distributed, and some of ob-gyn physicians do not provide maternity and obstetric services in particular areas. Previous researches indicated that the decreasing of accessibility of maternity care services may increase the risks of perinatal mortality and NICU hospitalization. However, the problems of human resources in obstetric care have not been indicated in current health statistics and researches in Taiwan. Therefore, the objective of this research is to investigate the number and distribution of obstetrician in Taiwan, and further explore the association between obstetrician resources and adverse birth outcomes. This research used National Health Insurance Research Databases from 1997 to 2008 and Birth Certificate Application databases of 2001, 2003, 2005, 2007, 2009 and 2011. “Obstetrician” is defined as the physician who provides prenatal cares and gives birth. All births contains both live births and stillbirths were born at more than 20 weeks or weigh over 500 grams. Descriptive statistics and geographic analysis were used to present the number and distribution of obstetrician. Trend test and multiple logistic regression model are conducted to investigate the association between obstetrician resources and adverse birth outcomes. First, this research found that Obstetricians in Taiwan present sufficiently but unevenly distributed. The number of obstetrician declines year by year, but the burden of obstetrics also declines. Besides, there is no obstetricians in over half of the towns, which affected 18.24~23.75% of the births. Second, the lack of obstetrician resources of a town increases the neonatal adverse birth outcomes, such as preterm, low birth weight, SGA, and fetal death. This is the first study in Taiwan to explore the resources of obstetricians by using large population-based database. This research expects the results can be contributed to obstetrician human resources policy and applied to decrease the differences of adverse birth outcomes.

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