Applying the German Demand Planning Guideline (BPL-RL) to Maternity Care Provision: Regional and Socioeconomic Disparities

Abstract

INTRODUCTION: Midwifery care in Germany is currently neither systematically monitored nor managed. A central register and a standardized planning framework are lacking, resulting in limited reliable data on the actual provision of care. Regional analyses also indicate substantial differences in access to midwifery care. The aim of this study was to apply the methodology of the German Demand Planning Guideline (BPL-RL) to midwifery care and to conduct a nationwide small-area analysis of regional and social disparities. METHODS: Address data from the German Midwives Association (DHV; August 2024) were geocoded using postal codes and aggregated at district level. Based on the BPL-RL framework, supply levels were calculated for women of reproductive age (15-49 years), adjusted using the German Index of Socioeconomic Deprivation (GISD, 2022), and supplemented by travel-time analyses. RESULTS: The analyses revealed pronounced socio-spatial inequalities. Overall, 23.8% of districts were (potentially) undersupplied (supply level < 75%), 45.8% were within the reference range of the BPL-RL framework (75-110%), and 30.5% showed high supply levels (> 110%), including 7.5% with substantial oversupply (> 140%). The average travel time to the nearest midwife was 9.6 min; longer travel times were concentrated in sparsely populated regions with high levels of deprivation. DISCUSSION: Applying the BPL-RL to midwifery care enables a structured and data-driven assessment of service provision in Germany. The findings highlight regional and social inequalities and provide an empirical basis for value-based, socially equitable, and systematically managed demand planning for midwifery care.