Air pollution, public service provision, and perinatal health in China

Ambient air pollution is widely recognized as an important determinant of adverse perinatal outcomes, yet the extent to which broader health and social care systems can mitigate these environmental risks remains insufficiently understood. Drawing on a 20-year provincial panel dataset from China, this study examines the association between ambient air pollution and perinatal health, with particular attention to the role of public service provision. Using a panel threshold modelling approach, this study explores potential non-linear buffering effects across both traditional public services and digital infrastructure. The findings indicate that higher levels of air pollution are consistently associated with poorer perinatal health outcomes. Importantly, this association varies systematically with the level of public service provision. In regions with stronger health and social care systems, the adverse association between air pollution and perinatal health is significantly attenuated, suggesting that service capacity plays a protective role in the context of environmental risk. Further analysis indicates that this moderating effect is non-linear, with the buffering function of public services becoming substantially more pronounced once a certain level of provision is reached. These results highlight that perinatal health is shaped not only by environmental exposure, but also by the capacity of health and social care systems to respond to such risks. Strengthening public service provision, alongside efforts to reduce digital inequalities, may therefore represent important pathways for improving maternal and neonatal health and reducing environmentally related health disparities.