Background The COVID-19 pandemic seriously endangers the public's mental health, especially to pregnant and postpartum women. But little is known about postpartum depression and health care needs among Chinese postpartum women. Aim To investigate the status and risk factors of postpartum depression and health care needs among Chinese postpartum women during the COVID-19 pandemic. Methods In this cross-sectional study, 209 Chinese postpartum women were recruited from May to July 2020 by convenience sampling and assessed online with self-designed Maternal General Information Questionnaire, Edinburgh Postpartum Depression Scale (EPDS) and Chinese Version of the Perceived Stress Scale (CPSS). Descriptive statistics, chi-square test, independent samples t -test, one-way ANOVA, Pearson correlation and multiple linear regression were used for data analysis. Results With the EPDS cut-off value of 10, the incidence of postpartum depressive symptoms was 56.9%. Age, history of abortion and perceived stress were the influencing factors of postpartum depression (adjusted R 2 = 0.432, F = 23.611, p < .001). The top three health care needs were infant rearing guidance (78.0%), maternal and infant protection guidance (60.3%) and dietary guidance (45.0%). The proportion of psychological rehabilitation guidance needs in the depressed group was significantly higher than that in the non-depressed group (34.5% vs. 20.0%, p < .05). Conclusions Maternal postpartum depression in China was at a high level during the COVID-19 pandemic. Women aged 25–34, with a history of abortion and high stress levels were at higher risk for postpartum depression. Timely psychological counselling, intervention and COVID-19-related health education are in great need for postpartum women.

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Background: Little is known about the relationship between health-related behavior and psychological status of pregnant women during the COVID-19 outbreak. We aimed to describe the health-related behavior changes and psychological status of Chinese pregnant women, and to explore the relationship between pregnant women’s characteristics, health-related behavior and different psychological status following the peak of COVID-19 outbreak.Methods: We conducted an online survey through social media (WeChat) from March 14 to April 7. A self-designed questionnaire was used to investigate Chinese pregnant women’s health-related behavior changes. Generalized Anxiety Disorder scale, Edinburgh Postnatal Depression Scale and Perceived Stress Scale were used to assess anxiety, depression and stress among pregnant women. Wilcoxon signed-rank test was used to compare health-related behavior changes before and during the COVID-19 outbreak and Spearman’s rank correlation analysis or logistic regression analysis were used to explore the relationships between variables.Results: A total of 113 pregnant women were included in this study. Most pregnant women wore masks (98.2%), changed location or tried to stay away from those who seem to have a cold or fever (99.1%) and washed hands more often than before (96.5%). Pregnant women washed hands with soap or hand sanitizer more often and went out less often than before the outbreak. There were 41.6% pregnant women who didn’t have antenatal visits or weren’t on time for antenatal visits. Majority (77.9%) pregnant women sought help when feeling panic or anxiety, whereas few turned to psychological workers. The rates of pregnant women with anxiety, depression and health risk stress were 64.6%, 58.4% and 54.9%, respectively. Analysis of relationship between variables showed that household income, gestational age, pregnancy complications, knowledge about COVID-19 and maternal and child protection, perception of the likelihood of infection, the frequency of going out, prenatal check-up behavior, help-seeking behavior were significantly associated or correlated with psychological status. Conclusions: Attention should be paid to the mental health of pregnant women with specific health-related behaviors changes. Screening for mental health problems and psychological interventions among pregnant women are needed.

Background As one of only a handful of countries that have achieved both Millennium Development Goals (MDGs) 4 and 5, China has substantially lowered maternal mortality in the past two decades. Little is known, however, about the levels and trends of maternal mortality at the county level in China.Methods Using a national registration system of maternal mortality at the county level, we estimated the maternal mortality ratios for 2852 counties in China between 1996 and 2015. We used a state-of-the-art Bayesian small-area estimation hierarchical model with latent Gaussian layers to account for space and time correlations among neighbouring counties. Estimates at the county level were then scaled to be consistent with country-level estimates of maternal mortality for China, which were separately estimated from multiple data sources. We also assessed maternal mortality ratios among ethnic minorities in China and computed Gini coefficients of inequality of maternal mortality ratios at the country and provincial levels. Findings China as a country has experienced fast decline in maternal mortality ratios, from 108•7 per 100 000 livebirths in 1996 to 21•8 per 100 000 livebirths in 2015, with an annualised rate of decline of 8•5% per year, which is much faster than the target pace in MDG 5. However, we found substantial heterogeneity in levels and trends at the county level. In 1996, the range of maternal mortality ratios by county was 16•8 per 100 000 livebirths in Shantou, Guangdong, to 3510•3 per 100 000 livebirths in Zanda County, Tibet. Almost all counties showed remarkable decline in maternal mortality ratios in the two decades regardless of those in 1996. The annualised rate of decline across counties from 1996 to 2015 ranges from 4•4% to 12•9%, and 2838 (99•5%) of the 2852 counties had achieved the MDG 5 pace of decline. Decline accelerated between 2005 and 2015 compared with between 1996 and 2005. In 2015, the lowest county-level maternal mortality ratio was 3•4 per 100 000 livebirths in Nanhu District, Zhejiang Province. The highest was still in Zanda County, Tibet, but the fall to 830•5 per 100 000 livebirths was only 76•3%. 26 ethnic groups had population majorities in at least one county in China, and all had achieved declines in maternal mortality ratios in line with the pace of MDG 5. Intercounty Gini coefficients for maternal mortality ratio have declined at the national level in China, indicating improved equality, whereas trends in inequality at the provincial level varied. Interpretation In the past two decades, maternal mortality ratios have reduced rapidly and universally across China at the county level. Fast improvement in maternal mortality ratios is possible even in less economically developed places with resource constraints. This finding has important implications for improving maternal mortality ratios in developing countries in the Sustainable Development Goal era.