Barriers to Hospital Deliveries among Ethnic Minority Women with Religious Beliefs in China: A Descriptive Study Using Interviews and Survey Data

Abstract

Background: China has made great progress in improving hospital delivery-the coverage of hospital delivery has increased to above 95% in most regions- some regions lag behind owing to geographic and economic inequality, particularly the poor ethnic minority areas of the Sichuan Province. This study explores factors which may influence hospital delivery from multiple perspectives, with implications for practice and policy. Methods: A framework analysis approach was used to identify and categorize the main barriers and levers to hospital delivery. Our analysis draws on basic information from the sampled counties (Butuo and Daofu). Results: The hospital delivery rate was below 50% in the two sampled areas. In both areas, the “New Rural Cooperative Medical Scheme” and “Rural hospital delivery subsidy” were introduced, but only Butuo county had a transportation subsidy policy. Socioeconomically disadvantaged women in both counties who delivered their babies in hospitals could also apply for financial assistance. A lack of transport was among the main reasons for low hospital delivery rates in these two counties. Furthermore, while the hospital delivery costs could be mostly covered by “New Rural Cooperative Medical Scheme” or “Rural Hospital Delivery Subsidy”, reimbursement was not guaranteed. People in Daofu county might be affected by their Buddhism religion for hospital delivery. Women in Butuo following the Animism religion would refuse delivery in hospitals because of language barriers. Traditional lay beliefs were the main factor that influenced hospital delivery; their understandings of reproductive health varied, and many believed that childbirth should not be watched by strangers and that a home delivery was safe. Conclusions: This study has highlighted a number of barriers and levers to hospital delivery in rural poor ethnic minority areas which could inform and improve the access and rate of hospital delivery rate; thereby reducing health inequalities in maternal and child health in China.

Inequality of obstetric and gynaecological workforce distribution in China

“…Comparing with the distribution of life-round women (≥15 years) and reproductive-aged women (15–49 years), the inequality of OB/GYN workforce distribution of women with maternal care requirements (per 1000 live births) was severer, this may require additional attention on the allocation of maternal professionals. Similar to the study of the inequality of paediatric workforce distribution in China [ 22 ], this study also highlighted very severe geographic distribution inequality, especially in the West region, this may not be a huge problem because the West region was less-populous when comparing with the other two regions, but this result still suggests that women in the West region may need to travel a longer distance to receive OB/GYN care services, and this may even cause bad consequences if the distance and transport become a major obstacle of care-seeking behaviours [ 32 ].…”

“…The levels of inequality varied among different sub-groups of OB/GYN workforce, regarding the demographic distribution (except live births), the level of inequality of midwives was the highest, this may reflect the shortage of midwives, especially in the East region, however, regarding the distribution of live births, the inequality was the highest in the West region, more attention should be given in this maldistribution of midwives because skilled birth attendance is essential for safe delivery, maternal and newborn lives [ 32 , 33 ]. However, the comparison of inequality of OB/GYN doctors and OB/GYN nurses was not the in line with the results of paediatricians and paediatric nurses, in this study, the OB/GYN doctor distribution was found to be more inequitable than OB/GYN nurse distribution, this may indicate that the OB/GYN doctors were in shortage than OB/GYN nurses.…”

Online Food Shopping: A Conceptual Analysis for Research Propositions

“…However, the majority of consumers are still concerned about freshness and food waste ( Yu et al, 2020 ). Unlike in a brick-and-mortar store where shoppers can visibly check the freshness of their produce, this is more difficult with home delivery ( Song et al, 2016 ). Thus, brands must try and opt for packaging that can keep food safe and fresh during transit and displays its freshness to re-assure customers.…”

Spatiotemporal trends and ecological determinants in maternal mortality ratios in 2,205 Chinese counties, 2010–2013: A Bayesian modelling analysis

“…The proportion of women whose highest educational level was elementary school or below in the 4 western provincial regions of Tibet, Xinjiang, Qinghai, and Yunnan was 83.5%, 37.1%, 52.9%, and 53.9%, respectively, which is higher than that of other provincial regions (http:// www.stats.gov.cn/tjsj/ndsj/2014/indexch.htm). Influenced by traditional customs, women in these areas, where the proportion of the ethnic minority or indigenous population is high, prefer to give birth at home [27][28][29][30]. Low levels of education or even illiteracy may limit the ability or willingness of women to seek the provision of formal healthcare services [31].…”