The trends in maternal mortality between 1996 and 2009 in Guizhou, China: Ethnic differences and associated factors

Du, Qing; Lian, Wei; Næss, Øyvind; Bjertness, Espen; Kumar, Bernadette Nirmal; Shi, Shaojun

doi:10.1007/s11596-015-1403-8

Cited by 8 publications

(7 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The increased per GDP was associated with decreased MMR and explained the most MMR declining trend. Other provinces of China studies also found this association [ 13 , 23 ]. Economic environment was also significantly associated with other low and middle-income countries, but little related to developed countries [ 24 ].…”

Section: Discussionmentioning

confidence: 52%

“…As a key finding that higher level of hospital delivery rate and antenatal care rate were associated with a lower level MMR, the previous alone clarified the most contrast in MMR between minority and non-minority counties and county variance. Increased hospital delivery rate being associated with decreased MMR has been evidenced by other studies in China [ 13 , 16 ]. Hospital delivery with skilled attendants may decrease the risk of maternal death.…”

Section: Discussionmentioning

confidence: 60%

See 1 more Smart Citation

Disparities in health system input between minority and non-minority counties and their effects on maternal mortality in Sichuan province of western China

et al. 2017

View full text Add to dashboard Cite

BackgroundThe maternal mortality rate (MMR) markedly decreased in China, but there has been a significant imbalance among different geographic regions (east, central and west regions), and the mortality in the western region remains high. This study aims to examine how much disparity in the health system and MMR between ethnic minority and non-minority counties exists in Sichuan province of western China and measures conceivable commitments of the health system determinants of the disparity in MMR.MethodsThe MMR and health system data of 67 minority and 116 non-minority counties were taken from Sichuan provincial official sources. The 2-level Poisson regression model was used to identify health system determinants. A series of nested models with different health system factors were fitted to decide contribution of each factor to the disparity in MMR.ResultsThe MMR decreased over the last decade, with the fastest declining rate from 2006 to 2010. The minority counties experienced higher raw MMR in 2002 than non-minority counties (94.4 VS. 58.2), which still remained higher in 2014 (35.7 VS. 14.3), but the disparity of raw MMR between minority and non-minority counties decreased from 36.2 to 21.4. The better socio-economic condition, more health human resources and higher maternal health care services rate were associated with lower MMR. Hospital delivery rate alone explained 74.5% of the difference in MMR between minority and non-minority counties. All health system indicators together explained 97.6% of the ethnic difference in MMR, 59.8% in the change trend, and 66.3% county level variation respectively.ConclusionsHospital delivery rate mainly determined disparity in MMR between minority and non-minority counties in Sichuan province. Increasing hospital birth rates among ethnic minority counties may narrow the disparity in MMR by more than two-thirds of the current level.Electronic supplementary materialThe online version of this article (10.1186/s12889-017-4765-y) contains supplementary material, which is available to authorized users.

show abstract

Section: Discussionmentioning

confidence: 52%

Section: Discussionmentioning

confidence: 60%

Disparities in health system input between minority and non-minority counties and their effects on maternal mortality in Sichuan province of western China

et al. 2017

View full text Add to dashboard Cite

show abstract

“…China bears some burden of global maternal mortality, the largest part being in the poor western provinces 19 . Hospital delivery should be completely covered because it has been recognized as an effective strategy in reducing maternal mortality.…”

Section: Discussionmentioning

confidence: 99%

Effect of China’s maternal health policy on improving rural hospital delivery: Evidence from two cross-sectional surveys

Fan

Stewart

et al. 2018

Sci Rep

View full text Add to dashboard Cite

This population-based cross-sectional study aims to explore the effect of China’s Rural Hospital Delivery Subsidy (RHDS) policy on the utilization of women’s hospital delivery between rural and urban areas. A total of 2398 women were drawn from the Fourth and Fifth National Health Service Surveys, from the Shaanxi province. A generalized linear mixed model was used to analyze the influence of the RHDS policy on the hospital delivery rate. Concentration index and decomposition methods were used to explore the equity of hospital delivery utilization. Prior to introduction of the RHDS policy, the difference in hospital delivery rates was −0.09 (95% CL: −0.16, −0.01) between rural and urban women when adjusting the influence of socioeconomic factors on hospital delivery; after implementation of the policy, the difference was reduced to 0.02 (95% CL: −0.01, 0.06). The horizontal inequity index was reduced from 0.084 to 0.009 for rural women and from 0.070 to 0.011 for urban women. China’s Rural Hospital Delivery Subsidy policy had some positive effect on reducing the gap between rural and urban women’s hospital delivery rate and inequity. However, there is still a pro-rich inequity of hospital delivery utilization for both rural and urban women.

show abstract

“…In our survey, only 10.8% of ethnic minority women had received five or more antenatal visits, 13.5% gave birth in hospital, and 1.7% had a caesarean section. Equally low levels of uptake of maternity care have been reported previously for ethnic minority women living across Western China [15, 34–36]. The extremely low caesarean section rates are particularly worrying: while caesarean section rates cannot be a substitute for the measurement of levels of maternal mortality, research has found that the caesarean section rate is negatively associated with maternal mortality when under 10% [37], and rates below 5% suggest an unmet need for life saving surgery [38].…”

Section: Discussionmentioning

confidence: 86%

Uptake of maternal care and childhood immunization among ethnic minority and Han populations in Sichuan province: a study based on the 2003, 2008 and 2013 health service surveys

Zhang

Mou

Liao

et al. 2019

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

Background China has made remarkable progress in maternal and child health (MCH) over the last thirty years, but socio-economic inequalities persist. Ethnicity has become an important determinant of poor MCH outcomes, but little rigorous analytical work has been done in this area. To understand the socio-economic factors that explain ethnic variation in uptake of MCH care, we report the findings from an analysis in Sichuan province. Methods We linked data from the 2003, 2008 and 2013 National Health Service Surveys in Sichuan Province. The ethnic disparities in uptake of maternal care (completing 5 antenatal visits, giving birth in hospital and receiving a caesarean section) and childhood immunization (Bacillus Calmette Guerin (BCG), three doses of diphtheria (DPT) and measles immunization) were examined by geographical (Han district/county vs. ethnic minority county) and individual-based (Han women/children vs. ethnic minority women/children) comparisons. We also examined variation by distance to township and county hospitals, women’s education, parity and age using weighted multilevel Poisson regressions with random intercept at district/county level. Results Ethnic inequalities in maternal care were marked, both at the geographical (district/county) and the individual level. The % of births in hospital was 90.7% among women in Han districts, compared to 83.3% among women living in Han counties (crude RR 0.93; 95% CI 0.75–1.15), 53.8% among Han women living in ethnic minority counties (crude RR 0.57; 95% CI 0.36–0.93), and 13.5% among ethnic minority women living in ethnic minority counties (crude RR 0.18; 95% CI 0.06–0.57). Adjusting the analysis for survey year, education, parity and distance to county level hospital weakened the association between geographical/individual ethnicity and uptake of maternity care, but associations remained remarkably strong. Coverage of childhood immunization was much higher than uptake of maternity care, and inequalities by ethnicity were much less pronounced. Conclusion Lessons can be learned from China’s successful immunization programme to further reduce inequalities in access to maternity care among ethnic minority populations in remote areas. Bringing the services closer to the women’s homes and strengthening health promotion from the township to the village level may encourage more women to seek antenatal care and give birth in hospital. Electronic supplementary material The online version of this article (10.1186/s12884-019-2371-y) contains supplementary material, which is available to authorized users.

show abstract

The trends in maternal mortality between 1996 and 2009 in Guizhou, China: Ethnic differences and associated factors

Cited by 8 publications

References 18 publications

Disparities in health system input between minority and non-minority counties and their effects on maternal mortality in Sichuan province of western China

Disparities in health system input between minority and non-minority counties and their effects on maternal mortality in Sichuan province of western China

Effect of China’s maternal health policy on improving rural hospital delivery: Evidence from two cross-sectional surveys

Uptake of maternal care and childhood immunization among ethnic minority and Han populations in Sichuan province: a study based on the 2003, 2008 and 2013 health service surveys

Contact Info

Product

Resources

About