Yanqiu Gao|Hong Zhou|Neha Singh|Timothy Powell?Jackson|Stephen Nash|Min Yang|Sufang Guo|Hai Fang|Melisa Martínez Álvarez|Xiaoyun Liu|Jay Pan|Yan Wang|Carine Ronsmans
Progress and challenges in maternal health in western China: a Countdown to 2015 national case study
Peking University|National Bureau of Statistics of China|Peking University|London School of Hygiene & Tropical Medicine|London School of Hygiene & Tropical Medicine|London School of Hygiene & Tropical Medicine|Research Center for Rural Economy|University of Nottingham|Sichuan University|Peking University|London School of Hygiene & Tropical Medicine|Peking University|Research Center for Rural Economy|Sichuan University|Peking University|Research Center for Rural Economy|London School of Hygiene & Tropical Medicine|Sichuan University
china one countdown countries achieved millennium development goal 5 75 reduction maternal mortality ratio 1990 2015 aimed examine health systems contextual factors might contributed substantial decline maternal mortality 1997 2014 chose focus western china poverty ethnic diversity geographical access represent particular challenges ensuring universal access maternal care regionin systematic assessment used data national census reports national statistical yearbooks national maternal child health routine reporting system china national health accounts report national health statistical yearbooks describe changes policies health financing health workforce health infrastructure coverage maternal care maternal mortality region 1997 2014 used multivariate linear regression model examine contextual health systems factors contributed regional variation maternal mortality ratio period using data crosssectional survey 2011 also examined equity access maternity care 42 poor counties western chinamaternal mortality declined 89 per year 1997 2014 geometric mean ratio year 091 95 ci 091092 adjusting gdp per capita length highways female illiteracy number licensed doctors per 1000 population proportion ethnic minorities maternal mortality ratio 118 higher western region 218 144328 41 higher central region 141 099201 eastern region rural western region proportion births health facilities rose 419 1997 984 2014 underpinning progress governments strong commitment longterm strategies ensure access delivery care health facilitieseg professionalisation maternity care large hospitals effective referral systems women medically socially high risk financial subsidies antenatal delivery care however poor western counties substantial disparity education level mother existed access health facility births 44 illiterate women vs 100 college higher education antenatal care 17 vs 69 least four visits caesarean section 8 vs 44despite remarkable progress maternal survival china substantial disparities remain especially poor less educated ethnic minority groups remote areas western china whether chinas highly medicalised model maternity care answer populations uncertain strategy modelled chinas immunisation programme whereby care provided close womens homes might need explored township hospitals taking prominent rolegovernment canada unicef bill melinda gates foundation