6 Improve maternal health
Where we are?
The Chinese Government has attached great importance to the living and health condition of women. China signed a number of international conventions on the protection of women, and formulated the Programme for the Development of Chinese Women, the Law on Maternal and Infant Health Care and the Population and Family Planning Law, providing a legal basis for Maternal and Child Health (MCH) services. The Chinese Government has continuously optimized the MCH legal system and service system. MCH public service projects have been implemented, MCH applicable technology has been popularized and the fairness and accessibility of MCH services has been improved. The national maternal mortality rate (MMR) and child mortality rate have dropped considerably, and the health status of women and children has been improved significantly. The MMR fell from 1,500 per 100,000 in the 1950s to 24.5 per 100,000 in 2012, and the infant mortality rate from 200 per 1,000 to 10.3 per 1,000 during the same period. China also strives to build a national healthcare system for women by increasing government input and integrating social resources, incorporating maternity insurance into the social security system. The Chinese Government steadily carries forward the maternity insurance for urban workers and advances the maternity protection measures for unemployed women in rural areas. Furthermore, the Chinese Government has also carried out public campaigns to enhance people's awareness of maternal and reproductive healthcare. These measures and initiatives have significantly improved maternal and reproductive health care in China.
Target 5A: Reduce by three quarters the maternal mortality ratio
Significant progress has been made on the reduction of the MMR in China. It is possible that by 2015 China will reach its target of reducing the MMR by three quarters ahead of schedule. In 2012, the MMR nationwide was 24.5 per 100,000, which is 74.1 percent lower and 53.8 percent lower compared with 1990 and 2000 respectively. However, there remains regional disparity: the MMR is higher in western regions than in central and eastern regions; the lowest MMR is in eastern regions. Nevertheless, this gap and the gap between urban and rural areas has reduced.
The top five causes of maternal mortality are obstetric haemorrhage, amniotic fluid embolism, hypertensive disorders in pregnancy, pregnancy associated with cardiac disease, and venous thrombosis and pulmonary embolism. Promoting hospitalized delivery is a key measure to ensure maternal and infant safety and reduce mortality. The Ministry of Health launched subsidies for hospitalized delivery of rural women in central and western regions in 2008, and expanded its coverage to all rural areas in 2009. A total of RMB 10.9 billion was invested in this programme by the Central Government from 2009 to 2012.
By 2011, over 500,000 professionals were engaged in MCH services; there were altogether 146,000 beds available and 170 million clinical visits per year. The coverage of MCH is gradually expanding and the service is improving. China established its MCH annual reporting system in the early 1980s, the national birth defects monitoring network in 1986, the national maternal mortality monitoring network in 1989 and the national under-five children mortality network in 1991. These were integrated in 1996. Furthermore, in order to reduce MMR and eliminate neonatal tetanus, China instituted the National Basic Public Health Service Programme with a subsidy of 15RMB per person from the central budget.
Challenges remain, particularly in relation to the rural–urban gap and in the regional population group disparities. P33para3sect2The MCH system and the service network need to be improved. The professional skills of relevant personnel need to be enhanced. The MCH service at local level is inadequate and unsatisfactory. Furthermore, there is poor accessibility and inadequate use of MCH services in poverty-stricken areas, remote mountainous areas and ethnic minority areas. Investment in MCH is inadequate. A stable MCH input and compensation mechanism has not been established. Midwifery is not recognized as an independent profession in the Chinese health system, despite midwives being the first medical personnel pregnant women meet in their community, especially in rural areas.
Target 5B: achieve universal access to reproductive health
According to Chinese regulation, all citizens at childbearing age in China have free access to family planning services, including contraceptive surgery, medication and devices. The overall contraceptive rate among married women of childbearing age has remained above 80 percent. Data from the 2008 National Demographic Change Sampling Survey showed that the fertility rate among adolescents (15-19 years old) is 5.26 in every thousand. According to estimates by the United Nations Population Division, China’s unmet requirement for family planning of the 15-49 age group accounts for 2.3 percent. Both are low compared with other countries.
Sound and systematic maternal health care management is an important measure to improve the quality of maternal health care, and to ensure maternal and infant health. China has established a complete set of systematic maternal health care system that includes prenatal care, prenatal screening and diagnosis, screening and management of high-risk pregnant women, hospitalized delivery, newborn care and postnatal visit. The rate of systematic maternal management rose from 77.2 percent in 2000 to 85.2 percent iis 47.31 in 2011.
The government attempts to make family planning more people-orientated, focusing on quality service, the satisfaction of citizens, informed choice on contraceptive methods and the legitimate rights of citizens. P34sect2To address the rising incidences of cervical cancer and breast cancer among Chinese women, the All-China Women’s Federation and Ministry of Health launched a free breast cancer and cervical cancer inspection project for rural women on a pilot basis in 2009. In collaboration with the United Nations Population Fund, the government is making efforts to improve the education and life skills of young people in response to the increasing unintended pregnancies of unmarried adolescents. The government has launched a programme called ‘Love and Care’ in order to promote equal access to basic health services and free family planning services.
Challenges remain in regional disparities, in provision for the migrant community and in issues of women’s reproductive health (breast cancer, cervical cancer, AIDS, syphilis etc). As the maternal and infant mortality rates decline, birth defects become an increasingly important problem. P35sect3para5Some enterprises and employees still lack enough awareness and measures on maternal health promotion. Measures at the workplace should be taken to prevent pregnant or breastfeeding women from being in a hazardous working environment. It is necessary to give women access to prenatal and postnatal health checks, to flexible working hours and breastfeeding facilities so that they do not suffer maternal discrimination.
Targets for MDG 5
- Reduce by three quarters the maternal mortality ratio
- Most maternal deaths could be avoided
- Giving birth is especially risky in Southern Asia and sub-Saharan Africa, where most women deliver without skilled care
- The rural-urban gap in skilled care during childbirth has narrowed
- Achieve universal access to reproductive health & inadequate funding for family planning is a major failure in fulfilling commitments to improving women’s reproductive health
- More women are receiving antenatal care
- Inequalities in care during pregnancy are striking
- Only one in three rural women in developing regions receive the recommended care during pregnancy
- Progress has stalled in reducing the number of teenage pregnancies, putting more young mothers at risk
- Poverty and lack of education perpetuate high adolescent birth rates
- Progress in expanding the use of contraceptives by women has slowed & use of contraception is lowest among the poorest women and those with no education