Access to maternal care among urban, rural non-minority, and rural minority populations in Sichuan: a study based on three cross-sectional Surveys of National Health Service

Abstract

BackgroundUrban–rural inequality in access to maternal care has attracted great attention in China. However, little attention has been given to access among minority populations. The aim of this study was to measure inequality in access to maternal care in Sichuan province. MethodsThis study was based on the analysis of cross-sectional data collected in three National Health Service surveys from 2003, 2008, and 2013, and we included data relevant to Sichuan Province. We analysed data of women who had given birth within the past 5 years and report the proportion of births for whom the mother had four or more antenatal visits, stayed in hospital during delivery, and had caesarean section. We used weighted Poisson regression to analyse variation in outcomes by urban or rural location (minority and non-minority), women's highest level of education, parity, and age. This study was a secondary analysis, and all personal information were eliminated, so ethics approval for our study was waived. FindingsThe number of women interviewed was 531 in 2003, 431 in 2008, and 795 in 2013. The weighted proportion of hospital delivery increased from 296 (63%) in 2003 to 554 (92%) in 2013, the weighted proportion of women who had four or more antenatal visits increased from 253 (52%) in 2003 to 426 (66%) in 2013, and the weighted proportion of women who had caesarean section increased from 95 (21%) in 2003 to 310 (54%) in 2013. There were marked inequalities by urban/rural/minority status. In 2013, 52 (19%) women from rural minority areas gave birth in hospital, 59 (22%) women had four or more antenatal visits, and 12 (4%) women had a caesarean section. By contrast, women living in urban areas had near universal access to maternal care, with 315 (96%) women having hospital delivery, 255 (78%) women having four or more antenatal visits, and 193 (59%) women delivering through caesarean section. These differences persisted after adjustment for education, income, parity, and age. InterpretationSichuan province had made substantial progress in increasing access to maternal care. However, huge inequalities among women persisted between urban and rural areas, particularly among the rural minority areas. Adjustment for education or income did not fully explain these inequalities, and therefore alternative reasons need to be explored. The extremely high caesarean section rates among women living in urban areas is concerning. FundingSpecial fund for 5th National Health Service investigation in Sichuan province, supported by Sichuan Health Bureau. CR is funded by Sichuan University, the London School of Hygiene & Tropical Medicine, and the “1000 talent programme” from the Chinese Government.