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.
Highlights
Approximately 800 women die each day from causes related to pregnancy and childbirth, 99% of which occur in developing countries, and most can be avoided with immediate and effective professional care during and after delivery [1,2]
Within Butuo and Daofu, all the towns were classified into respective-high and respective-low strata based on hospital delivery rates, and one town was sampled from each stratum
This study explores a number of potential influencing factors and the current barriers to hospital deliveries in poor ethnic minority areas, the findings can help local health governments to improve their strategies for promoting hospital delivery and, thereby, greatly improve maternal and child health
Summary
Approximately 800 women die each day from causes related to pregnancy and childbirth, 99% of which occur in developing countries, and most can be avoided with immediate and effective professional care during and after delivery [1,2]. Home births could be safe, hospital delivery is advocated in most countries as obstetric emergencies can be managed more efficiently [3]. 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
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