Abstract
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.
Highlights
IntroductionThe 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
The maternal mortality rate (MMR) markedly decreased in China, but there has been a significant imbalance among different geographic regions, and the mortality in the western region remains high
Despite the fact that the MMR markedly decreased in China, there has been a significant imbalance among different geographic regions
Summary
The 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. The main causes of maternal death were obstetric haemorrhage, hypertensive disorders in pregnancy, heart diseases, amniotic fluid embolism, puerperal infection in 1996, and still were obstetric haemorrhage, hypertensive disorders in pregnancy, heart diseases, amniotic fluid embolism, venous thrombosis and pulmonary embolism in 2014 [4]. Such causes are similar between minority and nonminority population nationwide. According to official statistics from China Health and Family Planning Commission Statistical Yearbook 2015, the MMR in the Sichuan of the Western China is around two circumstances higher than the created districts of east region, for example, Beijing, Tianjin and Shanghai
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