Abstract
Objectives: We aim to analyze equity in maternal, newborn, and child health (MNCH) interventions in Jilin, a northeastern province of China, 2008–2018.Study design: Cross-sectional study.Methods: We used provincially representative survey data from 2008, 2013, and 2018. We included 18 essential MNCH interventions, analyzed equity, and calculated the composite coverage score. We used logistic and multiple linear regressions to adjust sampling clusters and covariates.Results: Coverage of hospital-based interventions, such as hospital delivery and antenatal B-ultrasound tests, was nearly universal in Jilin province. Cesarean sections persisted at alarmingly high rates (57.6%). Enormous unmet needs and rural–urban inequalities existed for community-based interventions, such as improved drinking water sources (85.4 vs. 97.9%, p < 0.01), improved sanitation facilities (52.5 vs. 94.2%, p < 0.01), four government-funded antenatal care services (55.8 vs. 84.1%, p < 0.01), and at least eight antenatal care sessions (26.8 vs. 46.3%, p < 0.05). Compared to rural–urban inequity, individual-level disparities across income and education were either small in scale or statistically insignificant. The inequity in coverage of maternal and newborn care shrank during 2008–2018.Conclusions: Despite its success in reducing mortality, China's unique obstetrician-led safe motherhood strategy may come at the cost of over-medicalization and health inequity. Jilin province's recent efforts to revitalize primary health care show the potential to make a change. An integrated system that links families, communities, and all levels of health care organizations seems to be the most effective and efficient model to offer continuing MNCH care.
Highlights
Global health initiatives, such as the Millennium Development Goals (MDGs) and the Sustainable Development Goals (SDGs), prioritize maternal, newborn, and child health (MNCH) [1, 2]
Consensus was reached to extend health coverage along the MNCH care continuum with the rationale of effectively linking families, communities, and all levels of health care providers as a Equity in Essential MNCH Interventions means to universal coverage [3,4,5]
China adopted a unique hospital-based birth strategy in the 1990s and successfully achieved MDGs 4 and 5, which required each country to reduce its maternal mortality by three quarters and under-five mortality by two thirds between 1990 and 2015 [10,11,12]
Summary
Global health initiatives, such as the Millennium Development Goals (MDGs) and the Sustainable Development Goals (SDGs), prioritize maternal, newborn, and child health (MNCH) [1, 2]. Consensus was reached to extend health coverage along the MNCH care continuum with the rationale of effectively linking families, communities, and all levels of health care providers as a Equity in Essential MNCH Interventions means to universal coverage [3,4,5]. Focusing on 75 prioritized countries, the Countdown to 2015 ( Countdown to 2030) represents a decade of efforts to monitor the trends of coverage and equity in a series of essential MNCH interventions [6, 7]. The rise in hospital births fully account for the descending trends in maternal mortality and may prevent 48–70% of neonatal deaths in China [10, 17] These are positive trends, there are concerns that such a doctor-led approach may usher in over-medicalization and health system fragmentation, which may exacerbate health inequity [12, 18]
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