Abstract
BackgroundA community-based randomized control prenatal care trial was performed in a rural county of China during 2000-2003. The purpose of this paper is to describe the trial implementation and the impact of the trial on the utilization of prenatal care and perinatal outcomes.Materials and methodsIn the study county, 10 townships (from a total of 55) were each paired with a control (20 study townships in total), with the criteria for pairing being the township's socioeconomic development, perinatal health, and maternal care utilization and provision. One of each township pair was randomly allocated to the intervention or control groups. The trial interventions were: 1) training township hospital midwives and instructing them in how to provide systematic maternal care, 2) informing women in the community of the importance of prenatal care, 3) if needed, providing basic medical instruments to the hospitals. A variety of data sources were used to describe the trial implementation (observations, group discussions, field notes, survey to women). The data on pregnancy and perinatal outcomes were from the original hand-written work-records in the village family planning centers of the study townships.ResultsImplementation of the intervention was deficient. The factors hindering the trial implementation included poor coordination between midwives and family planning officers, broader policy changes implemented by the provincial government during the trial, the decentralization of county governance, and the lack of government funding for maternal care. There was only little difference in the use of maternal care, in women's opinions related to maternal care or content of prenatal care, and no difference in the perinatal outcomes between the intervention and control townships.ConclusionsA community based randomized controlled trial could not be fully carried out in rural China as planned due to the changing political landscape, the complexity of the socio-economic situation and a lengthy planning stage. The study could not answer if perinatal outcomes could be improved by increased use of prenatal care.Trial registrationNCT 01054235
Highlights
A community-based randomized control prenatal care trial was performed in a rural county of China during 2000-2003
The factors hindering the trial implementation included poor coordination between midwives and family planning officers, broader policy changes implemented by the provincial government during the trial, the decentralization of county governance, and the lack of government funding for maternal care
The study could not answer if perinatal outcomes could be improved by increased use of prenatal care
Summary
A community-based randomized control prenatal care trial was performed in a rural county of China during 2000-2003. The Ministry of Health issued guidelines entitled “Perinatal Care Management Approaches for Urban Women” and “Systematic Maternal Care Management Approaches for Rural Women” in 1987 and 1989, respectively [14]. Since both the provision and utilization of prenatal care have increased, discrepancies continue both between urban and rural areas and within them. By the late 1990s a few rural areas still had not organized systematic prenatal care This situation offered the possibility to conduct a randomized controlled trial to evaluate the effectiveness of prenatal care
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