Abstract
BackgroundPrenatal and postnatal visits are two effective interventions for protection and promotion of maternal health by reducing maternal mortality and improving the quality of birth. There is limited nationally representative data regarding the changes of prenatal and postnatal visits since the latest health system reform initiated in 2009 in Shaanxi, China. The aim of this study was to explore the current status and determinants of prenatal and postnatal visits in the background of new health system reform.MethodsData were drawn from two waves of National Health Service Surveys in Shaanxi Province which were conducted prior and post the health system reform in 2008 and 2013, respectively. A concentration index was employed to measure the degree of income-related inequality of maternal health services utilization. Multilevel mix-effects logistic regressions were applied to study the factors associated with prenatal and postnatal visits.ResultsThe study sample consists of 2398 women aged 15-49 years old. The data of the 5th National Health Services Survey in 2013 showed in the criterion of the World Health Organization (WHO), the percentage of women receiving ≥4 prenatal visits was 84.79% for urban women and 82.20% for rural women, with women receiving ≥3 postnatal visits were 26.48 and 25.29% for urban and rural women respectively. In the criterion of China’s ≥ 5 prenatal visits the percentages were 72.25% for urban women and 70.33% for rural women; 61.69% of urban women and 71.50% of rural women received ≥1 postnatal visits. As for urban women, the concentration index of postnatal visit utilization was −0.075 (95% CI:-0.148, −0.020) after the health system reform. The determinants related to prenatal and postnatal visits were the change of reform, women’s education, parity and the delivery institution.ConclusionsThis study showed the utilization of prenatal and postnatal visits met the requirement of the WHO, higher than other areas in China and other developing countries after the new health system reform. The new health system reform increased the utilization of postnatal visits in poor urban women and improved the frequency of prenatal and postnatal visits in rural women.
Highlights
Prenatal and postnatal visits are two effective interventions for protection and promotion of maternal health by reducing maternal mortality and improving the quality of birth
By using the Shaanxi Province data of the 4th and 5th National Health Services Survey, this paper empirically studied the influence of health system reform on the maternal health services utilization of prenatal and postnatal visits among urban and rural women in Shaanxi Province, Western China
The status utilization of prenatal and postnatal visits met the requirement of World Health Organization (WHO), and were higher than other areas in China and other developing countries
Summary
Prenatal and postnatal visits are two effective interventions for protection and promotion of maternal health by reducing maternal mortality and improving the quality of birth. Maternal health refers to the health of women during pregnancy, childbirth and the postpartum period. It is often a positive and fulfilling experience, for many women in developing countries, motherhood is associated with suffering, ill-health and even death. Maternal mortality rate (MMR) is an important indicator to evaluate the health status in developing countries and it has a strong association with the utilization of maternal health services [1]. Prenatal and postnatal visits are two effective approaches of maternal health services to detect and save the life of mother and newborn from life threatening complications (such as primary and secondary postpartum hemorrhage, infection, injuries, and hypothermia) and to ensure the healthy outcome for both mother and newborn [7]. 24% of women in Bangladesh and 25% in Nepal received postnatal care [13, 14]
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