Abstract
IntroductionSurmang, Qinghai Province is a rural nomadic Tibetan region in western China recently devastated by the 2010 Yushu earthquake; little information is available on access and coverage of maternal and child health services.MethodsA cross-sectional household survey was conducted in August 2004. 402 women of reproductive age (15-50) were interviewed regarding their pregnancy history, access to and utilization of health care, and infant and child health care practices.ResultsWomen's access to education was low at 15% for any formal schooling; adult female literacy was <20%. One third of women received any antenatal care during their last pregnancy. Institutional delivery and skilled birth attendance were <1%, and there were no reported cesarean deliveries. Birth was commonly attended by a female relative, and 8% of women delivered alone. Use of unsterilized instrument to cut the umbilical cord was nearly universal (94%), while coverage for tetanus toxoid immunization was only 14%. Traditional Tibetan healers were frequently sought for problems during pregnancy (70%), the postpartum period (87%), and for childhood illnesses (74%). Western medicine (61%) was preferred over Tibetan medicine (9%) for preventive antenatal care. The average time to reach a health facility was 4.3 hours. Postpartum infectious morbidity appeared to be high, but only 3% of women with postpartum problems received western medical care. 64% of recently pregnant women reported that they were very worried about dying in childbirth. The community reported 3 maternal deaths and 103 live births in the 19 months prior to the survey.ConclusionsWhile China is on track to achieve national Millennium Development Goal targets for maternal and child health, women and children in Surmang suffer from substantial health inequities in access to antenatal, skilled birth and postpartum care. Institutional delivery, skilled attendance and cesarean delivery are virtually inaccessible, and consequently maternal and infant morbidity and mortality are likely high. Urgent action is needed to improve access to maternal, neonatal and child health care in these marginalized populations. The reconstruction after the recent earthquake provides a unique opportunity to link this population with the health system.
Highlights
Surmang, Qinghai Province is a rural nomadic Tibetan region in western China recently devastated by the 2010 Yushu earthquake; little information is available on access and coverage of maternal and child health services
Common reasons for declining to participate in the study included that a different dialect of Kham Tibetan was spoken or that the woman was too busy with chores or physical labor
Recent evidence suggests that an equity-based strategy aimed at improving the lives and health of the most impoverished populations is the most cost effective approach for achieving the UN Millennium Development Goals [33]
Summary
Qinghai Province is a rural nomadic Tibetan region in western China recently devastated by the 2010 Yushu earthquake; little information is available on access and coverage of maternal and child health services. China is on track for meeting Millennium Development Goals 4 and 5 [1,2,3], predominantly due to rapid development in the country’s urban and densely populated regions Success in these areas, may mask represented an ongoing barrier to improving the health of the Tibetan people [4]. The nomadic lifestyle and geographic isolation of these 1.5 million ethnically Tibetan people make health and demographic information difficult to obtain and health care difficult to deliver. Their economic, political, social and educational disadvantage has translated into poor access to health care and poor health [4,6] compared to China overall
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