Abstract
BackgroundStudies on prenatal care in China have focused on the timing and frequency of prenatal care and relatively little information can be found on how maternal care has been organized and funded or on the actual content of the visits, especially in the less developed rural areas. This study explored maternal care in a rural county from Anhui province in terms of care organization, provision and utilization.MethodsA total of 699 mothers of infants under one year of age were interviewed with structured questionnaires; the county health bureau officials and managers of township hospitals (n = 10) and county level hospitals (n = 2) were interviewed; the process of the maternal care services was observed by the researchers. In addition, statistics from the local government were used.ResultsThe county level hospitals were well staffed and equipped and served as a referral centre for women with a high-risk pregnancy. Township hospitals had, on average, 1.7 midwives serving an average population of 15,000 people. Only 10–20% of the current costs in county level hospitals and township hospitals were funded by the local government, and women paid for delivery care. There was no systematic organized prenatal care and referrals were not mandatory. About half of the women had their first prenatal visit before the 13th gestational week, 36% had fewer than 5 prenatal visits, and about 9% had no prenatal visits. A major reason for not having prenatal care visits was that women considered it unnecessary. Most women (87%) gave birth in public health facilities, and the rest in a private clinic or at home. A total of 8% of births were delivered by caesarean section. Very few women had any postnatal visits. About half of the women received the recommended number of prenatal blood pressure and haemoglobin measurements.ConclusionDelivery care was better provided than both prenatal and postnatal care in the study area. Reliance on user fees gave the hospitals an incentive to put more emphasis on revenue generating activities such as delivery care instead of prenatal and postnatal care.
Highlights
Studies on prenatal care in China have focused on the timing and frequency of prenatal care and relatively little information can be found on how maternal care has been organized and funded or on the actual content of the visits, especially in the less developed rural areas
BMC Health Services Research 2008, 8:55 http://www.biomedcentral.com/1472-6963/8/55 systematic maternal care program was introduced in the 1980s and its utilisation and outcomes have been the target of many studies [2,3,4,5,6,7,8]
The studies on prenatal care in China have focused on the timing and frequency of prenatal care [12,19,22] and relatively little information can be found on how maternal care has been organized and funded, and the actual content of the prenatal visits, especially in the less developed rural areas
Summary
Studies on prenatal care in China have focused on the timing and frequency of prenatal care and relatively little information can be found on how maternal care has been organized and funded or on the actual content of the visits, especially in the less developed rural areas. The studies showed that the utilization of maternal care increased and that perinatal and maternal health indicators have improved since the early 1980s [3,7,9,13,14,15,16,17]. According to the results of national maternal and infant mortality surveillance, maternal mortality rate (MMR) fell from 94.7 to 53.4 per 100000 live births between 1989 and 2000 [14] and infant mortality rate (IMR) decreased from 37.9 per 1000 live births in 1982 to 32.5 per 1000 in 1998 [15]. In the study province MMR fell from 62 to 50 per 100000 live births and IMR decreased from 33 to 29 per 1000 live births between 1995 and 1999 [18]
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