Maternal health care seeking by rural Tibetan women: characteristics of women delivering at a newly-constructed birth center in western China.

Kunchok Gyaltsen,Jessica D Gipson,Lhusham Gyal,Andrew L Hicks,Anne R Pebley,Tsering Kyi

doi:10.1186/s12884-015-0634-9

Abstract

BackgroundIncreasing skilled birth attendance at delivery is key to reducing maternal mortality, particularly among marginalized populations. Despite China’s successful rollout of a national policy to promote facility deliveries, challenges remain among rural and ethnic minority populations. In response, a Tibetan Birth and Training Center (TBTC) was constructed in 2010 to provide high-quality obstetric care in a home-like environment to a predominantly Tibetan population in Tso-ngon (Qinghai) province in western China to improve maternal care in the region. This study examines if and how first users of the TBTC differ from women in the broader community, and how this information may inform subsequent maternal health care interventions in this area.MethodsTrained, Tibetan interviewers administered a face-to-face, quantitative questionnaire to two groups of married, Tibetan women: women who had delivered at the TBTC between June 2011-June 2012 (n = 114) and a non-equivalent comparison group of women from the same communities who had delivered in the last two years, but not at the TBTC (n = 108). Chi-squared and ANOVA tests were conducted to detect differences between the samples.ResultsThere were no significant differences between the samples in education or income; however, women from the TBTC sample were significantly younger (25.55 vs. 28.16 years; p < 0.001) and had fewer children (1.54 vs. 1.70; p = 0.05). Items measuring maternity health care-seeking and perceived importance of health facility amenities indicated minimal differences between the samples. However, as compared to the community sample, the TBTC sample had a greater proportion of women who reported having the final say regarding where to deliver (26 % vs. 14 %; p = 0.02) and having a friend or family member who delivered at home (50 % vs. 28 %; p < 0.001).ConclusionsFindings did not support the hypothesis that the TBTC attracts lower-income, less-educated women. Minimal differences in women's characteristics and perceptions regarding delivery care between the two samples suggest that the TBTC is serving a broad cross-section of women. Differences between the samples with respect to delivery care decision-making and desire for skilled birth care underscore areas that may be further explored and supported in subsequent efforts to promote facility delivery in this population, and similar populations, of women.

Highlights

Increasing skilled birth attendance at delivery is key to reducing maternal mortality, among marginalized populations
Stark disparities in maternal mortality rates have persisted despite the implementation of a national policy promoting hospital-based childbirth and subsidization of maternal health care services through the New Cooperative Medical Scheme [12, 13]
Recent evidence suggests that the urban–rural divide in maternal mortality may be narrowing [14], a recent review of provincial maternal mortality surveillance systems in China found that remote areas (i.e., Qinghai and Gansu provinces) had, on average, maternal mortality ratio (MMR) that were six- to nine-fold higher than the comparison region of Shanghai (Relative risks: 6.71–9.36), and that these disparities have not narrowed since 1999 [12]

Summary

Introduction

Increasing skilled birth attendance at delivery is key to reducing maternal mortality, among marginalized populations. Key intervention strategies to prevent maternal deaths are focused on increasing the proportion of deliveries at health care facilities and the proportion attended by a skilled birth attendant [2, 3]. These interventions are relevant for populations at increased risk of maternal mortality and in addressing unique cultural factors that may affect women’s use of services, e.g., rural, impoverished, and ethnic minority women [1, 4,5,6]. Recent evidence suggests that the urban–rural divide in maternal mortality may be narrowing [14], a recent review of provincial maternal mortality surveillance systems in China found that remote areas (i.e., Qinghai and Gansu provinces) had, on average, MMRs that were six- to nine-fold higher than the comparison region of Shanghai (Relative risks: 6.71–9.36), and that these disparities have not narrowed since 1999 [12]

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