Abstract
BackgroundThe Chinese government introduced the maternal health services as part of the Basic Public Health Service (BPHS) project in 2009. While China has made progress in reducing maternal mortality, the longitudinal association between the utilization rate of the maternal health services of the BPHS project and such reduction was rarely evaluated with robust methods.MethodsWe conducted a longitudinal study on the maternal health service utilization rates of the BPHS project and the maternal mortality ratios (MMR) in mainland China and its 31 provincial regions. The data were extracted from the National Health Statistic Yearbooks (2009–2016). Panel data models were used to evaluate the association between the utilization rate and the MMR after adjusting for available covariates on healthcare resources. Stepwise regression models were used to gauge the direction and magnitude of omitted variable bias.ResultsIt was found that the service utilization rate increased from 79.24% in 2009 to 91.67% in 2016, while MMR decreased from 30.90 to 17.88 per 100,000 livebirths at the national level. The results of the fixed effects panel data model revealed that the utilization rate was associated with MMR deduction continuously. With every 1% increase in utilization rate, the maternal death would decrease by 0.35 per 100,000 livebirths after having the health resources variables adjusted.ConclusionsThe utilization of maternal health services increased continuously after the introduction of BPHS project in 2009 and MMR went downward from then on. The utilization of maternal health services did have significant association with MMR and could reduce MMR effectively. Such improvement could be attributed to the fact that this program was designed to serve the targeted population throughout the continuum of maternal care and the government’s rigorous efforts in stressing equality and standard care in program implementation.
Highlights
The Chinese government introduced the maternal health services as part of the Basic Public Health Service (BPHS) project in 2009
Data collection The maternal mortality ratio (MMR), the maternal health service utilization rates and the health resource data of the mainland China and its 31 provincial regions were collected by the Chinese government and reported in the National Health Statistic Yearbook
It was found that the service utilization rate increased from 79.24% in 2009 to 91.67% in 2016, while MMR decreased from 30.90 to 17.88 per 100,000 livebirths at the national level
Summary
The Chinese government introduced the maternal health services as part of the Basic Public Health Service (BPHS) project in 2009. While China has made progress in reducing maternal mortality, the longitudinal association between the utilization rate of the maternal health services of the BPHS project and such reduction was rarely evaluated with robust methods. 800 women die each day due to preventable causes related to pregnancy and childbirth according to the World Health Organization (WHO) report [1], indicating that the maternal mortality is still a worldwide public health challenge. The main causes of maternal deaths were found to be obstetric hemorrhage, sepsis, unsafe abortion, hypertensive disorders, and obstructed labor, which were mostly preventable [4], and could be averted if all women had access to timely health services and interventions for the prevention and treatment of pregnancy and birth complications [5]. WHO have announced that the antenatal healthcare should include at least 4 visits [13] to health facilities for an uncomplicated pregnancy and at least 3 postnatal care visits [14] are recommended for all mothers and newborns
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