Provincial-level outcomes of China\u2019s \u2018Reducing maternal mortality and eliminating neonatal tetanus\u2019 program

Peiran Chen,Mingrong Li,Qi Li,Juan Liang,Yanping Wang,Hanming Liu,Zheng Liu,Yi Mu,Li Dai,Jun Zhu

doi:10.1038/s41598-020-70257-x

Abstract

To determine whether the nationwide program ‘Reducing maternal mortality and eliminating neonatal tetanus’ contributed to the rapid decline in China’s maternal mortality ratio (MMR) and neonatal tetanus elimination by enhancing hospital delivery, we compared MMR and neonatal tetanus incidence rate (NTR) reductions by province from 2000 to 2013. The difference-in-difference method was used to analyze the program effect. Long-term effects were analyzed relative to MMR and NTR in 2000 and 2002, respectively, while short-term effects in a given year were analyzed relative to MMR and NTR in the preceding year. The national program was associated with a faster decline in MMR in the long term. The rate of decline showed an inverse ‘U’ shape from 2000 to 2013, peaking in 2009. The program had a short-term effect in MMR reduction in 2005, 2007, and 2009. The program was also associated with faster decline in NTR in the short term at some time points, but this association was not consistent and was not found in the long term. In conclusion, the program accelerated decline of MMR from 2000 to 2013 but did not clearly reduce NTR at the province level. Therefore, this targeted program worked efficiently in resource-poor areas.

Highlights

To determine whether the nationwide program ‘Reducing maternal mortality and eliminating neonatal tetanus’ contributed to the rapid decline in China’s maternal mortality ratio (MMR) and neonatal tetanus elimination by enhancing hospital delivery, we compared MMR and neonatal tetanus incidence rate (NTR) reductions by province from 2000 to 2013
A World Health Organization (WHO) report released at the end of 2015 showed that the global maternal mortality ratio (MMR) fell by 44% from 385 to 216 deaths per 100,000 live births between 1990 and 2015, which fell short of the 75% decline stipulated in Millennium Development Goal 5 (MDG 5)[2]
Annual MMR reduction rate in China was only 2.8% from 1996 to 1 9993, which is less than the 5.5% that WHO estimated to be needed in order to achieve MDG 5

Summary

Introduction

To determine whether the nationwide program ‘Reducing maternal mortality and eliminating neonatal tetanus’ contributed to the rapid decline in China’s maternal mortality ratio (MMR) and neonatal tetanus elimination by enhancing hospital delivery, we compared MMR and neonatal tetanus incidence rate (NTR) reductions by province from 2000 to 2013. The program was associated with faster decline in NTR in the short term at some time points, but this association was not consistent and was not found in the long term. The program accelerated decline of MMR from 2000 to 2013 but did not clearly reduce NTR at the province level. A World Health Organization (WHO) report released at the end of 2015 showed that the global maternal mortality ratio (MMR) fell by 44% from 385 to 216 deaths per 100,000 live births between 1990 and 2015, which fell short of the 75% decline stipulated in Millennium Development Goal 5 (MDG 5)[2]. One of the challenges to reduce maternal death in China is the regional inequity in healthcare infrastructure and access. These deaths would have been preventable if the births had occurred with skilled attendants under disinfected and sanitary conditions

Methods

Results

Conclusion