Abstract
BackgroundChina has made remarkable progress in maternal and child health (MCH) over the last thirty years, but socio-economic inequalities persist. Ethnicity has become an important determinant of poor MCH outcomes, but little rigorous analytical work has been done in this area. To understand the socio-economic factors that explain ethnic variation in uptake of MCH care, we report the findings from an analysis in Sichuan province.MethodsWe linked data from the 2003, 2008 and 2013 National Health Service Surveys in Sichuan Province. The ethnic disparities in uptake of maternal care (completing 5 antenatal visits, giving birth in hospital and receiving a caesarean section) and childhood immunization (Bacillus Calmette Guerin (BCG), three doses of diphtheria (DPT) and measles immunization) were examined by geographical (Han district/county vs. ethnic minority county) and individual-based (Han women/children vs. ethnic minority women/children) comparisons. We also examined variation by distance to township and county hospitals, women’s education, parity and age using weighted multilevel Poisson regressions with random intercept at district/county level.ResultsEthnic inequalities in maternal care were marked, both at the geographical (district/county) and the individual level. The % of births in hospital was 90.7% among women in Han districts, compared to 83.3% among women living in Han counties (crude RR 0.93; 95% CI 0.75–1.15), 53.8% among Han women living in ethnic minority counties (crude RR 0.57; 95% CI 0.36–0.93), and 13.5% among ethnic minority women living in ethnic minority counties (crude RR 0.18; 95% CI 0.06–0.57). Adjusting the analysis for survey year, education, parity and distance to county level hospital weakened the association between geographical/individual ethnicity and uptake of maternity care, but associations remained remarkably strong. Coverage of childhood immunization was much higher than uptake of maternity care, and inequalities by ethnicity were much less pronounced.ConclusionLessons can be learned from China’s successful immunization programme to further reduce inequalities in access to maternity care among ethnic minority populations in remote areas. Bringing the services closer to the women’s homes and strengthening health promotion from the township to the village level may encourage more women to seek antenatal care and give birth in hospital.
Highlights
China has made remarkable progress in maternal and child health (MCH) over the last thirty years, but socio-economic inequalities persist
Half of all women (45.8%) lived in Han districts, 22.7% lived in Han counties, and 31.5% lived in ethnic minority counties
The % of births in hospital was 90.7% among women in Han districts, compared to 83.3% among women living in Han counties, 53.8% among Han women living in ethnic minority counties, and 13.5% among ethnic minority women living in ethnic minority counties
Summary
China has made remarkable progress in maternal and child health (MCH) over the last thirty years, but socio-economic inequalities persist. To understand the socio-economic factors that explain ethnic variation in uptake of MCH care, we report the findings from an analysis in Sichuan province. China has made remarkable progress in maternal and child health (MCH) over the last thirty years. China’s substantial investments in education and infrastructure have greatly facilitated access to care [6]. A recent analysis in poor counties of Western China suggested that educational differences in access to antenatal and delivery care remained surprisingly large [2]. Studies have shown markedly lower uptake of immunisation with BCG, DPT3, and measles among the poor and uneducated [8,9,10], though some studies have shown no inequalities by level of education [2]
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