title: Reducing high maternal mortality rates in western China: a novel approach.
abstract: Among the Millennium Development Goals, maternal mortality reduction has proven especially difficult to achieve. Unlike many countries, China is on track to meeting these goals on a national level, through a programme of institutionalizing deliveries. Nonetheless, in rural, disadvantaged, and ethnically diverse areas of western China, maternal mortality rates remain high. To reduce maternal mortality in western China, we developed and implemented a three-level approach as part of a collaboration between a regional university, a non-profit organization, and local health authorities. Through formative research, we identified seven barriers to hospital delivery in a rural Tibetan county of Qinghai Province: (1) difficulty in travel to hospitals; (2) hospitals lack accommodation for accompanying families; (3) the cost of hospital delivery; (4) language and cultural barriers; (5) little confidence in western medicine; (6) discrepancy in views of childbirth; and (7) few trained community birth attendants. We implemented a three-level intervention: (a) an innovative Tibetan birth centre, (b) a community midwife programme, and (c) peer education of women. The programme appears to be reaching a broad cross-section of rural women. Multilevel, locally-tailored approaches may be essential to reduce maternal mortality in rural areas of western China and other countries with substantial regional, socioeconomic, and ethnic diversity.
authors.affiliation: Professor and Tibetan Medical Doctor, Tso-ngon (Qinghai) University Tibetan Medical College, Xining City; and Kumbum Tibetan Medical Hospital, Kumbum Monastery, Lusar (CH: Huangzhong), Qinghai Province, P.R. China.
authors.forename: Kunchok
authors.initials: K
authors.lastname: Gyaltsen Gongque Jianzan
authors.affiliation: Professor and Dean, Tso-ngon (Qinghai) University Tibetan Medical College, Xining City, Qinghai Province, P.R. China.
authors.forename: Lhusham
authors.initials: L
authors.lastname: Gyal Li Xianjia
authors.affiliation: Assistant Professor, Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, CA, USA.
authors.forename: Jessica D
authors.initials: JD
authors.lastname: Gipson
authors.affiliation: Director and Obstetrician-Gynaecologist, Tibetan Birth and Training Center, Tongren County of Huangnan Prefecture, Qinghai Province, P.R. China.
authors.forename: Tsering
authors.initials: T
authors.lastname: Kyi Cai Rangji
authors.affiliation: Professor, California Center for Population Research, UCLA, Los Angeles, CA, USA. Electronic address: pebley@ucla.edu.
authors.forename: Anne R
authors.initials: AR
authors.lastname: Pebley
mesh_terms: D000293:Adolescent; D000328:Adult; D002681:China / Q000453:epidemiology; D003906:Developing Countries; D005260:Female; D006301:Health Services Needs and Demand; D006306:Health Surveys; D006801:Humans; D007373:Interinstitutional Relations; D008427:Maternal Health Services / Q000379:methods / Q000458:organization & administration*; D008428:Maternal Mortality; D008875:Middle Aged; D011247:Pregnancy; D011248:Pregnancy Complications / Q000401:mortality / Q000517:prevention & control*; D018609:Tibet / Q000453:epidemiology; D055815:Young Adult
keywords: China; Millennium Development Goals; Tibet; cultural competence; integrative medicine; maternal mortality; minority health; multilevel interventions; reproductive health