title: Maternal health care seeking by rural Tibetan women: characteristics of women delivering at a newly-constructed birth center in western China.
abstract: BACKGROUND
  Increasing 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.
  
  
  METHODS
  Trained, 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.
  
  
  RESULTS
  There 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).
  
  
  CONCLUSIONS
  Findings 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.
authors.affiliation: Tso-ngon (Qinghai) University Tibetan Medical College, No. 16 Kunlun Road., Xining City, Qinghai Province, 81001, P.R. China. Kunchokg5@gmail.com.|Tibetan Birth and Training Center, Tongren County of Huannan Prefecture, Qinghai, P.R. China. Kunchokg5@gmail.com.
authors.forename: Kunchok
authors.initials: K
authors.lastname: Gyaltsen
authors.affiliation: Department of Community Health Sciences, UCLA Fielding School of Public Health, 650 Charles E. Young Drive South CHS 46-071B, Los Angeles, CA, 90095-1772, USA. jgipson@ucla.edu.|California Center for Population Research, University of California Los Angeles, Los Angeles, CA, USA. jgipson@ucla.edu.
authors.forename: Jessica D
authors.initials: JD
authors.lastname: Gipson
authors.affiliation: Tso-ngon (Qinghai) University Tibetan Medical College, No. 16 Kunlun Road., Xining City, Qinghai Province, 81001, P.R. China. lxgyal@sina.com.|Tibetan Birth and Training Center, Tongren County of Huannan Prefecture, Qinghai, P.R. China. lxgyal@sina.com.
authors.forename: Lhusham
authors.initials: L
authors.lastname: Gyal
authors.affiliation: Tibetan Birth and Training Center, Tongren County of Huannan Prefecture, Qinghai, P.R. China. Annie_cuo@hotmail.com.
authors.forename: Tsering
authors.initials: T
authors.lastname: Kyi
authors.affiliation: CCPR Statistics and Methods Core, California Center for Population Research, University of California Los Angeles, Los Angeles, CA, USA. andrew@ccpr.ucla.edu.|Current address: Department of Health Care Policy, Harvard Medical School, Boston, MA, USA. andrew@ccpr.ucla.edu.|California Center for Population Research, University of California Los Angeles, Los Angeles, CA, USA. andrew@ccpr.ucla.edu.
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Hicks
authors.affiliation: Department of Community Health Sciences, UCLA Fielding School of Public Health, 650 Charles E. Young Drive South CHS 46-071B, Los Angeles, CA, 90095-1772, USA. pebley@ucla.edu.|California Center for Population Research, University of California Los Angeles, Los Angeles, CA, USA. pebley@ucla.edu.
authors.forename: Anne R
authors.initials: AR
authors.lastname: Pebley
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D016550:Birthing Centers / Q000706:statistics & numerical data*; D003657:Decision Making; D036861:Delivery, Obstetric / Q000379:methods / Q000523:psychology / Q000706:statistics & numerical data*; D004522:Educational Status; D005260:Female; D006801:Humans; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011247:Pregnancy; D012424:Rural Population / Q000706:statistics & numerical data*; D012923:Social Class; D018454:Spouses; D011795:Surveys and Questionnaires; D018609:Tibet; D055815:Young Adult