Maternal and Child Health in Yushu, Qinghai Province, China

Abstract


Introduction: Surmang, Qinghai Province is a rural nomadic Tibetan region in western China recently


devastated by the 2010 Yushu earthquake; little information is available on access and coverage of


maternal and child health services.


Methods: A cross-sectional household survey was conducted in August 2004. 402 women of


reproductive age (15-50) were interviewed regarding their pregnancy history, access to and utilization of


health care, and infant and child health care practices.


Results: Women’s access to education was low at 15% for any formal schooling; adult female literacy


was <20%. One third of women received any antenatal care during their last pregnancy. Institutional


delivery and skilled birth attendance were <1%, and there were no reported cesarean deliveries. Birth


was commonly attended by a female relative, and 8% of women delivered alone. Use of unsterilized


instrument to cut the umbilical cord was nearly universal (94%), while coverage for tetanus toxoid


immunization was only 14%. Traditional Tibetan healers were frequently sought for problems during


pregnancy (70%), the post partum period (87%), and for childhood illnesses (74%). Western medicine


(61%) was preferred over Tibetan medicine (9%) for preventive antenatal care. The average time to reach


a health facility was 4.3 hours. Postpartum infectious morbidity appeared to be high, but only 3% of


women with postpartum problems received western medical care. 64% of recently pregnant women


reported that they were very worried about dying in childbirth. The community reported 3 maternal deaths


and 103 live births in the 19 months prior to the survey.


Conclusions: While China is on track to achieve national Millennium Development Goal targets for


maternal and child health, women and children in Surmang suffer from substantial health inequities in


access to antenatal, skilled birth and postpartum care. Institutional delivery, skilled attendance and


cesarean delivery are virtually inaccessible, and consequently maternal and infant morbidity and mortality


are likely high. Urgent action is needed to improve access to maternal, neonatal and child health care in


these marginalized populations. The reconstruction after the recent earthquake provides a unique


opportunity to link this population with the health system.