China: lowering maternal mortality in Miyun County, Beijing

Abstract

In Miyun County in China the medical authorities registered an elevated maternal mortality ratio which needed to be verified in order to design corrective changes. A decision was taken in 1988 to start a project of pilot interventions in the organization of maternal health services and access for obstetric emergencies. A control and pilot area were chosen in order to test the validity of the interventions. The reduction in maternal mortality from the main complications (postpartum haemorrhage and eclampsia) was impressive and no more maternal deaths were registered in the pilot area with reference to these causes. The overall maternal mortality ratio per 100,000 live births dropped by more than 75% in the pilot area throughout the three-year implementation period. It was therefore shown that the synergistic effect of additional training of medical workers and traditional birth attendants, improved health education, the provision of easier access to emergency care services, the establishment of obstetric rescue teams at the county level, generally improved MCH services, and strengthened management capacity for high risk pregnancies were the most appropriate interventions to lower maternal mortality.

PIP: This account provides a description for Miyun County (outside Beijing), China, of the number of maternal deaths, access to maternal health services, and system improvements during 1985-88. Maternal health care in Miyun County is provided through local township hospitals, county hospitals, and maternity hospitals. Community education is provided locally by village doctors and birth attendants at health stations. Health procedures were changed to include the application of Ministry of Public Health rules on strengthening referrals between village health stations, township hospitals, and county hospitals. Case management procedures were established for caring for postpartum hemorrhage, severe pregnancy-induced hypertension, amniotic embolism, shock, and neonatal asphyxia. Maternal health records were standardized, monitoring procedures for perinatal care were widely promoted, and high-risk pregnancies were identified and referred according to specific procedures. Six pilot areas were identified for testing the success of program implementation. Findings of this evaluation were that 27.3% (33) of maternal deaths were not reported. Maternal mortality was adjusted to account for these deficiencies (114/100,000). 60% of deaths were obstetrically-related. The leading causes were hemorrhage, followed by postpartum infections and pregnancy-induced hypertension. 63% of deaths involved insufficient prenatal care. Almost 40% of deaths were unnecessary, and about 66% were preventable. In the pilot townships hospitals showed improvements in hospital equipment and staff training. Only in the pilot areas did mortality rates improve. The maternal mortality rate in pilot areas declined by over 75%.