China: Maternal deaths remain high for ethnic minorities
Case study By Rinnai Ngadan
Many minority women in western China do not give birth in hospitals because of poor-quality facilities and culturally insensitive care.
Despite China’s national progress in the areas of maternal and infant health, rural and ethnic minority regions lag behind. A 2010 UN report tracing China’s progress toward the Millennium Development Goals shows that maternal mortality rates are almost twice as high in western regions, where many ethnic minorities live, than in wealthier eastern provinces.
Since 2000, China has campaigned for all women to give birth in hospitals, in an effort to reduce the number of mother and newborn deaths. And yet such a policy focus ignores two persistent realities that hinder maternal and child health for rural minority women – lower-quality care in rural hospitals and a lack of understanding of traditional birthing practices.
Studies show that ethnic minority women are much less likely to seek health care or give birth in hospitals than the majority Han population. A major study in 2007 investigated the challenges of using maternal health care services for Yi and Mong ethnic minority women in a remote area of southwest China’s Sichuan province.
The study found that accessibility, while clearly a factor given the lack of good roads and transport, was not as important as many presume.
Hospital deliveries are very expensive. The government’s new cooperation insurance scheme was introduced in the area in 2006, and although most women have paid their contributions, many do not know how to use the scheme. Furthermore, costs of a hospital birth – including medication, transportation and family accommodation – exceed any reimbursement available through the scheme.
Women are also staying at home because of the poor quality of care in township hospitals, where medical staff cannot perform caesarean sections or keep safe blood supplies.
Lack of understanding of local culture and beliefs among health care staff is another important and neglected barrier. The cultural inappropriateness of birthing practices causes women discomfort and embarrassment; and there is a lack of incentives such as pain relief during labour.¹
Researchers noted how women said that they would prefer not to be shaved, to be allowed to walk around during labour and to give birth in a position similar to the traditional semi-sitting position which was not available as a choice in the hospital.
The focus on Western medical approaches to health and childbirth, and the lack of sensitivity to local culture and practices, contributes to the lack of trust and desire for minority women to give birth in a hospital setting. The government also does not support relationships between health staff and experienced traditional midwives.
In spite of China’s progress towards health targets, health issues among ethnic minorities continue to be neglected. The government’s emphasis on increasing accessibility and improving health infrastructure ignores the much-needed improvement in service quality. Most critically, a bias towards Western medicine in hospitals does not give sufficient attention to the potential and roleof traditional health practices.
Case study taken from the Asia chapter of MRG’s State of the World’s Minorities and Indigenous Peoples 2013 report – focus on health
Photo: Yi woman and child
¹ Harris, A., Zhou, Y., Liao, H., Barclay, L., Zeng, W. and Gao, Y., ‘Challenges to maternal health care utilization among ethnic minority women in resource-poor region of Sichuan Province China’, Health Policy and Planning, vol. 25, pp. 311–18, 2010, retrieved June 2013: http://heapol.oxfordjournals.org/content/25/4/311.full.pdf+html