Ethnic disparity in maternal and infant mortality and its health-system determinants in Sichuan province, China, 2002–14: an observational study of cross-sectional data

Abstract

Background The disparity in maternal and child health is a global issue. This study aimed to examine how much disparity in maternal and infant mortality exists between ethnic minority and non-minority counties in Sichuan province, and to examine the health-system determinants of this disparity. Methods In this cross-sectional observational study, we obtained data for maternal mortality and infant mortality, and health system data on health-related human resources, institutions, and services, for 67 minority counties (based on an official classification that considered size of the minority population, number of townships with a high concentration of minority residence, and a history of minority residency) and 116 non-minority counties inSichuan province for the years of 2002, 2006, 2010, and 2014. Data on maternal health-care service indicators were obtained from the Sichuan Maternal and Child Health Hospital; data on health human resources and health infrastructure were obtained from the Sichuan Health and Family Planning Statistic Information Centre; and data on socioeconomic and demographic characteristics were taken from the Sichuan Statistical Yearbook. A series of two-level Poisson regression models with different health system factors were fitted to identify the contributions of each factor to the inequality in maternal and infant mortality.

The development and application of a two-step surveillance process for Healthy China Initiative based on wide coverage interagency data

“…The evidence from Sichuan Province showed that the penetration of the Healthy China Initiative had a significant impact in Sichuan Province with the inflection points of surveillance outcomes at the end of 2019 when the initiative started, but more efforts are still needed given the 3-years unsatisfactory outcomes and the relatively slow implementation status. As indicated by the indexes, large disparities displayed among different regions in Sichuan Province, especially between the developed and less developed regions [69,70], which were likely to be affected by various factors including the capacity of the local government, socioeconomic factors, geographical environment, and the impact of COVID-19 [71]. Furthermore, we found that inflection points appeared in all regions by the end of 2019 to 2020 based on the evaluation results, especially in the "Disease Prevention and Control" and "Health Service" domains.…”

Development and evaluation of a culturally adapted digital-platform integrated multifaceted intervention to promote the utilization of maternal healthcare services: a single-arm pilot study

“…This disparity was particularly pronounced among ethnic minority women residing in ethnic minority counties [ 9 ]. It was estimated that the difference in hospital delivery rates between ethnic minority counties and non-minority counties was responsible for 74.5% of the maternal mortality disparity in Sichuan province [ 10 ]. Previous studies in Liangshan have identified several barriers to the utilization of antenatal and hospital delivery care, including women’s low education levels [ 11 , 12 ], poor awareness of ANC and hospital delivery [ 11 ], women’s subordinate position within their own household [ 12 ], the traditional norm of delivery at home [ 11 ], poor affordability of transportation costs for accessing healthcare facilities [ 12 ], and low quality of healthcare services [ 13 ].…”

Ethnic Disparities in Utilization of Maternal and Child Health Services in Rural Southwest China

“…Reducing MCH disparity has been a crucial issue across the whole nation in China, a developing country with the largest population in the world [ 8 , 9 , 10 , 11 ]. The Chinese government has taken a series of actions in order to increase the coverage of the interventions of MCH among disadvantaged populations in less developed regions [ 12 , 13 , 14 ].…”

“…The Lancet–Lowitja Institute Global Collaboration study has shown that Yunnan province and Tibet Autonomous Region in China have not yet reached the UN SDG for underserved populations [ 18 ]. Some studies related to ethnic populations have reported health coverage and health outcomes based on the whole population from the Autonomous Region rather than classified by ethnic type [ 8 , 19 ]. No study has compared differences of MCH between Han and ethnic minorities at a provincial level, because the medical records and vital statistics were rarely classified by ethnicity in the official health statistics system.…”