Study On Maternal Health Care Status In Two Counties Of Anhui Province

Objective The study aims to understand the situation and influencing factors of rural maternal health care and the needs for maternity, and to analyze the impact of maternal health care on gestational outcome, for the purpose of improving service quality in rural maternal health care and promoting reproductive health of rural women of child-bearing age.Method Two counties were selected from south of Anhui. Qualitative and quantitative studies were both used with administrators and workers of MCH(maternal care health)and women who had delivery history in recent two years. The current situation and demands of maternal health services in rural areas and the influencing factors were reviewed. The individual depth interview were carried out with the County government deputy head in charge of health affairs, head of MCH services in County Health Bureau, administrator in charge of county CMS (Cooperative medical scheme) office, County Family Planning Committee and Chairpersons of Women's Federation between two countys (eight people). The focus group discuss with 18 administrators of township hospitals and CMS (divide into 3 groups), with 24 Township doctors and nurses (divide into 3 groups), with 18 Village doctors and FP workers (divide into 3 groups), with 22 Women who have used maternal health services (divide into 4 groups). 2 326 women who had delivery history in recent two years participated in the questionnaire survey, include 1 227 women in county A and 1 099 women in county B. The data were used to described the situation of MCH in prenatal, intrapartum and postpartum period, and to compare the differences of MCH influencing factors, prevalence of cesarean section and low birthweight newborns between two counties.Results Qualitative study results showed that inequality existed in maternal health care services, with high coverage rate of prenatal checkup and poor high-risk management in township hospitals which undertook the primary maternal health, Insufficient equipments, the low level of medical care and poor health care consciousness were the main factors influencing the demands of MCH in rural areas. Service charge varied from different health institutions in rural and urban areas. All the interviewees thought traffic inconvenience was the main obstructive factors in obtaining maternal health care.Questionnaire survey results showed that among 2 326 women, 2 249 women (96.7%) reported having prenatal checkups, in which 1 160 women (49.9%) reported having prenatal checkups during the first 3 months pregnancy and 1 342 women (57.7%) reported more than 5 times prenatal checkups during pregnancy, 829 women (35.6%) reported system prenatal checkups, (both prenatal checkups during the first 3 months pregnancy and 5 times prenatal checkups during pregnancy). 2 308 women (99.2%) reported hospital delivery, 1 051 women (45.2%) vagina delivery, 1 275 women (54.8%) cesarean section. 2 225 women (95.7%)reported no postpartum visit.but 956 women (41.1%) reported had been some discomfort during postpartum, 491 women (51.3%) who felt discomfort had done nothing during postpartum,136 women (14.2%) had been treated with some tradition methods when they felt discomfort during postpartum.As classified by systematic prenatal checkups (both prenatal checkups during the first 3 months pregnancy and 5 times prenatal checkups during pregnancy) criteria, women who reprorted systematic prenatal checkups in county B were higher than that of women in county A (P<0.01). Multiple logistic regression models of county A showed that women who reported having more education years, being primiparous, having consciousness of prenatal checkups and being migrant workers were positively associated with seeking for systematic maternal care services; Multiple logistic egression models of county B showed that being old was a danger factor, but women reported having more education years, known CMS were stimulative associated with seeking for systematic maternal care services. As classify by prenatal checkups during the first 3 months pregnancy criteria, the rate of prenatal checkups during the first 3 months pregnancy in county B was higer than that of county A (P<0.01). As classified by prenatal checkups≥5 criteria,the women in county A were more than women in county B (P<0.05). As classified by prenatal checkups criteria, there were no statistically differences in two counties.As classified by hospital delivery criteria, there was no statistical differences in two counties (P>0.05). As classified by cesarean section criteria, there were statistically differences in two counties (P<0.05). By using multinomial logistic regression model, it showed that primiparous women, earning >20 000, illness in pregnancy and derate the charge of hospital dilevery by cesarean section were risk factors in county A, while education years, systematic prenatal checkup times were risk factors in county B, with known CMS positively associated with cesarean section of women in county B. There were no statistically differences in postpartum hemorrhage, newborn asphyxia and the death of 7 days newborn (P>0.05).The rate of low birth weight showed no statistically differences between two counties. In multiple logistic regression models of low birth weight,it showed that premature delivery, twin pregnancy were risk factors of low birth weight, but≥5 prenatal checkups were protective factors of low birth weight.Conclusions The culture and consciousness of health care were the main influencing factors of maternal health care. Systematic and skilled prenatal checkups can improve the pregnant outcome. Enhancing the quality of maternal care services is the key method to improve pregnant outcome. Delivery monitoring, high risk preganacy management, health education of maternal care and systematic maternal care should be strengthened to improve the current draggled maternal care service.