| ObjectivesThe overall objective is to evaluate the impact of Qinba health project on maternal health services utilization in there areas. The specific objectives are to find out the factors which influence the maternal healthcare utilization in these areas according to the Behavioral Model of Andersen Health Service Utilization, to compare the utilization of maternal care between the intervention group and control group, then to give some advices to improve the utilization of the maternal care in these areas.Materials and Methods(1) Source of materials: The data in this research was collected from the post intervention household health survey for Health projectâ…§in 2006 by MOH. The survey was carried out in three provinces, including 4 counties in Ningxia, 5 counties in Shaanxi and 5 counties in Sichuan respectively, with a total of 14 counties. There were 4 intervention townships and 2 control townships which were randomly selected from each county, and then there were 2 villages randomly selected from each township, and next there 40 households randomly selected from each village. The women who had live birth from 2002 to 2006 were included in this study, finally this study sampled a total of 1653 cases, 1145 cases of the intervention group and 508 cases of the control group.(2) Content of the study: This study included part of content of the household survey, including the demographics and socio-economic status of the maternity and her family, the accessibility and utilization of maternal health services and other related information.(3) Methods: To describe these influencing factors according to behavior model of Andersen health services utilization and compare the utilization of maternal health care services between the intervention group and control group and use the multi-level model to test the effect of intervention and other influencing factors on the utilization of maternal health care. Results(1) The women's houses were far away from the hospitals, and the women needed a lot of time to get there. The proportions of women's house to the clinic within 1 km distance were 49.04% and 52.36%, the proportions of women's house to the clinic within 10 mininutes' distance were 62.88% and 68.90%. The average distances between the women's house and the township hospitals were 9.4 km and 6.6 km, the average time needed to get the township hospitals are 36.6 mininutes and 26.3 mininues. The average distances between the women's house and the county hospitals were 48.4 km and 36.3 km, the average time needed to get the county hospitals were 115.7 mininutes and 80.1 mininues. Generally speaking, the women's houses in the intervention group were farther than the control groups, and they also needed more time to reach the maternal health care services than the control group. The annual average household income was quite low in these areas, the annual average household income is 1450.0 Yuan and 1707.5 Yuan; so it was hard for them to afford the maternal care services; and the situations in the intervention group was even worse than the control group. So the accessibility of maternal health care in the intervention group was lower than the control group.(2) The proportion of prenatal visit and the proportion of early prenatal visit were gradually increasing in these areas from 2002 to 2006. The proportion of prenatal visit in the intervention group increased from 87.06% to 97.02%, and in the control group, it increased from 83.75% to 93.10%. The proportion of the first prental visit within 13 weeks of gestation in the intervention group increased from 35.37% to 53.88%, and in the control group, it increased from 42.42% to 48.57%. And the extent of the change in the intervention was greater than in the control group. The average times of prenatal visit in the intervention group increased from 2.8 to 3.6, and in the control group, it increased from 2.4 to 3.4. The difference between the intervention group and control group were statistically significant after the adjustment of other influencing factors.(3) The proportion of hospital delivery increased with the time in these areas from 47.06% to 68.44% in the intervention group, and increased from 45.00% to 73.91% in control group After adjusting confounding factors, the probability of hospital delivery in the intervention group was a little more than in the control group, the OR is 1.17, though the difference is not statistically significant.(4). The proportion of postnatal visit at least more than one time increased from 66.27% to 76.83% in intervention group and increased from 61.25% to 71.30% in control group. The average times of postnatal visit increased from 1.5 to 1.9 in intervention group and increased from 1.3 to 1.4 in conrol group. The times of postnatal visit in the intervention group were more than in the control group after the adjustment of other influencing factors, and the difference was statistically significant.(5) The accessibilities and utilization of maternal care services were quite different among different provinces and counties, and the utilization in the same county were quite similar, the ICCs for average prenatal visits, proportion of hospital delivery and average postnatal visits were 0.2355, 0.0821 and 0.1879 respectively, and the similarity were statistically significant.(6) According to the index of Composite prenatal care utilization, the proportion of insufficient in the intervention group and control group were 65.76% and 65.94% respectively, but from 2002 to 2006, this percentage decreased from 77.65% in 2002 to 57.14% in 2006 in the intervention group, and from 75% in 2002 to 60% in 2006 in the control group. According to the index of Composite prenatal care utilization, the probability of the hospital delivery for the appropriate or adequate is 2.3 times and 1.9 times of the insufficient, the average times of post-natal visits was 0.39 times and 0.59 times higher than the insufficient, and all the differences were statistically significant.Conclusions and Suggestions(1) There were more utilizations in the intervention group than the control group even though the accessibility in the intervention group were worse in the control group, so the intervention had improved the utilization of the maternal health care services by improving health care systems and economic accessibility of the poor maternal family.(2) The social and economical development in study areas was slower than the other rural areas. There is still big room for improvement in the area of maternal care provision and utilization. We should invest more to change women's belief in maternal care utilization and improve the access to maternal care in these areas.
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