Study On The Strategies Of Further Reducing The Midwest Maternal Mortality Rates

1. Study Significances and ObjectivesThe maternal mortality rate is an important indicator to reflect the level of economic and social development of a country or region. Through the support of government policies and programs, maternal mortality status in China significantly improved. Maternal mortality decreased from80.0/10million to30.0/10million between1991and2010nationally. China has commitmentted to reduce MMR to22.2/10million by2015in the United Nations Millennium Declaration, which is still30.8/10million in2010. It can not be ignored that the Midwest MMR is still higher than the national. The central and western regions is the key to achieve the Millennium Development Goals.In the intervention of national policies and programs, the Midwest MMR is declining from2000to2010, but it declined slowly in the past three years. MMR even rebounded in more than10provinces. It’s in line with the life cycle theory and policy effectiveness law of diminishing. The maternal adjust their behavior and direction, thus the key factors changed. To make MMR maintain the continued downward trend, It’s needed to re-examine the key factors. The purpose of this study is to analyze the intervention strategies based on learn about the Midwest hospital delivery and MMR.2. Materials and MethodsAccording to the gradualist policy model and maternal survival theory, theoretical framework is established. System theory, contradiction analysis and stakeholder theory are used to analyse the intervention strategies for the Midwest MMR. Main data resources include academic papers, second-hand data, field investigations and interviews. Excel2007and QSR NVivo8was used to establish database, SPSS16.0and QSR NVivo8was used to analyze data.3. Main Results(1)Domestic researches are based on descriptionMaternal mortality is the focus of research, the current study is mainly based on specific regions with the data from maternal mortality cards, hospital deaths and maternal assessment, Most researches explore the causes and strategies of maternal mortality, but it is rare to see the implementation and the evaluation of the implementation of the strategies.(2)MMR rebound in some provinces of the central and western regionsThe Midwest MMR declined slowly in recent years, some provinces rebound. Gansu Province and the Xinjiang Production and Construction Corps are site investigated. MMR in Gansu Province declined significantly, but MMR rebound and hospital delivery rate is under the provincial average in Gannan Prefecture which is under the jurisdiction of Gansu Province. Hospital delivery rate is high in Xinjiang Production and Construction Corps, but maternal mortality rebound.(3) Analysis of influencing factorsContradictory analysis method is used to analyze regional disparities, stakeholder analysis method is used to analyze the demands of the different objects.Thus we can come out the key factors of MM in Gansu Province and Xinjiang Production and Construction Corps.The factors of maternal and child health are mainly social factors in Gansu Province, Alpine terrain, poor economic conditions and Living Buddha beliefs custom make hospital delivery rate low. In addition, inaccessible emergency and poor level of emergency obstetric care result in maternal mortality. Corps hospital delivery rate has reached a high level, MMR rebound mainly attributed to the floating population and unplanned fertility maternal. In Corps small changes contributed in larger changes of MMR based small population, thus MMR in Corps is much higher than the national average.(4) Study on intervention strategiesThrough the collection of interventions from the literature and site investigation, this study formed three dimensions nine intervention strategies for maternal mortality based on maternal survival analysis thoery. Intervention model means that first determine the critical factors of maternal mortality by expert scoring method based on maternal influencing factors, the use of to affecting maternal mortality, then evaluate which module is in among the maternal survival analysis framework, depending on the module, the appropriate strategy is confirmed. Finally, these strategies are collected to form appropriate intervention in the local. Gansu model is advised to use mainly strategy4, strategy6, strategy7, strategy8, which focus on further improve health awareness and strengthen the establishment of first aid green channel. Corps model is advised to use strategy3, Strategy5, which focus on floating population and the unplanned fertility maternal. In addition, Obstetric capacity is advised to improve in both municipal hospital and primary hospital.4. Main conclusions(1) Differential management is needed to reduce maternal mortality;(2) Local model should be selected based on deeply analysis of key factors;(3) Monitoring and evaluation mechanism should be established to optimize and evaluate the intervention model;(4) The coordination between the various stakeholders should be strengthened to maximize the play of social benefits;(5) The rational allocation of personnel of medical institutions should be improved as well as the incentive mechanism;(6) Cultural quality of the maternal should be improve and the security system be optimized with the whole society efforts.