| Objective:To analyze the status of Maternal and Child Health(MCH)and Reproductive Health in Yunnan Province and its gaps with the targets set up by the Sustainable Development Goals(SDGs),the existing problems,difficulties and challenges,to summarize the intervention strategies and measures taken by the Province to improve MCH in Yunnan Province,to predict the values of MCH indicators by 2030,and to provide recommendations to the government for achieving MCH and Reproductive Health targets listed in SDGsMethods:Multiple research methods including the stratified purpose sampling method,interview,collection and analysis of secondary data and trend projection were employed in this research.Three cities/prefectures and three counties/districts were selected as research sites.Qualitative data was collected through interviews,and the Yunnan Provincial Maternal and Child Health Annual Report and the China Health and Family Planning Statistical Yearbook were used to collect quantitative data,including maternal mortality rate(MMR),neonatal mortality rate,infant mortality rate(IMR),and under-five mortality rate(U5MR)and their causes of death,induced abortion and contraception indicators.We also used trend projection method to predict the values of MMR,IMR,and U5MR in 2030 and to analyze whether SDGs targets can be met.Results:MMR,neonatal mortality rate,and U5MR in Yunnan Province in 2017 already achieved the targets set up by SDGs for 2030,but those rates have gaps with the targets set up in the China's National Action Plan of Implementing 2030 Agenda for Sustainable Development(the National Plan).In 2017,the MMRs of Yunnan urban areas and Kunming City were higher than the target value of 2030 by 1.43/100,000 and 1.48/100,000 respectively;the MMRs of whole province and Chuxiong Prefecture were higher than the target value of 2030 by 7.30/100,000 and 5.22/100,000 respectively,the gaps were obvious;and the MMRs of Yunnan rural areas and Nujiang Prefecture were higher than the target value of 2030 by 14.62/100,000 and 49.49/100,000 respectively,which were greater gaps.In 2017,IMRs in Yunnan urban areas,Kunming City and Chuxiong Prefecture already achieved the 2030 target of the National Plan,but the IMRs of the whole province and rural areas were higher than the target value of 2030 by 1.70 ‰ and 2.97 ‰respectively,which were obvious gaps;and the IMR of Nujiang Prefecture was higher than the target value of 2030 by 9.04 ‰,which was a significant gap.In 2017,the U5MRs in Yunnan urban areas and Kunming City already achieved the target of the National Plan by 2030;and the U5MR in Chuxiong Prefecture was higher than the target value of 2030 by 0.10‰,a minor gap,but the U5MRs of whole province and the rural areas were higher than the target value of 2030 by 2.79 ‰ and 4.51 ‰respectively,which were as obvious gaps;and the U5MR in the Nujiang Prefecture was higher than the target value of 2030 by 10.19‰,which was a significant gap.In 2016,the major cause of maternal deaths in Yunnan was still obstetric hemorrhage;the main cause of deaths for both neonatal and infant deaths were premature or low birth weight,and the main cause of deaths for children under 5 years old was other causes.The results of trend projection show that except for Nujiang Prefecture,by 2030 the whole province and other study sites in Yunnan can achieve MCH targets set up by the National Plan.The rate of induced abortion of reproductive age women in Yunnan increased since 2013 and in 2015 it reached 31.99%and the ratios of induced-abortion numbers to live-birth numbers showed similar trend while the contraceptive prevalence rate of married women of childbearing age remained above 78%during 2009—2017.The overall sexual education of schools in Yunnan Province is still in its infancy.There are problems including insufficient teaching materials and teachers,fewer class hours,simple content and one way teaching without the participation of students.The main interventions taken by the government to improve MCH in Yunnan Province include promoting hospital delivery by providing subsides to pregnant women,strengthening the identification and management of high risk pregnant women and children,strengthening the rescue of critical ill pregnant women and newborns,autopsy and assessment of the causes of maternal and children under 5 years old deaths,and incorporating the Government's "Care for Women and Children's Health Action" into the practice of things benefiting the people.However,there are problems and challenges in improving MCH in Yunnan that include insufficient health care providers,weak capacity,poor equipment at health facilities at grassroots level that cause failure to identify high-risk maternal cases and children in time,and in some remote mountainous areas women and children in emergent situation cannot be transferred in time to up level health institution for treatment due to transportation difficulty.Conclusions and recommendations:In 2017,MMR,neonatal mortality rate,IMR and U5MR in Yunnan Province was close to the national level for the first time,but there was still a big gap between different regions in Yunnan Province,and it is necessary to focus on poor and remote areas.At present,the major cause of maternal deaths in Yunnan Province remain obstetric hemorrhage,indicating that the overall quality of obstetrics is not high,which is added by the insufficient and uneven distributed obstetrics and pediatric resources lead to the difficulty in the improvement of service capacity.Although the contraceptive prevalence rate of married women of childbearing age was higher in Yunnan Province,the indicators of induced abortion keep at a higher level.Teachers of sex education in schools are seriously lacking,and rural and off-campus youths even have not received any sex education.We recommend that the government increase investment in medical resources in remote areas and improve the service quality;each prefecture/city should develop its plan to address the outstanding health problems facing women and children,to ensure that all sectors coordinate and cooperate to achieve SDGs.We also suggest that government to provide high-quality reproductive health services to both married and unmarried people to meet their needs for these services.Comprehensive sex education that includes gender equality and rights should be provided for adolescents. |
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