Free hospital delivery improves rural women's lives

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The first time she got pregnant, in 2004, Yang Lanyan panicked when her period stopped for two months, because she had no idea what it meant.

"I was too shy to tell my mother-in-law," says Yang, a farmer in Pailou Village, in the relatively underdeveloped Huishui County of China's southwestern Guizhou Province, home to Buyi and Miao ethnic minority people.

Instead, she took a friend's advice and bought a pregnancy test paper in town. She followed the instructions and the test was positive.

Poor knowledge of reproductive health and the low hospital delivery rate in the countryside used to pose grave health risks to Chinese rural women.

In 1949, when the People's Republic of China was founded, 15 in every 1,000 women died in childbirth, according to a progress report by the Ministry of Health.

Modern China's maternal mortality ratio has fallen from 1,500 per 100,000 then to 31.9 per 100,000 in 2009, according to statistics of the health ministry.

Health Minister Chen Zhu said in September 2009, China's maternal mortality ratio was among the lowest in the developing world.

Wang Linhong, vice director of National Center for Women and Children's Health, the Chinese Center for Disease Control and Prevention, believes the decline in childbirth related deaths and greater access to maternal health care is the greatest-ever achievement in improving Chinese women's health.

One of the main reasons behind the progress is the policy of free or subsidized hospital delivery to rural women and corresponding improvements in maternal health care.

Under the policy, rural women receive benefits if they give birth in hospital, and those women who join the new rural corporative medical care system (NCMS) have medical expenses almost entirely reimbursed.

This policy has been carried out since 2005. A similar policy aimed at reducing maternal mortality and eliminating neonatal tetanus was tried out previously in certain areas.

Yan Lanyan, a mother of two boys, has personal experience of such progress.

"It never occurred to me that I should get maternity checks when I was pregnant the first time," she says. Instead, she worked as usual.

"I was going to ask my aunt who was the midwife of our village to help with the birth."

However, three months into the pregnancy, she began to bleed.

She went to the county hospital, and the doctor suggested a hospital stay.

But she refused to take the advice because she could not afford it. The family barely made ends meet with her husband earning 600 yuan (87.8 U.S.dollars) a month.

She went back home and worked as usual. In November, 2004, one month ahead of the due date, she gave birth to a boy.

But he was so weak that he caught cold and pneumonia at eight months. "We borrowed 4,000 yuan to cover medical fees," says Yang.

She was much better off during her second pregnancy in 2009. Village cadres encouraged her to have regular maternity checks.

Yang went eight times in the township health clinic. "It was amazing that I could know how my baby developed at each stage. This time I didn't fall ill for once."

She had her baby delivered at hospital in January. "This time I had no worries, because I knew the expenses would be covered by insurance."

Yang's hospital stay cost her more than 1,000 yuan, most of which was covered by NCMS, and she only paid 60 yuan out of her own pocket.

She stayed in hospital for five days receiving post-natal care.

Yang Yingju, director of the maternal clinic of Huishui County, says that since 2005, pregnant women can get 500 yuan for a natural birth and 800 yuan for a caesarian section if they are not covered by the NCMS.

According to the United Nations Children's Fund (UNICEF), post-natal care is crucial. "Evidence indicates that the risks of maternal mortality and morbidity are high in the 48 hours immediately following birth," says its report on Maternal and Newborn Health for 2009.

Yang Fang, the head of a township-level clinic in Huishui county, says, "Women know perfectly that hospital births are safe and healthy, but they couldn't afford it in the past. Now with insurance or government subsidies, most would go to hospital to give birth."

Only women in remote and inaccessible areas still have to give births at home, she says. "But even in that scenario, their births are attended by skilled health workers."

She said 13 pregnant women of Pailou village gave birth in hospital last year. The rate of hospital delivery of the township was 66 percent.

According to the Health Ministry's report on the development of China's health programs in 2009, the rate of hospital delivery across China in 2008 stood at 94.5 percent, and in the countryside at 92.3 percent.

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