Gyaltsen Gongque Jianzan Kunchok, Gyal Li Xianjia Lhusham, Gipson Jessica D, Kyi Cai Rangji Tsering, Pebley Anne R
Professor and Tibetan Medical Doctor, Tso-ngon (Qinghai) University Tibetan Medical College, Xining City; and Kumbum Tibetan Medical Hospital, Kumbum Monastery, Lusar (CH: Huangzhong), Qinghai Province, P.R. China.
Professor and Dean, Tso-ngon (Qinghai) University Tibetan Medical College, Xining City, Qinghai Province, P.R. China.
Reprod Health Matters. 2014 Nov;22(44):164-73. doi: 10.1016/S0968-8080(14)44802-X.
Among the Millennium Development Goals, maternal mortality reduction has proven especially difficult to achieve. Unlike many countries, China is on track to meeting these goals on a national level, through a programme of institutionalizing deliveries. Nonetheless, in rural, disadvantaged, and ethnically diverse areas of western China, maternal mortality rates remain high. To reduce maternal mortality in western China, we developed and implemented a three-level approach as part of a collaboration between a regional university, a non-profit organization, and local health authorities. Through formative research, we identified seven barriers to hospital delivery in a rural Tibetan county of Qinghai Province: (1) difficulty in travel to hospitals; (2) hospitals lack accommodation for accompanying families; (3) the cost of hospital delivery; (4) language and cultural barriers; (5) little confidence in western medicine; (6) discrepancy in views of childbirth; and (7) few trained community birth attendants. We implemented a three-level intervention: (a) an innovative Tibetan birth centre, (b) a community midwife programme, and (c) peer education of women. The programme appears to be reaching a broad cross-section of rural women. Multilevel, locally-tailored approaches may be essential to reduce maternal mortality in rural areas of western China and other countries with substantial regional, socioeconomic, and ethnic diversity.
在千年发展目标中，降低孕产妇死亡率已被证明特别难以实现。与许多国家不同，中国正通过一项将分娩制度化的计划，在国家层面上朝着实现这些目标迈进。尽管如此，在中国西部的农村、贫困和多民族地区，孕产妇死亡率仍然很高。为了降低中国西部的孕产妇死亡率，我们作为一所地区性大学、一个非营利组织和当地卫生当局之间合作的一部分，制定并实施了一种三级方法。通过形成性研究，我们在青海省一个藏族农村县确定了七个阻碍住院分娩的因素：（1）前往医院的交通困难；（2）医院缺乏供陪同家属住宿的地方；（3）住院分娩的费用；（4）语言和文化障碍；（5）对西医缺乏信心；（6）对分娩的看法存在差异；（7）受过培训的社区助产士很少。我们实施了一项三级干预措施：（a）一个创新的藏族分娩中心，（b）一个社区助产士项目，以及（c）对妇女的同伴教育。该项目似乎正在惠及广大农村妇女群体。多层次、因地制宜的方法对于降低中国西部农村地区以及其他存在巨大区域、社会经济和民族差异的国家的孕产妇死亡率可能至关重要。
