Moucheraud Corrina, Gyal Lhusham, Gyaltsen Kunchok, Tsering Lumo, Narasimhan Subasri, Gipson Jessica
University of California Fielding School of Public Health, 650 Charles E. Young Drive South, Los Angeles, CA, 90095, USA.
Tso-Ngon (Qinghai) University Tibetan Medical College, No. 16 Kunlun Road Rd., Xining, 810001, Qinghai, People's Republic of China.
Matern Child Health J. 2018 Feb;22(2):264-273. doi: 10.1007/s10995-017-2398-5.
Introduction Despite significant global improvements in maternal health, large disparities persist. In China, rural women and women who live in western regions experience lower rates of maternal healthcare utilization and higher rates of maternal mortality than women elsewhere in the country. This paper examines maternal health care-seeking among nomadic Tibetan women in rural western China, a particularly understudied group. Methods Secondary data analysis was conducted with survey data collected in 2014 in Qinghai Province, China. Participants (rural, nomadic, adult women) provided birth histories and information on care received during antenatal, intrapartum and/or postpartum period(s). Using bivariate and multivariable logistic regression models, these outcomes were explored in relation to maternal characteristics (e.g., educational attainment and parity), use of health insurance, and time. Results Approximately half of all women had ever used antenatal care, institutional delivery, and/or skilled birth attendance. The utilization of these services has increased over time, from 10% of births prior to the year 2000, to approximately 50% since 2000. Utilization increased by year (odds ratios ranging from 1.1 to 1.3) even after controlling for covariates. Women with health insurance coverage were significantly more likely to use these services than women without insurance, although less than 20% of women reported that insurance paid for any antenatal and/or childbirth care. Discussion Utilization of maternal care is improving among this population but rates remain low in comparison to other women in rural, western China. Further targeted interventions may be needed to reach and adequately address the maternal health needs of this unique population.
引言 尽管全球孕产妇健康状况有了显著改善，但巨大差距依然存在。在中国，农村妇女以及西部地区的妇女相比国内其他地区的妇女，孕产妇保健服务利用率较低，孕产妇死亡率较高。本文研究了中国西部农村游牧藏族妇女的孕产妇保健就医情况，这是一个特别缺乏研究的群体。
方法 对2014年在中国青海省收集的调查数据进行二次数据分析。参与者（农村游牧成年女性）提供了生育史以及产前、产时和/或产后期间接受护理的信息。使用双变量和多变量逻辑回归模型，探讨这些结果与孕产妇特征（如教育程度和平产次）、医疗保险使用情况和时间的关系。
结果 约一半的妇女曾使用过产前护理、机构分娩和/或熟练接生服务。这些服务的利用率随时间有所增加，从2000年前分娩的10%，增加到2000年以来的约50%。即使在控制协变量后，利用率仍逐年增加（优势比在1.1至1.3之间）。有医疗保险的妇女比没有保险的妇女更有可能使用这些服务，尽管不到20%的妇女报告保险支付了任何产前和/或分娩护理费用。
讨论 该人群的孕产妇护理利用率正在提高，但与中国西部农村的其他妇女相比，比例仍然较低。可能需要进一步的针对性干预措施，以满足这一独特人群的孕产妇健康需求。
