Although overall maternal and child mortality rates are continuing to fall in China, the decline is slower than would normally be expected of a country experiencing such robust economic growth, and there is very wide variation between rates in urban and outlying, rural areas, according to a Joint Review of the Maternal and Child Survival Strategy in China published in December by Unicef, UNFPA, WHO and the Ministry of Health.

More rapid and even progress, says the review, has been blocked by insufficient growth of public funding, inequitable allocation of existing health resources (which are heavily concentrated in urban areas), and a “market-oriented approach” that emphasises “treatment over prevention and paid over non-paid services.”

Over the period 1991-2004, national statistics show an overall decline in maternal mortality from 80 to 48.3 deaths per 100,000 live births, and a decline in under-5 mortality from 61 to 21.5 deaths per 1,000 live births.

China’s under-5 mortality rate is now higher than that of Malaysia, Vietnam, Sri Lanka, Thailand and the Philippines.

According to the review, improvements in China’s maternal and child mortality have slowed or even “stalled” in recent years, showing “an obvious discrepancy between China’s MCH improvement and socio-economic development.”

Moreover, when China’s national figures are disaggregated, they reveal a yawning gap between richer and poorer areas. For example, by 2004 the maternal mortality rate in small and medium cities had declined to 15.3 deaths per 100,000 live births, compared to 96 deaths per 100,000 in remote rural areas. The gap, says the report, has widened since 1996.

In many rural areas maternal and child health services have limited reach and low uptake, with nearly 40% of rural deliveries taking place at home.

In addition, the review points to inadequate or unaffordable services for rural migrants, suggesting that uptake of antenatal screening is extremely low, and that as many as 50% of births to migrant women take place at home.

The review states that “there is no precise data” on the health situation of migrants (or ethnic minorities). It does not make clear whether mortality amongst migrant women and children is counted in the national statistics.

The review concludes that “over 75% of the maternal and child mortality in China is caused by a small number of preventable or curable causes,” and that “universal access to the most cost-effective interventions” could halve maternal deaths and reduce child deaths by a third.

It calls for universal access to an essential package of antenatal, obstetric and neonatal care.

Report by Nick Young, January 18 2006