Maternal health care seeking by rural Tibetan women: characteristics of women delivering at a newly-constructed birth center in western China

Background: Increasing skilled birth attendance at delivery is key to reducing maternal mortality, particularly among marginalized populations. Despite China’s successful rollout of a national policy to promote facility deliveries, challenges remain among rural and ethnic minority populations. In response, a Tibetan Birth and Training Center (TBTC) was constructed in 2010 to provide high-quality obstetric care in a home-like environment to a predominantly Tibetan population in Tso-ngon (Qinghai) province in western China to improve maternal care in the region. This study examines if and how first users of the TBTC differ from women in the broader community, and how this information may inform subsequent maternal health care interventions in this area. Methods: Trained, Tibetan interviewers administered a face-to-face, quantitative questionnaire to two groups of married, Tibetan women: women who had delivered at the TBTC between June 2011-June 2012 (n = 114) and a non-equivalent comparison group of women from the same communities who had delivered in the last two years, but not at the TBTC (n = 108). Chi-squared and ANOVA tests were conducted to detect differences between the samples. Results: There were no significant differences between the samples in education or income; however, women from the TBTC sample were significantly younger (25.55 vs. 28.16 years; p < 0.001) and had fewer children (1.54 vs. 1.70; p = 0.05). Items measuring maternity health care-seeking and perceived importance of health facility amenities indicated minimal differences between the samples. However, as compared to the community sample, the TBTC sample had a greater proportion of women who reported having the final say regarding where to deliver (26 % vs. 14 %; p = 0.02) and having a friend or family member who delivered at home (50 % vs. 28 %; p < 0.001). Conclusions: Findings did not support the hypothesis that the TBTC attracts lower-income, less-educated women. Minimal differences in women's characteristics and perceptions regarding delivery care between the two samples suggest that the TBTC is serving a broad cross-section of women. Differences between the samples with respect to delivery care decision-making and desire for skilled birth care underscore areas that may be further explored and supported in subsequent efforts to promote facility delivery in this population, and similar populations, of women

Examining the Maternal and Child Health Care Services in Rural Nepal

This study examines the strengths and opportunities of Maternal Child Health Workers (MCHWs) in providing Maternal and Child Health (MCH) care services in rural communities of Nepal. It explores the selection procedure of MCHWs, and their knowledge, skills, and attitudes. The study also explores the supervision of MCHWs, the delivery of medical supplies to the Sub-Health Posts, and other social factors of MCHWs in Rautahat and Bara Districts in the Terai region of Nepal. In addition, the paper discusses the overall perspectives of both theoretical and practical programs of MCH which include the MCH concept and applications as well as MCH practices. The study used structured interviews, focus group discussions, and observation to explore the MCH services in sixteen Village Development Committees (VDC) in Rautahat and Bara Districts. Sixteen MCHWs and sixteen mothers were interviewed to discover the MCHWs\u27 work performance in terms of strengths and opportunities in their responsibility areas. The study found that the strengths of the MCHWs were their high educational background, good basic knowledge and skills on certain topics of MCH services, positive attitudes toward MCH services, and good work performance in their communities. The opportunities or weaknesses of the MCHWs were a lack of competence in some topics of the MCH knowledge and skills, incomplete MCH services, and the lack of essential drugs, medical supplies and equipment. The study also found that there were other social and political elements involved, which affect the MCHW’s programs in rural Nepal

Examining the Maternal and Child Health Care Services in Rural Nepal

This study examines the strengths and opportunities of Maternal Child Health Workers (MCHWs) in providing Maternal and Child Health (MCH) care services in rural communities of Nepal. It explores the selection procedure of MCHWs, and their knowledge, skills, and attitudes. The study also explores the supervision of MCHWs, the delivery of medical supplies to the Sub-Health Posts, and other social factors of MCHWs in Rautahat and Bara Districts in the Terai region of Nepal. In addition, the paper discusses the overall perspectives of both theoretical and practical programs of MCH which include the MCH concept and applications as well as MCH practices. The study used structured interviews, focus group discussions, and observation to explore the MCH services in sixteen Village Development Committees (VDC) in Rautahat and Bara Districts. Sixteen MCHWs and sixteen mothers were interviewed to discover the MCHWs\u27 work performance in terms of strengths and opportunities in their responsibility areas. The study found that the strengths of the MCHWs were their high educational background, good basic knowledge and skills on certain topics of MCH services, positive attitudes toward MCH services, and good work performance in their communities. The opportunities or weaknesses of the MCHWs were a lack of competence in some topics of the MCH knowledge and skills, incomplete MCH services, and the lack of essential drugs, medical supplies and equipment. The study also found that there were other social and political elements involved, which affect the MCHW’s programs in rural Nepal

Nomadic Tibetan women's reproductive health: findings from cross-sectional surveys with a hard-to-reach population.

BackgroundWestern China has undergone substantial sociodemographic change, yet little is known about the health status of ethnic minority populations living in these areas.MethodsWe report findings from two cross-sectional surveys conducted with female Tibetan nomads living in rural areas of Western China/Eastern Tibet. We present results of descriptive analyses of data collected from reproductive-aged females who attended community health fairs in 2014 (n = 193) and 2016 (n = 298).ResultsOn average, sexual debut preceded marriage among study participants, with fertility near replacement levels (2.7 and 2.1 in 2014 and 2016, respectively). Contraceptive use was common, and dominated by use of IUDs and female sterilization. Although over three-quarters (76%) of 2016 survey participants reported ever having at least one sexually transmitted infection (STI) symptom, there was low awareness of STIs (59%) and action to prevent STIs (21%). Younger women (&lt; 40) were more likely to report having had had an STI symptom, as compared to older women (84% versus 71%; p &lt; 0.05).ConclusionsWe demonstrate feasibility of collecting data with this hard-to-reach population. Reporting of STI symptoms warrants further investigation to identify and address health conditions in this population of Tibetan nomadic women, especially amidst broader social and contextual changes that may affect the Tibetan population

Maternal health care seeking by rural Tibetan women: characteristics of women delivering at a newly-constructed birth center in western China.

BackgroundIncreasing skilled birth attendance at delivery is key to reducing maternal mortality, particularly among marginalized populations. Despite China's successful rollout of a national policy to promote facility deliveries, challenges remain among rural and ethnic minority populations. In response, a Tibetan Birth and Training Center (TBTC) was constructed in 2010 to provide high-quality obstetric care in a home-like environment to a predominantly Tibetan population in Tso-ngon (Qinghai) province in western China to improve maternal care in the region. This study examines if and how first users of the TBTC differ from women in the broader community, and how this information may inform subsequent maternal health care interventions in this area.MethodsTrained, Tibetan interviewers administered a face-to-face, quantitative questionnaire to two groups of married, Tibetan women: women who had delivered at the TBTC between June 2011-June 2012 (n = 114) and a non-equivalent comparison group of women from the same communities who had delivered in the last two years, but not at the TBTC (n = 108). Chi-squared and ANOVA tests were conducted to detect differences between the samples.ResultsThere were no significant differences between the samples in education or income; however, women from the TBTC sample were significantly younger (25.55 vs. 28.16 years; p &lt; 0.001) and had fewer children (1.54 vs. 1.70; p = 0.05). Items measuring maternity health care-seeking and perceived importance of health facility amenities indicated minimal differences between the samples. However, as compared to the community sample, the TBTC sample had a greater proportion of women who reported having the final say regarding where to deliver (26% vs. 14%; p = 0.02) and having a friend or family member who delivered at home (50% vs. 28%; p &lt; 0.001).ConclusionsFindings did not support the hypothesis that the TBTC attracts lower-income, less-educated women. Minimal differences in women's characteristics and perceptions regarding delivery care between the two samples suggest that the TBTC is serving a broad cross-section of women. Differences between the samples with respect to delivery care decision-making and desire for skilled birth care underscore areas that may be further explored and supported in subsequent efforts to promote facility delivery in this population, and similar populations, of women

Tibetan women's perspectives and satisfaction with delivery care in a rural birth center.

ObjectiveTo identify sociodemographic characteristics and factors involved in Tibetan women's decisions to deliver at the Tibetan Birth and Training Center (TBTC) in rural western China.MethodsIn the present mixed-methods study, a random sample of married women who delivered at the TBTC between June 2011 and June 2012 were surveyed. Additionally, four focus group discussions were conducted among married women living in the TBTC catchment area. Descriptive analyses were conducted, and dominant themes were identified.ResultsIn focus group discussions, women (n=33) reported that improved roads and transportation meant that access to health facilities was easier than in the past. Although some of the 114 survey participants voiced negative perceptions of healthcare facilities and providers, 99 (86.8%) indicated that they chose to deliver at the TBTC because they preferred to have a doctor present. Most women (75 [65.8%]) said their mother/mother-in-law made the final decision about delivery location. Women valued logistic and cultural aspects of the TBTC, and 108 (94.7%) said that they would recommend the TBTC to a friend.ConclusionStudy participants preferred delivery care that combines safety and comfort. The findings highlight avenues for further promotion of facility delivery among populations with lower rates of skilled deliveries

Reducing high maternal mortality rates in western China: a novel approach.

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

Reducing high maternal mortality rates in western China: a novel approach.

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