China's process and challenges in achieving the United Nations Millennium.

OBJECTIVE

China was categorized as one of the 68 "countdown" countries to achieve the United Nations Millennium Development Goals (MDG) 5. This paper aimed to analyze the situation of maternal survival, and coverage of proven cost effective interventions in China, where specific attention was paid to disparities.

METHODS

National maternal and child mortality surveillance data were used to estimate maternal mortality ratio (MMR). Coverage for proven interventions was analyzed based on National Health Services Survey, where experts' consultations were made for complementation.

RESULTS

There had been a significant reduction of MMR in China, however great disparities existed, with rural II to IV areas experiencing 2 to 5 times higher maternal mortality risks than urban areas and accounting for over 70% maternal mortality burdens. Postpartum hemorrhage, pregnancy associated hypertension, embolism and sepsis were the leading causes, and over 75% of the maternal mortality was caused by preventable or curable causes. Maternal health services utilization decreased in accordance with region's development level. Socioeconomic factors like financial difficulties were the main obstacles hindering access of care. Even those who made deliveries in hospitals faced different probabilities in receiving qualified care according to their socioeconomic standings.

CONCLUSION

China is on track to achieve MDG 5, however great disparities exist. It is necessary to specifically target rural types II to IV areas. Major causes of maternal mortality which can be prevented or averted through the provision of essential obstetrical care. Yet as compared with maternity health needs, insufficient coverage of maternal and child health (MCH) care services and poor service quality are the leading predisposing factors contributing to maternal mortality in China.