With a smile on her face, Mai Jinrong, 23, sits proudly on a bed
in the Women and Children's Healthcare Hospital in Guangxi's Tiandong County her one-day-old
daughter sleeping beside her.
Compared to women in more developed areas, who regard delivering
a child at hospital as the norm, Mai's happy moment was hard
earned.
Living in a small, remote mountain village in Tiandong, south
China's Guangxi Zhuang Autonomous Region, it took her more than
five hours to get to the hospital, located in the urban area of the
county.
She spent the first two hours on a simple stretcher, which
villagers carried to the nearest road, where doctors and an
ambulance were waiting.
The overall cost of Mai's stay at the hospital was about 350
yuan (US$42), hospital president Huang Xiaoxiong told China
Daily in a recent interview.
The government paid 300 yuan (US$36) as part of a special
program, leaving Mai to fork out just 50 yuan (US$6).
"For wealthy women in cities, 300 yuan (US$36) is not even
enough to buy a nice suit. But for mothers here, it is a lifeline,"
said Chen Lili, director of the Department of Maternal and Child
Healthcare and Community Health at Guangxi Provincial Health
Bureau.
The annual income of Mai's family is less than 500 yuan
(US$60).
Most pregnant women in the village give birth at home because of
poverty, as well as remote location and a centuries-old local
culture of children being delivered within the family
residence.
But home deliveries carry a high mortality rate for mothers and
babies, Chen said.
Mai would have found it impossible to give birth at hospital
without the financial assistance offered by the national program,
aimed at mothers-to-be in rural areas.
It was launched by the Ministry of Health in 2001, and rolled
out to Guangxi three years later.
Up to now, 51 counties of Guangxi, covering half of its total
population, benefit from the program. The majority of these
counties are remote and poverty-stricken.
Last year, about 23.74 million yuan (US$2.86 million) was
injected into the program by governments at various levels and
helped 28,054 poor women give birth in hospital.
The number of women having hospital births in 2005 in the
program-supported areas of Guangxi reached 81.23 percent, more than
9 percent higher than the previous year.
The number of women dying in delivery also dropped
considerably.
The maternal mortality rate in 30 poor counties in Guangxi was
40.89 per 100,000 births in 2005. In the previous year, the figure
was 72 per 100,000.
Long-time traditions
Chen said that she and her team have also had to work hard to
overcome the strong belief held by people in remote areas that
women should give birth at home.
In Guangxi's remote rural areas, where 80 percent of the
region's population lives and where even the help of a midwife can
be a luxury, home deliveries have been taking place for
centuries.
In many villages with minority ethnic groups, such as Zhuang and
Yao, it is regarded as a bad omen for a woman to deliver her child
outside of her home and village.
In some villages, according to the traditional cultures of some
minority groups, it was common for women to give birth in a cowshed
or pigpen as little as 10 years ago, said Chen.
Chen and her team, which includes doctors and officials, have
made extensive efforts to improve public education.
One target is to change commonly-held views in some areas that
women have a lower social status.
Chen Shuzhen, deputy director of Chen Lili's department, said
she still cannot forget a scene she once witnessed in the early
1990s when she was working as a doctor in a village.
One day, a villager asked her to check on a woman who was giving
birth at home.
"I was deeply shocked by what I saw," she said.
"The woman was lying on a bed with a lot of blood below her
body; a straw rope was tied between her placenta and one of her
feet. Her husband was checking on their newborn son, with his wife
left by herself.
"The straw rope was tied there just to help the mother haul the
placenta out through extending her leg."
Chen carried out emergency treatment at the scene, and called an
ambulance for the woman to receive proper care at hospital.
"Since then, I was determined to devote myself to helping local
women, saving the lives of them and their children," she said.
But traditional views cannot be changed overnight, Chen Lili
said.
She and her team have tried various ways to raise awareness,
even before the program to support women to give birth at hospital
came into effect.
In 2003, she took a medical team to a village to take a heavily
pregnant woman to hospital.
However, Zhuang minority villagers tried to bar their way, as
they believed bad luck would be brought on the village if the woman
was taken away to give birth.
They were finally persuaded to let the woman go, on condition
Chen herself stayed in the village in case bad luck struck.
Three days later, when the villagers realized that the woman's
birth away from the village had not brought disaster, Chen was
allowed leave.
"I really took a risk by deciding to stay in the village,
because they might have attacked me if even the smallest
unfortunate thing happened," she said.
However, she added that it was all worth it in the end as it
helped people in the village to think differently.
Changing men's views
Another archaic belief that had to be changed was that men
should not serve or support women.
To change it, Chen launched a "stretcher campaign" in Guangxi's
mountainous areas in 2001.
She persuaded village leaders and doctors to make stretchers
with wood and bamboo, and then organize volunteer teams to carry it
when pregnant women needed taking to the nearest road to get to
hospital.
At first, many husbands refused to carry the stretcher at all.
But gradually, influenced by volunteers and doctors, they began to
accept it, and now the sight of stretchers carrying expectant
mothers down mountains has become a beautiful and fairly common
scene.
To better implement the program, which aims to reduce the
maternal mortality rate through governmental intervention and
financing, social support and medical service network building,
Guangxi has carried out its work in a comprehensive manner.
The maternal mortality rate is a key standard to evaluate the
work of a local official or authority in Guangxi.
An information system has been established to monitor the
standards of child delivery, from regional hospitals in big cities
to the township hospitals.
It is customary practice for all cars and vehicles, especially
those that belong to governments, to stop and take pregnant women
to hospital if they need assistance, Chen said.
In some remote towns where there are only a few cars, the car of
the leader of the local government is used dozens of times a year
to take women to hospital to give birth.
As well as paying the bulk of hospital fees, the program also
allocated nearly 7 million yuan (US$840,000) to improve the medical
service capacity of hospitals at various levels.
All village doctors and officials have signed a responsibility
document with higher-level authorities to monitor the situation of
pregnant women of their villages.
If it is time for a woman to be hospitalized to give birth or if
there is another emergency regarding her pregnancy, village doctors
and officials must contact a nearby hospital.
The hospital is then required to send an ambulance to meet the
woman at a designated place.
Meanwhile, local health authorities also stipulate that if the
birth process is a natural labor, the hospital costs should not
exceed 700 yuan (US$84).
This is to prevent hospitals from cashing in on the scheme.
However, Guangxi, which has an annual financial income of about
only 43 billion yuan (US$5 billion), less than that of a city such
as Suzhou in east China, still has lots of difficulties ahead, Chen
said.
Dozens of counties in the region are still not covered by the
program because of financial difficulties. Rural women there, who
do not have medical insurance and have barely any money, often have
to deliver their children on their own.
Even in some areas covered by the program, the rate of women
giving birth in hospitals can be as low as 40 per cent, where
maternal mortality rates can reach 119.94 per 100,000.
In Guangxi, about 830,000 children are born every year, mostly
from rural, remote and mountainous regions.
Because some rural families violate the nation's one-child
policy, they often turn down support for fear of repercussions.
Many mountainous villages in Guangxi also still have no
stretchers, each of which costs just 300 yuan (US$36), Chen Lili
said.
Local governments and hospitals have been donating stretchers
for several years, but there is still a need for many more.
Chen has appealed to the outside world, especially people from
big cities and foreign countries, to offer financial support to
help mothers and children in Guangxi.
She said she hoped to improve the standards of stretchers that
are currently available because they are uncomfortable and not
designed for pregnant women.
"It is quite easy for the woman to fall off as she is carried
down the mountain," she said.
But, better stretchers cost more money, which is a major
problem.
"I want people to help prevent women dying a lonely death as
they bring a new life into the world," Chen said.
The birth process only marks the start of a series of new
challenges.
Many new mothers and their children in the mountainous regions
face serious difficulties as they are so poor, said Yang Anna, a
doctor from Silin Town Hospital in Tiandong County.
She helped a woman deliver her child last year, whose husband
had died five months earlier. She lived with her 79-year-old
father-in-law, who was mentally ill.
Yang said: "There was no income at all for her family, and while
the fees involved in having the baby were virtually free, what
about the future?"
(China Daily May 15, 2006)