Factors affecting the frequency and contents of routine antenatal care in remote rural China in 2009-2016: an observational study
【Abstract】 Objective We assessed factors associated with frequency and contents of antenatal care (ANC) in remote rural China, including province of residence and individual level factors. Design Survey-based cross-sectional study. Setting Remote rural China, Five provinces- Jilin, Shaanxi, Hunan, Guizhou, and Ningxia. Sample 3,918 women with a live birth in 2009-2016. Methods Poisson regression. Main outcome measures ANC frequency- 5+ visits starting in the first trimester. ANC contents- co-coverage of six care components, and overuse of ultrasound. Main results Three quarters (72.9%) of women had 5+ visits starting in the first trimester, 68.8% received all six care components, and 94.5% had 3+ ultrasounds. Only 30.9% women sought ANC from township hospitals, paying between $3.8 and 25.8 per-visit. ANC frequency and contents were associated with women's socio-economic characteristics, but provincial effects were much stronger, even after adjusting for individual factors. Women living in Guizhou and Ningxia, the two poorest provinces with high proportions of ethnic minorities, were particularly underserved. Compared to women in Shaanxi, women in Guizhou were 33% (adjusted RR 0.67, 95%CI 0.61-0.74) less likely to receive 5+ ANC starting in the first trimester; women in Ningxia were 17% less likely (adjusted RR 0.83, 95% CI 0.76-0.90) to receive all six care components. Conclusion The province of residence was a stronger predictor of ANC frequency and contents than women’s individual characteristics in China, suggesting that strengthening the decentralised system of financing and organisation of ANC at province level is crucial to achieving success. Future efforts are warranted to engage sub-regional administrations.
【Author】 Xing Lin Feng, Ying Wang, Zhengchao Chen, Ronsmans Carine
【Keywords】 Antenatal care, China, Equity, Quality of Care
【Journal】 BJOG: An International Journal of Obstetrics and Gynaecology(IF：1) Time：2021-12-05