Poor, rich disparities affect women, children's health care

China has made substantial progress in improving maternal and child health, but great disparities between developed eastern and underdeveloped western regions, urban and rural areas as well as the rich and poor may affect China's drive to achieve better results, experts say.

China has been dedicated to health care of women and children, especially mothers, and is on track for achieving Millennium Development Goals, said Henk Bekedam, the World Health Organization's representative in China.

The progress can be seen in the marked drop of the maternal mortality rate (MMR), which fell from 1,500 per 100,000 in 1949 to 51.2 per 100,000 in 2003, and the infant mortality rate (IMR), which declined from 200 to 25.5 per 1,000 during the same period.

China now ranks 88th place among 191 countries in the world in the regard, ahead of many other developing countries.

However, big disparities between the east and west of China, between cities and countryside and between a floating population and residents in cities remain and may affect China's efforts if the poor do not have easy access to medical services, said Bekedam, who attended a ceremony in Beijing to mark April 7 the World Health Day, which focus on the theme of "Make every mother and child count."

According to the 2004 Children Development Report of China issued by the National Working Committee for Children and Women of the State Council, 29 million poverty-stricken people live in the countryside in 2003, most in western areas. The 2003 MMR and IMR in remote areas was 5.8 times and 4.4 times higher than in eastern coastal areas.

In Shanghai, for example, the IMR has dropped to 10 per 100,000, almost as low as developed countries, while in Tibet the rate is still 100 per 100,000.

Siri Tellier, United Nations Population Fund (UNFPA) representative in China, voiced the same concern. "Two-thirds of maternal deaths in urban areas appear to be of migrant women, who account for only 10 percent of total pregnancies. And more than 75 percent of maternal deaths are preventable," she said.

She warned that the downward trends may be stagnating in China and there are worrying signs that the child mortality rate may be declining more slowly for girls than for boys.

Koenraad Vanormelingen, senior program officer for health with the United Nations Children's Fund (UNICEF), warned that the disparities are in danger of increasing.

"Different indicators have shown remarkable declines, but changes are slowing down. Take IMR for example. Little progress has been made in the past five years in poor regions," he said.

The experts all urged the Chinese government to invest more money to ensure that everybody, especially those in poor, remote or ethnic minorities regions, has access to medical services and know how to make use of them.

In 2004, China spent a total of 84.8 billion yuan (10.2 billion US dollars) on public health, but urban areas remain the biggest receiver of the money, Bekedam said.

"China has incorporated market strategy very well, but health should not be made a market commodity," he said.

The high cost of medical services has kept many poor from getting sound services. WHO figures indicate that 39 percent of China's rural population and 36 percent of its urban population in need of medical care re do not have access to it for financial reasons.

"It's important for the government to think about what should be done in ten years time and rethink where to focus its attention on health," said Bekedam.

To improve the health and safety of women and children in rural and western areas, the Ministry of Health (MOH) began a program in 2001 offer medicare services, purchase medical equipment, training medical personnel and setting up a fund to help distressed pregnant women. So far, a total of 400 million yuan (48 million dollars) has been invested in the program.

"The program has covered some 300 million people in 1,000 counties in all the 23 provinces and regions in central and western China," said Yang Qing, director of the Department of Maternal, Children and Community Health at the MOH.

The money, however, is still far from enough for rural families to cover their medical expenses.

"The government needs to ensure a minimum package of medical services for those in need for free or at subsidized rates," Koenraad said.