Tuesday, 29 July 2014

Good news on infant mortality rates in China - but have the numbers been exaggerated?

by Michael Woodhead

The Economist [aka 'the Monetarist'] is impressed with China's socialist achievement in reducing rates of maternal and infant mortality over the last decade. 

The magazine this week cites a WHO report that praises China for reducing rates of infant mortality from 61  to 12 deaths per 1,000 live births since 1991 - meaning they are now one fifth of what they were in the time of Deng Xiaoping. Maternal mortality rates have also dropped by about 70% over the same period. The improvements are attributed to the introduction of universal health insurance  schemes that subsidise hospital care for maternity care - and also implementation of infant vaccination programs.

The Economist then raises a lot of questions about whether China's vaccination program is as safe and appropriate as it could be - mentioning the recent scare about hepatitis vaccine quality and the ineffectiveness of measles vaccine programs. It even makes an absurd suggestion that China should step back from blanket immunisation and instead test mothers for immunity to various diseases before vaccinating them accordingly.  The overall message, however, is that China deserves credit for a major improvement in mother and baby health.

Coincidentally this week a letter is published in The Lancet Global Health from Chinese researchers questioning whether the gains are as extensive as they seem. Dr You Hua and colleagues at the School of Public Health, Zhejiang University School of Medicine, Hangzhou, write that recent improvements in infant mortality have been confined to rural areas - with little change in urban areas despite much greater rises in standards of living. 

Like WHO, they also attribute the improvements in rural areas to the introduction of the New Cooperative Medical Scheme in 2003. The coverage of this scheme reached 97% of village hospitals in 2011 and the subsidies allowed pregnant women to access antenatal and postnatal services. The Chinese researchers note that maternal mortality rates fell from 65 to 27 per 100 000 between 2003 and 2011 in rural areas, but remained virtually unchanged in urban areas. They speculate that the lack of change in cities may be due to the influx of uninsured women from rural migrant worker families.

Dr You also questions whether the impressive reductions in maternal mortality reported by the government are authentic. She remarks that health departments are financially rewarded for achieving targets such as maternal and infant mortality - and punished for not meeting them. The officially reported figures may therefore be subject to 'inflation', she suggests.

"These reservations notwithstanding, it is important to call attention to the dramatic reduction in rural maternal mortality in China and the lack of progress in the urban maternal mortality. The levelling out of urban maternal mortality in China in the past decade calls for increased attention," the researchers conclude.

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