China cut maternal deaths dramatically, but faces new challenges in mental health and inequality.
China has made remarkable gains in reducing the number of women who die during childbirth and boosting child survival rates over the past 70 years, according to new review.
The Lancet report brought together China’s health research institutions alongside its international colleagues from Australia, the UK, and the US to review the country’s progress in maternal, newborn, child, and adolescent health and nutrition since 1949.
Murdoch Children’s Research Institute (MCRI) Professor George Patton, one of the international researchers, said over the past 70 years China had made a remarkable transition from where the survival of women and children was the priority to one where children and adolescents now have similar health profiles to young Australians.
“This progress has been driven by rapid socioeconomic development and reducing poverty, the country’s capacity for top-down leadership such as the reorganization of social health insurance and systematic public health planning,” he said.
“China population policy over the past seven decades, including its previously one-child policy, has profoundly affected its age structure. But its growing focus on the health of children and young people reflects a need to invest in its next generation. This is something that we will increasingly see in other countries across the region including Australia.”
The study found rapid reductions in the maternal death ratio from about 1500 cases per 100,000 births in 1949 to 17.8 cases per 100,000 births in 2019. The infant death rate has lowered from about 200 cases per 1000 births in 1949 to 5.6 cases per 1000 births in 2019.
Lessons for Low- and Middle-Income Countries
Professor Patton said in some aspects China was a model for what other low- and middle-income countries could achieve.
“Some elements of China’s success such as good quality antenatal and postnatal care, scaling up of childhood vaccination and delivering a good health education in schools are relevant almost everywhere,” he said. “But it’s questionable how successful China’s strategies might be in countries with different cultural norms and political systems.”
However, the report also found a series of emerging or neglected conditions in China that now require a greater focus including infertility, advanced maternal age, stillbirth, child protection, mental health, and sexual and gender-based violence, as well as emerging infectious diseases such as COVID-19.
Mental Health Remains a Major Barrier
Professor Patton said several barriers remained in addressing maternal depression and child and adolescent mental health.
“Mental health problems are still poorly understood and stigmatized in China,” he said. “Pregnant women are reluctant to seek help and mental health problems among children and adolescents are neglected. There is also a shortage of health service providers including child psychiatrists and counselors, especially in rural areas where the mental health problems of children left-behind by parents migrating to the cities for work are considerable.”
Professor Patton said maternal, newborn, child, and adolescent health would continue to be vital for the healthy development of the next generation in China.
“The next 10 years will be crucial for China’s goal of universal health coverage, particularly in addressing disparities and inequities in marginalized and disadvantaged communities,” he said.
Reference: “A Lancet Commission on 70 years of women’s reproductive, maternal, newborn, child, and adolescent health in China” by Prof Jie Qiao, MD; Yuanyuan Wang, PhD; Xiaohong Li, PhD; Prof Fan Jiang, MD; Yunting Zhang, PhD; Prof Jun Ma, PhD; Yi Song, PhD; Jing Ma, MD; Prof Wei Fu, PhD; Prof Ruyan Pang, MD; Prof Zhaofang Zhu, PhD; Prof Jun Zhang, MD; Prof Xu Qian, PhD; Prof Linhong Wang, MD; Prof Jiuling Wu, MD; Hsun-Ming Chang, MD; Prof Peter C K Leung, PhD; Prof Meng Mao, MD; Prof Duan Ma, PhD; Prof Yan Guo, MPH; Prof Jie Qiu, MD; Li Liu, PhD; Haidong Wang, PhD; Prof Robert J Norman, MD; Prof Joy Lawn, FMedSci; Prof Robert E Black, MD; Prof Carine Ronsmans, MD; Prof George Patton, MD; Prof Jun Zhu, MS; Dr Li Song, PhD and Prof Therese Hesketh, PhD, 24 May 2021, The Lancet.
DOI: 10.1016/S0140-6736(20)32708-2
Funding: J.Q was supported by grants from the National Natural Science Foundation of China (81730038), the Chinese Academy of Engineering (2020-XZ-22), and the National Key Research and Development Program (2019YFA0801400).
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