Hospital births saving babies in China, study says

AP News
Posted: Sep 16, 2011 7:08 AM
Hospital births saving babies in China, study says

New data show that encouraging Chinese women to give birth in the hospital has contributed to a sharp drop in infant deaths over a 12-year period.

A study released Friday in The Lancet, a British medical journal, says that newborn deaths fell 62 percent between 1996 and 2008 based on analysis of 1.5 million births.

The study, co-authored by researchers from Peking University and the London School of Hygiene and Tropical Medicine, said more babies survived mainly because women were increasingly giving birth in hospitals or clinics.

"In 1988, less than half of all women in China gave birth in hospital, but only 20 years later, hospital births have become almost universal," it said.

"Where you give birth really matters," said one of the authors, Carine Ronsmans, a professor at the London School of Hygiene and Tropical Medicine.

There were 24.7 deaths of newborns in China per 1,000 live births in 1996 but by 2008 that figure had fallen to 9.3 per 1,000, it said.

Traditionally, poorer countries have tried to reduce newborn deaths by training community health workers like midwives to assist in home births. Ronsmans said those methods have helped reduce newborn deaths "a little bit" in countries such as Nepal and India.

"But you couldn't achieve a 62 percent reduction just with a community-based strategy," she said.

"What's novel here is that the Chinese government has adopted a very different strategy," she said. "The Chinese government has really invested in strengthening hospitals."

The approach has proved effective nationwide, even in the poorest Chinese provinces, she said.

However, one of the downsides, said Ronsmans, is that the rise in hospital births overseen by doctors may have encouraged unnecessary medical interventions, such as cesarean sections, which now account for as many as 65 percent of births in China.

Ideally, Chinese women should continue to give birth in health care centers or hospitals but with a midwife's supervision, instead of a doctor, unless medically necessary, she said.

"Investment in midwives is something that the Chinese government did not do and that's something I would do differently but I would still encourage facility-based delivery because you offer a much safer environment than at home," she said.

Maria Pawlowska, a healthcare analyst based at London specializing in reproductive health who did not participate in the study, said the paper "clearly shows fewer babies are dying." But she said it didn't look closely enough at other factors beyond the hospital setting that might have been preventing deaths.

"Women who were able to give birth in urban hospitals might have come from more privileged socio-economic backgrounds and therefore could have had better nutrition during pregnancy _ an important factor in neonatal mortality," Pawlowska said. "The fact that the birth happened in the hospital could really have been the end result of a chain of events that led to the decreased likelihood of the baby dying."

Ronsmans countered the point saying that in China today "almost all women give birth in hospital, whether rich or poor."

The study was funded by UNICEF and the China Medical Board, a New York-based non-governmental organization.