China's facility-based birth strategy and neonatal mortality: a population-based epidemiological study.

Area of Science:

• Public Health
• Epidemiology
• Obstetrics

Background:

• China's healthcare system has significantly improved obstetric care quality and access.
• Facility-based strategies are a key component of China's approach to maternal and child health.

Purpose of the Study:

• To evaluate the impact of China's facility-based intrapartum care strategy on neonatal mortality.
• To assess the effect on regional inequalities in neonatal mortality.

Main Methods:

• Population-based epidemiological study using China's National Maternal and Child Mortality Surveillance System (1996-2008).
• Analysis of neonatal mortality by cause, socioeconomic region, and place of birth across 116 surveillance sites.
• Poisson regression used to calculate relative risks, attributable risks, and preventable fractions for hospital vs. home births.

Main Results:

• Neonatal mortality decreased by 62% from 1996 to 2008.
• Hospital births were associated with significantly lower neonatal mortality rates across all regions compared to home births.
• While urban hospital births had low neonatal mortality, rural hospital births (especially in less developed areas) showed higher risks.

Conclusions:

• China's facility-based strategy has substantially reduced neonatal mortality, outperforming community-based interventions.
• Increased demand for and quality of facility-based intrapartum care is recommended for other countries.
• Addressing regional disparities in facility-based care is crucial for further reductions in neonatal mortality.