With a smile on her face, Mai Jinrong, 23, sits proudly on a bed in the Women and Children's Healthcare Hospital in Guangxi's Tiandong County her one-day-old daughter sleeping beside her.

 

Compared to women in more developed areas, who regard delivering a child at hospital as the norm, Mai's happy moment was hard earned.

 

Living in a small, remote mountain village in Tiandong, south China's Guangxi Zhuang Autonomous Region, it took her more than five hours to get to the hospital, located in the urban area of the county.

 

She spent the first two hours on a simple stretcher, which villagers carried to the nearest road, where doctors and an ambulance were waiting.

 

The overall cost of Mai's stay at the hospital was about 350 yuan (US$42), hospital president Huang Xiaoxiong told China Daily in a recent interview.

 

The government paid 300 yuan (US$36) as part of a special program, leaving Mai to fork out just 50 yuan (US$6).

 

"For wealthy women in cities, 300 yuan (US$36) is not even enough to buy a nice suit. But for mothers here, it is a lifeline," said Chen Lili, director of the Department of Maternal and Child Healthcare and Community Health at Guangxi Provincial Health Bureau.

 

The annual income of Mai's family is less than 500 yuan (US$60).

 

Most pregnant women in the village give birth at home because of poverty, as well as remote location and a centuries-old local culture of children being delivered within the family residence.

 

But home deliveries carry a high mortality rate for mothers and babies, Chen said.

 

Mai would have found it impossible to give birth at hospital without the financial assistance offered by the national program, aimed at mothers-to-be in rural areas.

 

It was launched by the Ministry of Health in 2001, and rolled out to Guangxi three years later.

 

Up to now, 51 counties of Guangxi, covering half of its total population, benefit from the program. The majority of these counties are remote and poverty-stricken.

 

Last year, about 23.74 million yuan (US$2.86 million) was injected into the program by governments at various levels and helped 28,054 poor women give birth in hospital.

 

The number of women having hospital births in 2005 in the program-supported areas of Guangxi reached 81.23 percent, more than 9 percent higher than the previous year.

 

The number of women dying in delivery also dropped considerably.

 

The maternal mortality rate in 30 poor counties in Guangxi was 40.89 per 100,000 births in 2005. In the previous year, the figure was 72 per 100,000.

 

Long-time traditions

 

Chen said that she and her team have also had to work hard to overcome the strong belief held by people in remote areas that women should give birth at home.

 

In Guangxi's remote rural areas, where 80 percent of the region's population lives and where even the help of a midwife can be a luxury, home deliveries have been taking place for centuries.

 

In many villages with minority ethnic groups, such as Zhuang and Yao, it is regarded as a bad omen for a woman to deliver her child outside of her home and village.

 

In some villages, according to the traditional cultures of some minority groups, it was common for women to give birth in a cowshed or pigpen as little as 10 years ago, said Chen.

 

Chen and her team, which includes doctors and officials, have made extensive efforts to improve public education.

 

One target is to change commonly-held views in some areas that women have a lower social status.

 

Chen Shuzhen, deputy director of Chen Lili's department, said she still cannot forget a scene she once witnessed in the early 1990s when she was working as a doctor in a village.

 

One day, a villager asked her to check on a woman who was giving birth at home.

 

"I was deeply shocked by what I saw," she said.

 

"The woman was lying on a bed with a lot of blood below her body; a straw rope was tied between her placenta and one of her feet. Her husband was checking on their newborn son, with his wife left by herself.

 

"The straw rope was tied there just to help the mother haul the placenta out through extending her leg."

 

Chen carried out emergency treatment at the scene, and called an ambulance for the woman to receive proper care at hospital.

 

"Since then, I was determined to devote myself to helping local women, saving the lives of them and their children," she said.

 

But traditional views cannot be changed overnight, Chen Lili said.

 

She and her team have tried various ways to raise awareness, even before the program to support women to give birth at hospital came into effect.

 

In 2003, she took a medical team to a village to take a heavily pregnant woman to hospital.

 

However, Zhuang minority villagers tried to bar their way, as they believed bad luck would be brought on the village if the woman was taken away to give birth.

 

They were finally persuaded to let the woman go, on condition Chen herself stayed in the village in case bad luck struck.

 

Three days later, when the villagers realized that the woman's birth away from the village had not brought disaster, Chen was allowed leave.

 

"I really took a risk by deciding to stay in the village, because they might have attacked me if even the smallest unfortunate thing happened," she said.

 

However, she added that it was all worth it in the end as it helped people in the village to think differently.

 

Changing men's views

 

Another archaic belief that had to be changed was that men should not serve or support women.

 

To change it, Chen launched a "stretcher campaign" in Guangxi's mountainous areas in 2001.

 

She persuaded village leaders and doctors to make stretchers with wood and bamboo, and then organize volunteer teams to carry it when pregnant women needed taking to the nearest road to get to hospital.

 

At first, many husbands refused to carry the stretcher at all. But gradually, influenced by volunteers and doctors, they began to accept it, and now the sight of stretchers carrying expectant mothers down mountains has become a beautiful and fairly common scene.

 

To better implement the program, which aims to reduce the maternal mortality rate through governmental intervention and financing, social support and medical service network building, Guangxi has carried out its work in a comprehensive manner.

 

The maternal mortality rate is a key standard to evaluate the work of a local official or authority in Guangxi.

 

An information system has been established to monitor the standards of child delivery, from regional hospitals in big cities to the township hospitals.

 

It is customary practice for all cars and vehicles, especially those that belong to governments, to stop and take pregnant women to hospital if they need assistance, Chen said.

 

In some remote towns where there are only a few cars, the car of the leader of the local government is used dozens of times a year to take women to hospital to give birth.

 

As well as paying the bulk of hospital fees, the program also allocated nearly 7 million yuan (US$840,000) to improve the medical service capacity of hospitals at various levels.

 

All village doctors and officials have signed a responsibility document with higher-level authorities to monitor the situation of pregnant women of their villages.

 

If it is time for a woman to be hospitalized to give birth or if there is another emergency regarding her pregnancy, village doctors and officials must contact a nearby hospital.

 

The hospital is then required to send an ambulance to meet the woman at a designated place.

 

Meanwhile, local health authorities also stipulate that if the birth process is a natural labor, the hospital costs should not exceed 700 yuan (US$84).

 

This is to prevent hospitals from cashing in on the scheme.

 

However, Guangxi, which has an annual financial income of about only 43 billion yuan (US$5 billion), less than that of a city such as Suzhou in east China, still has lots of difficulties ahead, Chen said.

 

Dozens of counties in the region are still not covered by the program because of financial difficulties. Rural women there, who do not have medical insurance and have barely any money, often have to deliver their children on their own.

 

Even in some areas covered by the program, the rate of women giving birth in hospitals can be as low as 40 per cent, where maternal mortality rates can reach 119.94 per 100,000.

 

In Guangxi, about 830,000 children are born every year, mostly from rural, remote and mountainous regions.

 

Because some rural families violate the nation's one-child policy, they often turn down support for fear of repercussions.

 

Many mountainous villages in Guangxi also still have no stretchers, each of which costs just 300 yuan (US$36), Chen Lili said.

 

Local governments and hospitals have been donating stretchers for several years, but there is still a need for many more.

 

Chen has appealed to the outside world, especially people from big cities and foreign countries, to offer financial support to help mothers and children in Guangxi.

 

She said she hoped to improve the standards of stretchers that are currently available because they are uncomfortable and not designed for pregnant women.

 

"It is quite easy for the woman to fall off as she is carried down the mountain," she said.

 

But, better stretchers cost more money, which is a major problem.

 

"I want people to help prevent women dying a lonely death as they bring a new life into the world," Chen said.

 

The birth process only marks the start of a series of new challenges.

 

Many new mothers and their children in the mountainous regions face serious difficulties as they are so poor, said Yang Anna, a doctor from Silin Town Hospital in Tiandong County.

 

She helped a woman deliver her child last year, whose husband had died five months earlier. She lived with her 79-year-old father-in-law, who was mentally ill.

 

Yang said: "There was no income at all for her family, and while the fees involved in having the baby were virtually free, what about the future?"

 

(China Daily May 15, 2006)