It was a quiet afternoon and sunshine poured into the room through a window, which opened onto a view of distant snow-capped mountains.

Basking in the sunlight was a baby boy, several months old, sleeping soundly amid the scents of milk and mild Tibetan incense. His mother, 27-year-old Cering Zhoigar, tucked in his quilt gently.

"This is my fourth child," she said. "The first three died within a fortnight after their births."

The difference in this case was the baby was born in a hospital, rather than the room at home where his three siblings lived and died.

Like many Tibetan women, the introverted Cering from the Lhaze Township of Xigaze grew up believing it was dangerous and perhaps shameful to give birth in a hospital.

"It (a hospital) was ominous," she said. "People would die if they gave birth there."

Even pregnancy itself should be kept secret, according to traditional thinking. If anyone knew, or so the belief went, the mother would suffer life-threatening difficulties while in labor.

Besides superstition, many Tibetan women also hold conservative beliefs that keep them out of hospitals.

Lhagyi, 28, of Copu Village is the mother of two boys. But she can still remembered how, six years ago when she was about to have her first child, she was reluctant to go to a hospital.

"I was young and shy," she said, flushing. In her traditional Tibetan robes, with her hair in plaits, she looked much younger than her age. "I didn't want to remove my clothes in front of strangers."

Lhaze, with a population of some 50,000 and an altitude of 4,010 meters, is about 200 kilometers from Mount Qommolangma (or Mount Everest) and among the impoverished counties in China.

According to Dorje Pula, director of the Lhaze Health Bureau, only about 16 percent of women gave birth in hospitals before 2000,while the current rate is 62.4 percent.

"Local women would cut themselves off from the world as soon as they realized they were pregnant," he said.

However, the official noted, without proper sanitation, "it was unclean to deliver a baby at home," he said. "If they didn't send for a doctor in time, both the mother and the baby could be in danger."

When the subject of home births vs. hospitals came up, some villagers avoided mentioning superstition and tradition. Instead, they would insist that they couldn't get to a hospital because the roads were so bad. That wasn't entirely untrue.

Tsenam, 27, joined the health bureau in 2003. He recalled at that time, about one-fifth of the villages in the 4,505-square-kilometer county had no roads. "You had to ride a horse to some villages," he said.

Qonglha, 43, has worked in the Lhaze medical clinic for 24 years. "It took three to four hours from some villages to our clinic," she said.

That was too long for many women in labor.

She still recalls vividly how in 1989, a pregnant woman from Zhipo Village sent a brother to lead her to the home.

"It took me half a day on horseback," she recalled.

But on the way, they encountered another relative, who was in tears.

"He said that I no longer needed to come, as the patient had already died," she said, bitterly. "I am a woman too, and I felt sorry for her."

A joint project to encourage hospital delivery was started by the local government and the United Nations Children's Fund (UNICEF) in 1999. Under the program, which covers 15 counties in seven prefectures, a new mother who delivered her child in a hospital would get a 20-yuan subsidy (US$ 3) for herself and 10 yuan for the person who accompanied her.

"The average annual income in villages was about 3,000 yuan, while some poor farmers only earned 1,500 yuan a year," said Tsenam.

Starting in 2002, parents of a newborn could also get a set of free baby clothes.

In 2007, the subsidies for new mothers and their escorts climbed to 30 yuan and 20 yuan, respectively, and the program was expanded to cover the entire Tibet Autonomous Region. Mothers from farming and herding families could have their travel costs to the hospital reimbursed and were exempted from hospital and delivery fees.

Newborns became entitled to a range of free vaccines such as hepatitis, measles, diphtheria and tetanus, after a physical examination. Post-natal care was also provided, with three doctor visits to newborns.

At the same time, the infrastructure improved rapidly in Tibet. By the end of 2008, 94.3 percent of its 683 counties and townships and 67 percent of the villages had roads. "In Lhaze, all the villages have roads now," said Tsenam.

UNICEF conducted training twice a year for local officials who were in charge of the program, like Tsenam. The officials then went back to train doctors in village clinics and grassroots cadres in charge of women's affairs.

Among the trainees was 59-year-old Lhapa Gela of Copu Village.

"I have worked for women in our village for 30 years and I started to educate people about hospital delivery in 2002," she said.

She showed a reporter a worn-out black notebook, in which she had carefully recorded her training in the Tibetan language. She had also logged the names and ages of the 500 women in her 1,000-person village.

"I have three children and the youngest is 24 now. All of them were born at home," she said.

"Although they are healthy, I felt weak after my deliveries due to blood loss." After delivering her youngest, she fainted on the way to the toilet.

Drawing on her experience, Lhapa decided to encourage fellow villagers not to repeat her suffering.

But the job was tough at first. When she approached Lhagyi, the woman's mother-in-law argued with her.

"Will you help us with the chores if we go to a hospital?" she said. Lhapa replied: "I will find someone to do the chores for you, if you really have difficulty."

During a few visits, she told Lhagyi and her mother-in-law about the benefits of hospital delivery. "You not only don't have to pay, but you could receive money from the government," she said.

Guo Sufang, UNICEF program officer in charge of health care, thought highly of the work of local people like Lhapa in Tibet. "They are nice, cooperative, and diligent," she said.

Guo admitted that because of geographic and historical reasons, health care used to be poor in Tibet. Before 1959, the mortality rate of pregnant and lying-in women was 5,000 per 100,000, while the infant mortality rate was 43 percent.

By last year, according to the regional health department of Tibet, the rates had dropped to 254.6 per 100,000 and 2.71 percent, respectively.

A report by the national Health Ministry said that in 2008, the average mortality rate of pregnant and lying-in women was 34.2 in every 100,000 in China as a whole and that of infants was 1.49 percent.

Although there was still a gap, Guo was optimistic. "After all, there has been a lot of rapid change in recent years, both in terms of local development and people's ideas," she said.

Lhagyi said she planned to convince her friends to deliver in hospitals as well. "It is safe, and I recovered pretty fast."

Cering Zhoigar still regrets the loss of her first three children. Not long after the birth of her son, she tied a red thread around his wrist, which is considered a lucky symbol.

A Buddhist like most Tibetans, she went to thank Buddha in a local temple and asked a lama to name her son.

"His name is Lodro Cering," she said. Cering means "long life" in Tibetan.

(Xinhua News Agency February 26, 2009)