Systematic Maternal Health Care in Shanghai

Abstract

Maternal health care in China has been enriched and perinatal health care has gradually evolved in recent years in line with the family planning objectives of achieving a decrease in the birthrate. In Shanghai there are 9 maternity hospitals and 3 children's hospitals and a number of Obstetrics and Gynecology and Pediatric Departments in general hospitals at different levels led by the Maternal and Child Health (MCH) Division of the Shanghai Municipal Health Bureau with a total of 4794 obstetric and gynecologic beds and 2587 pediatric beds. The Shanghai First Maternity and Infant Health Institute and the Shanghai Children's Hospital are responsible for technical supervision in the field of maternal and child health care for the city of Shanghai. Changes implemented to achieve improvements in the MCH field are reviewed. Each district and county has its own MCH center in close cooperation with the clinical departments of the district or county hospitals. The center has responsibility for therapeutic and preventive procedures along with medical training and research studies in that area. At the primary level, there are 104 subdistrict hospitals in urban districts and 200 commune hospitals in the rural counties, with a MCH group in each of them. Each MCH group has 3-5 members who work as a team. All commune hospitals have obstetrical, gynecological, and pediatric clinics and in addition a hospital delivery service. The primary workers in the production brigade (barefoot doctors) who are under the direction of the MCH group are trained to provide antenatal and postpartum home visits, family planning consultation, distribution of contraceptives, simple medical treatment, preventive vaccinations, popularization of the knowledge of hygiene and care of women during menstruation, pregnancy, puerperium, and lactation. Because of their cooperative efforts, the maternal mortality rate decreased from 320/100,000 in 1949 to 10/100,000 in 1980. The perinatal death rate at the Shanghai First Hospital of Maternal and Child Health Care during 1961-77 was 12.8/1000. To promote the quality of maternal health work and maximization of the function of the primary organization, the MCH personnel of the hospital designed a maternity health card which was used in the urban districts beginning in 1978. Every pregnant woman is registered at the primary maternity health group where the midwife takes the history, performs a preliminary examination, and provides health directions for early pregnancy. After the registration, the card is given to the mother. The main findings and procedures performed in the hospital are recorded on the card. The maternity health care card strengthens the mutual cooperation between the 3 grade MCH network and promotes the quality of the work of the MCH group. By conducting systematic statistical analysis of the cards, knowledge is gained as to how the MCH work is progressing, quality levels and the results, enabling further improvement in the work.