Women and Health

(A) Efforts and Progress

1. The portfolio of laws, regulations and policies provided an institutional guarantee for women's health

China's medical system restructuring ushered into a new stage in 2009. From then on, maternal and child health has become a priority of public health efforts, better supported by the government in terms of policy and funding, etc. The Chinese government has been living to its commitments to the Beijing Declaration, the Platform for Action, the CEADW and other international conventions and documents, including maternal and child health objectives in the Twelfth Five-Year Plan; The National Human Rights Action Plans of China (2012-2015) released by the State Council in 2012 describes women's health as one of the critical human rights to be safeguarded. The Twelfth Five-Year Plan for the Health Sector also puts forward a development goal of strengthening maternal and child health and building capacity for health education. The Program for the Development of Chinese Women (2011-2020) continues to prioritize women's health as a development orientation, attached with specific objectives and strategic measures. The Law of the People's Republic of China on the Protection of Rights and Interests of Women has been amended, stressing women's inviolable rights of life and health. The ongoing implementation of the Law on Maternal and Infant Health Care, the Population and Family Planning Law, the Regulations Concerning the Labor Protection of Female Staff and Workers and other relevant laws and regulations also serve to provide an institutional guarantee for women's health.

2. Further increased funding for women's health went together with better-established institutions

From 2009 to 2013, government health expenditure increased to 836.598 billion yuan from 481.626 billion yuan . Throughout 2013, the NCMS reached 99 percent of rural residents, with the state providing 41 free basic public health services under 10 categories to all residents. The per capita funding threshold was raised to 25 yuan in 2011 from 15 yuan in 2009, and the beneficiary population continued to expand. Rural women suffering cervical and breast cancers as well as children with congenital heart disease, acute leukemia and other major diseases found their reimbursement quota constantly elevated, effectively alleviating the financial burden of women and children who caught major diseases . Also from 2009 to 2013, a total of 47.28 million pregnant women in rural areas benefited from the scheme of hospital delivery subsidy for rural pregnant women, pushing up rural hospital delivery rate to 99.2 percent, a powerful guarantee for maternal and child safety. Major state-led public health service projects were implemented aiming at non-common diseases, vulnerable groups and specific regions, such as replanting the Hepatitis B vaccine for residents aged below 15, replenishing rural women with folic acid prior to pregnancy and during early pregnancy, etc. Nearly 200 million people benefited from these projects.

Maternal and child health services at all levels have been better-established. As of 2012, there were 3,044 maternal and child health agencies, 495 maternity hospitals and 89 children's hospitals across China, with 349,148 beds ready for obstetrics and gynecology departments at medical and health institutions nationwide, as well as 285,180 people working at MCH bodies . Professional organizations of maternal and child health are used as hubs, based on urban and rural primary health care institutions and backed by medium and large-sized comprehensive medical institutions as well as research and education institutes, offering all-inclusive health care services for women and children.

3. Services for women's health were enhanced, with a focus on addressing key problems affecting women's health through major projects

In April 2010, the National Population and Family Planning Commission in conjunction with the Ministry of Finance issued the Notice of Piloting the Project for Free Pre-pregnancy Birth Health Check Nationwide and officially launched the project at the first group of pilot sites. In 2013, all counties (cities and prefectures) were covered by the project compared to 60 percent of coverage at the beginning, reaching all couples planning a pregnancy in rural areas nationwide, namely the target population . As of 2013, 89.5 percent of pregnant women were covered the system, contributing to an antenatal rate of 95.6 percent; 88.9 percent of children aged below 3 and 90.7 percent of children aged below 7 were covered by such health management systems.

A series of major public health service projects have been implemented, benefiting the majority of women. In 2009, free check of breast/cervical cancer for rural women, a program jointly launched by the Ministry of Health and the ACWF, was accepted as one of the state's major public health service projects. As of the end of 2013, cumulatively 32.38 million and 4.77 million rural women received free check of cervical cancer and breast cancer respectively . To address the funding challenge of treating impoverished women patients in rural areas, the ACWF set up a Special Relief Fund for "poor mothers to combat the two cancers", with 50 million yuan appropriated by the Ministry of Finance annually from the central government's lottery chest for treatment of sick poor rural women. As of the end of 2013, the 50-million-yuan fund relieved a total of 32.38 million rural women with cervical cancer, namely 20,715 affected women receiving 10,000 yuan each as an aid accumulatively . The project for prevention and control of AIDS, syphilis and hepatitis B MTCT, which started in 2010, has provided HIV/AIDS counseling, testing and other services for 41.66 million pregnant women, and the MTCT rate has dropped to 6.3 percent.

NGOs have played an active role in promoting women's health. Since 2009, the China Family Planning Association has implemented the Five-year Plan for Reproductive Care of Youth Health (2008-2013) across the country, with extensive interactive training campaigns for health knowledge organized among adolescents, contributing to improved women's health. The "Assistance Program for Impoverished Pregnant Women" launched by the China Foundation for Poverty Alleviation (the CFPA) has sent cesarean section grants to poverty-stricken pregnant women and offered relief for women with serious illnesses. By the end of 2012, the cumulative number of beneficiaries reached 186,000 women, including 364 critically ill pregnant women who received emergency rescue . "Mother Health Express", a project launched by the China Women's Development Foundation (the CWDF), has been scaled up with ever-expanding geographical coverage. As of the end of 2013, 2,023 vehicles had been distributed to 30 provincial-level jurisdictions, benefiting 39 million women.

4. Chinese women's health has been considerably improved

Chinese women and children's health has been significantly improved since 2009, with women's average life expectancy reaching 77.37 years. From 2009 to 2013, the country's maternal mortality dropped to 23.2 from 31.9 per hundred thousand, infant mortality declined to 9.5 from 13.8 per thousand, and the mortality rate of children aged below 5 decreased to 12 from 17.20 per thousand. Hospital delivery rate increased to 99.2 percent in 2012 from 96.3 percent in 2009 . The urban-rural gap regarding childbirth was further narrowed down, while that relevant to maternal mortality was largely wiped out. The UN Millennium Development Goal for the mortality rate of children under five was reached before schedule. The WHO acknowledged and announced China's achievement in eliminating maternal and neonatal tetanus.

(B) Gaps and Challenges

1. Women's health care financing system should be bettered

A stable mechanism for investment in and compensation for women's health care endeavor is still to be set up in the face of the lack of overall government funding. Impacted by the market-oriented reform in medical and health services, women's health care agencies in China have failed to act as true public health providers over the years.

2. Women's health service system remains lagging behind

Women's health care system has encountered new challenges as a service provider in the new era. During a long period of time, maternal and child health care facilities and family planning services have been segregated with scattered service resources, failing to achieve the maximum effectiveness. The lack of funding for grassroots-level women's health care organizations, coupled with poor infrastructure and a shortage of professionals, hindered the ability to offer quality service. In 2013, integration of health and family planning resources was initiated, though not fully completed yet. In the days to come, with accelerated improvement in fertility policy and the explosion of cumulative fertility demand, the number of births will increase, and so will the proportion of women of advanced maternal age, which means a considerable rise of exposure to pregnancy complications and birth defects. These all require the existing health care system for women to evolve up to a new level of service quality.

3. Equity and inclusiveness of women's health services have not been fully realized

Imbalance between urban and rural areas as well as between coastal and remote regions in terms of maternal and child health services have resulted in huge disparities of the availability and quality of women's health services in different areas. Women's health conditions, therefore, also differ from region to region and group to group. Access to maternal and child health services is relatively low in western, poor, remote and mountainous areas and among ethnic minority groups. Maternal mortality in western regions is 2.5 times higher than that in eastern regions, infant mortality and mortality of children below five in rural areas are respectively 2.4 times and 2.8 times of that in urban areas, and the proportion of rural pregnant women suffering moderate and severe anemia is 1.3 times higher than that of urban pregnant women. The priority task and concern of women's health endeavor remains to be improving the health conditions of women in western regions, rural areas and among migrant residents . Besides, it is still difficult for elderly, poor, disabled and other vulnerable groups of women in rural areas to get equal access to health care opportunities, resources and services.

4. Some diseases have exposed women's physical and mental health to higher risks

Sexual and reproductive health education for adolescents has not yet been incorporated into China's official education system, and young people cannot get such health information and services from the formal channels. This has resulted in the rising proportion of adolescent girls having unsafe sex, so that the unwanted pregnancy and abortion exposed young women to greater health risks. According to incomplete statistics, annual induced abortions account for nine million cases in the country, of which about half are unmarried female adolescents. Artificial induction from fetal sex selection also endangers women's health. With the improvement of living standards, prevalence of gynecological cancers and related diseases has increased, including breast cancer and cervical cancer. From 2000 to 2011, the incidence of these two types of cancer grew up to 10.4 and 15.3 per 100,000 from 7.9 and 9.6 per 100,000 respectively, stressing the need to strengthen prevention and control of the diseases . Also, frequent cesarean sections, high infertility and mental disorders have increasingly become a prominent problem of public health. Both the number and the proportion of women infected with HIV have increased. As of the end of 2011, the estimated number of surviving HIV-infected people and AIDS patients totaled 780,000, of which 28.6 percent were women. The sex ratio between HIV-infected men and women declined to 2.5:1 from the 5:1 in 2009 , indicating a faster increase in the proportion of HIV-infected women, whose living and medical service needs have not been sufficiently attended.

(C) Suggestions in Response

1. Further strengthen the government's leading role and public responsibility in promoting women's health, with increased investment in women's health care endeavor

Women's health should be identified as a priority for the government in the development of public services, with the government's social responsibility in promoting accessibility, equalization and inclusiveness of the service. There should be a substantial increase in the budget for maternal and child health care, including such funds in the priority areas of public finance. The funding mechanism for women's health and family planning should be bettered, setting up proportions of women's health care funding at national, provincial, city and county (prefecture) levels on a reasonable shared basis, with the position of target sites of migrants identified in guarantee of women's health services funding. The nature of women's health care agencies as nonprofit organizations should be established.

2. The allocation of women's health care resources should be optimized, coupled with accelerated integration of women's health service resources at the grassroots level between health care and family planning sectors

Full play should be given to the technical strength of maternal and child health departments as well as the well-established network of the family planning sector to make women's health and medical services more available. Education and training of professionals in women's health care and midwifery services should be enhanced to level up the overall service quality, getting prepared for a dramatic increase in the demand for obstetrics and women's health services in the years to come.

3. Women's health care efforts should be focused on the grassroots level, with more health care resources allocated to the grassroots and poor areas

More attention should be paid to migrants and other special groups, with efforts made to foster coordinated development of women's health care between urban and rural areas as well as between regions. More women's health service facilities should be constructed in the central and western regions, rural areas and remote areas of ethnic minorities, coupled with reinforced policy preferences in terms of funds allocation and personnel training.

4. The health conditions and service needs of women in different stages of the life cycle should be studied and attended

In response to unwanted pregnancy and abortions among adolescents, relevant policy advocacy as well as multi-departmental cooperation is necessary. Adolescent education programs for sexual and reproductive health should be incorporated into the official education system, with efforts made to build "youth-friendly" reproductive health services and to improve the accessibility and availability of sexual and reproductive health services for adolescents. Reduction of adolescent abortion and cervical cancer vaccination for females should become part of the national public health service scheme. Intervention should be carried out to address the current high rate of cesarean section, while labor protection and health education for women in the workplace should be intensified, and a close eye should be kept on the mental health of women.

(Women of China)