Across China: Improved medicare makes delivery safer across Tibet

For years, the preference for traditional home deliveries in Tibet have pushed up the region's infant mortality rate (IMR), but improved maternal care has reversed the trend.

BIRTH ON THE ROOF OF THE WORLD

When 27-year-old Tibetan Weaser, who had never heard about surgery or anesthesia, had complications during her labor, the doctor's plan to "cut open her belly to get the baby" sounded like a death sentence.

Her herdsmen family was equally frightened. Her 70-year-old mother chanted sutra for her daughter's safety and was vehemently opposed to this "unnatural" procedure. But the nurses eventually convinced Weaser's husband to agree to the surgery.

One year on, and with babe-in-arms, Weaser reflected on being the first woman to undergo a cesarean birth in Tibet's Maizhokunggar County.

Weaser's case is just one example of a safer birthing environment in Tibet. The region's maternal mortality rate (MMR) in the first half of 2014 had dropped to 154.5 per 100,000 from 399 a decade ago, and its IMR had decreased to 20 per 1,000 from 26 in the same period.

Behind the trend is improved obstetrical capacity and a growing acceptance of hospital births. Tibet's health authority says 82 percent of women chose hospital births in the first half of 2014.

Home delivery has long been the preferred method in rural Tibet, which is home to 80 percent of the region's population. Many residents live in remote areas and it is difficult for them to get to the region's large hospitals.

A belief that home births are more "natural" was also widespread, said Tseten Lhamo, a doctor at the hospital where Weaser underwent her c-section.

MAKING CARE ACCESSIBLE

Government investment has funded the construction of medical centers in remote areas, bringing health care closer to herdsmen. A white paper on Tibet's development, issued last year, says every village in Tibet now has a clinic, and all rural residents have access to public health care.

Moreover, local health authorities have launched a campaign to train more obstetricians and to make maternal care more affordable.

"Tibetan women are now reimbursed all of their hospital fees. They also receive subsidies between 100 yuan [16 U.S. dollars] and 500 yuan, in addition to necessities like baby clothes," Tseten Lhamo said.

However, Tibet's MMR and IMR figures are still higher than the national average of 23 per 100,000 and 9.5 per 1,000. Medical practitioners said this was due to a lack of capable doctors at rural hospitals and clinics.

Bai Shufang, a doctor from the eastern city of Nanjing who works in Maizhokunggar under the government-led Aid Tibet program, observed poor obstetrical capacity in Tibet's local hospitals. Babies with serious health problems must be transferred to large cities, in some cases even out of Tibet.

Weaser considers herself lucky. Like many other Tibetan counties, Maizhokunggar's county hospital could not offer c-section deliveries until last year. Up until then, women had to go to Lhasa, a two hour drive along mountain roads, explained another Aid Tibet doctor Su Dongmei.

"Many babies didn't survive the journey," Su said. Endi