Feature: Giving China's poorest children a better start in life

Ten years ago, Feng Zhaoxiong's first child was born during a bumpy journey through the mountains to a county hospital - no prenatal checkup, no doctors. Fortunately, she and her son came through safe and sound.

Feng lives in a remote village in Gansu Province, northwest China, a two-hour ride on mountain trails to the county seat. At that time, Feng, suffering from rickets, was one of the few women in the village who wanted her child born in a hospital. Because of poor transport and a lack of information, most women gave birth on their own brick beds at home, just like their mothers before them.

Last year, Feng fell pregnant again. This time, the village doctor persuaded her to go to a health center in the town for prenatal checkups as well.

Feng was illiterate and couldn't really understand. "What is the sense of so many examinations?" she asked. But when the doctor explained that she could receive a cash subsidy, Feng was persuaded.

The subsidy was available under the conditional cash transfer (CCT) project, which aims to increase Maternal and Child Health (MCH) in China's poor rural areas by increasing the use of MCH services. It falls under the auspices of the Ministry of Commerce and the United Nations Children's Fund (UNICEF).

Since 2013, the CCT project has been set up in Yunnan, Gansu and Sichuan provinces. It provides incentives for poor mothers to take advantage of MCH services.

In April 2013, a CCT pilot project was launched in Yeliguan Town, Chengguan Town and Yangsha Township, all in Lintan County, Gannan Tibetan Autonomous Prefecture of Gansu Province.

Lintan is on the national priority poverty relief list. More than 60 percent of the 45,000 people in the three pilot locations are farmers, and many households have an annual per capita income of less than 3,500 yuan.

With the help of the village doctor, Feng received a subsidy of 100 yuan immediately. She duly completed five regular prenatal checkups at Lintan Maternity Hospital and successfully gave birth to a girl in November last year.

After completing her post-delivery visit, Feng received another 640 yuan. If she keeps breastfeeding for half a year, and her daughter undergoes four physical examinations and seven vaccinations in her first year, she will receive 1,000 yuan in total.

Feng learned more than how to claim subsidies. "In my first pregnancy, I felt uncomfortable, but I didn't know what was wrong. This time, I realized that most of what I thought and did before was wrong," Feng says. "During the late term of my pregnancy, I was diagnosed with anemia. The doctor advised me to eat more nutritious food and take better care of myself."

Li Junfa, who has worked in Yangsha Township Health Center since 2010, has been touched by the changes in individual behavior and in community attitudes.

"When I first came here, pregnant women didn't realize they should undergo examinations, and if they did come here, they were ashamed of being checked by a doctor," Li said.

"Seventy percent of elderly people are illiterate, and most of the adults only went to elementary school or middle school. If we intend to impress on them the importance of maternal and child health, we need to educate not only the young women, but also their parents and husbands.

"For example, only 88 percent of women came back to the health center for post-delivery visits 42 days after giving birth, which can be explained by two reasons: first is the tradition of a 45-day confinement after delivery, which means we need to persuade the older family members who take care of the new mother; second is the poor transport, and if family members of the new mother have all gone out to work after her delivery, she may have nobody to accompany her to an examination," said Li.

"However, people's thinking is changing. Now they attach greater importance to the health of pregnant women and their unborn babies. Even pregnant women who live in very remote villages come to the health center in the township or the county seat for prenatal checkups. Some even want a few more examinations."

Wang Yanqin, deputy head of Lintan Maternal and Child Health Station, said 898 pregnant women had registered for the CCT project in the three designated locations in the first three years, accounting for more than 85 percent of the total.

"And in Yangsha Township and Yiliguan Town, the registered proportion is above 95 percent," said Wang. "Disease rates for women and children have significantly decreased. Since 2013, no parturient woman has died during delivery or given birth at home or on a mountain trail."

"We spread the concept of health, and the women and children here have developed healthy habits."

Shi Chunfang, who lives in Xijia Village near Yeliguan Town, still recalls her panic in pregnancy and delivery. She suffered from pregnancy hypertension. Approaching her due date, she was diagnosed with antepartum eclampsia after she fainted with cramps. If she hadn't stayed in hospital for monitoring, the outcome might have been too dreadful to contemplate.

"I didn't know it'd be so dangerous to get pregnant," Shi said. "Thanks to the prenatal checkups, my hypertension was brought under control. I was treated promptly in the hospital and I had a caesarean operation."

Now, Shi's daughter is 18 months old and runs around the family's brick home. Shi received a subsidy of 950 yuan from the CCT project, all of which she spent on nutritional food and toys for her daughter.

At the beginning of this year, Shi got a job as a waitress in a hot-pot restaurant with a monthly salary of 1,500 yuan. Despite not finishing middle school herself, she has plans and expectations for her daughter's future. She hopes her daughter will study hard and go to university.

Lin Fei, child development specialist in the UNICEF Office for China, is the chief designer of the CCT project. She said more frequent use of MCH services will lead to improved maternal and child health and nutrition.

As of March 31, the CCT project had distributed 5.66 million yuan in total in the pilot areas, helping 13,134 women and children.

"We hope that the CCT can be used in other settings and for other programs outside the project area and across China and help improve conditions in the remaining pockets of hard core poverty in remote, mountainous area of the county," Lin said. Endi