China has slashed the death rate of newborn babies by almost two-thirds in 12 years by promoting hospital births, research has shown.
Deaths fell from 24.7 per 1,000 live births in 1996 to 9.3 in 2008. Only half of women gave birth in hospital at the start of that period, whereas by the end almost all did so outside the most deprived rural areas.
The study, led by Xing Linfeng and Yan Guo of Peking University and published in the Lancet, was based on data from 37 Chinese urban districts and 79 rural counties.
"The decline is spectacular across all the regions," said Professor Carine Ronsmans of the London School of Hygiene and Tropical Medicine, who co-authored the study.
"I think the Chinese government can be congratulated on its efforts to reduce neonatal mortality and maternal mortality – which has declined just as much."
She added: "It's a combination of strengthening facilities, training providers, equipping them with the skills and drugs to offer better care – and, through insurance, encouraging families to give birth in hospitals.
"It has moved away from the midwife programme to one that supports doctors – although in China, doctors range from someone trained for three to four years to what we would call an MD."
There was still some disparity, with babies in poorer areas four times as likely to die as in wealthier urban areas – apparently reflecting poorer quality services in township hospitals.
"In urban China, babies born in hospital have a very low newborn mortality rate of 5 per 1,000, almost that of the UK, which is 3 to 4 per 1,000," said Ronsmans.
Ronsmans said separate research they had done had shown that there was very little variation between socioeconomic groups in the uptake of maternity services, even though the health insurance programme that China has introduced in rural areas covers only part of the cost of hospital births.
According to UN figures, China has met its goal to reduce the under-five mortality rate by two-thirds between 1990 and 2015. It is also on course to reduce the maternal mortality ratio by three-quarters. Last week Chinese officials said the rate had dropped further since 2008 thanks to new subsidies to help rural women.
Fu Wei, a senior official with the ministry of health, said the figure had fallen from 34.2 per 100,000 to 30 out of 100,000 last year.
More than 22 million mothers have benefited from a programme giving each pregnant woman in the countryside 500 yuan for hospital delivery.
Fu said 96.7% of mothers from rural areas gave birth in hospitals last year.
But she warned that birth defects remained a problem, affecting around 5% of newborn babies, compared with 0.68% in the United States. Authorities have begun distributing free folic acid to expectant mothers in rural areas to reduce neural tube defects.
