A fast glance around hospitals and health centers across America will tell you that it is nearly impossible to separate the realm of health from economics, politics, and social equity. In fact, you can hardly exclude any country from exhibiting this type of complicated web. China is no exception. The former communist state has slowly adopted new policies and ideologies, not void of external stimulus; yet the corruption still remains embedded within its infrastructure. In recent efforts to correct a small portion of destruction, health reforms have attempted to redistribute funding towards social services like health—maternal health in particular. While maternal mortality ratios have decreased since the implementation of the reform, the striking disparities between rich and poor continue to intensify. This paper will examine China’s political and economic past and present and the constant power struggle, and evaluate how these items affect the path to improving China’s maternal health system.
Since its transition out of dynasty rule and into the establishment of the Chinese Republic in 1912, China has seen drastic changes in terms of social, political, and economic regulations. At that time, China was heavily controlled by the military and notions of communism. After Mao Zedong gained control of the Chinese Communist Party, he quickly declared the People’s Republic of China in 1949 and steered the state into another wave of corruption. Both the First and Second Five-Year Plans sought to increase militarism, capital investment, Soviet good, industrialization, and move China towards an overall nationalized system. However, in parallel, efforts were also made to improve maternal health and even reduced maternal mortality rates from 700 live births to 15 per 100,000. Yet, the larger reform policies limited improvements to urban regions, while rural areas were simply neglected.
The entrance of Deng Xiaoping’s Reform and Opening Policy in 1978 marked a transition towards individualism, autonomy of enterprises, and an expanded property rights. Once again, the rural health structure did not receive the same benefits as urban centers. The entire system experienced a major restructuring and redistribution of costs as the number of individuals covered under cooperative medicine dropped from 90 percent in 1978 to 9.5 percent in 1986. Not only did the number of women paying out-of-pocket for maternal health expenses increased sufficiently, but the number of birthing attendants decreased which negatively impacted birth safety and mortality rates.
Needless to say, the effects of Deng’s reform policies and consequential health reforms have not been evenly distributed across all socioeconomic groups. Although China has experienced isolated increases in resources and technology advancements, such amenities are limited to the wealthier incomes. However, while Harris et al recognize the disparities, they argue that wealthier groups are also at risk for exploitation within the health system. In order to compensate for reduce national spending on health care, hospitals and clinics over-medicalize and over-treat patients. In particular, mothers face high risk for unnecessary pregnancy treatments which puts their health as well as the child’s health in jeopardy. Maternal health faces a paradoxical relationship: while such programs and efforts have improved outcomes for mothers and children and decreased maternal mortality ratios, they have also decreased the safety of hospital and clinical care for mothers and children.
The gap between rich and poor continues to increase, and the questions surrounding who should pay, who can pay, and who has access to health care complicate the situation even more. Moreover, the inequitable distribution of health care towards women and children only leads to increased mortality, morbidity, and further social and economic issues.