In China, about 10 000 women die every year in pregnancy and childbirth. These women are young, aged 24 to 34. Morbidity among all women is still high. About one-third of married women surveyed in some regions have cervicitis or vaginitis. Ninety percent of the total population have hepatitis A by young adulthood. Because increasing proportions of pregnancies are first pregnancies, the risks of complications, such as toxemia and difficult labor, are higher. Even though there are still wide regional differences in the mortality rate, from 18 maternal deaths per 100000 live births in Shanghai to 108 in Ningxia Autonomous Region, China's achievements in reducing the maternal deaths to levels less than those found in other developing countries are impressive. China's policy 1960 - 1980 concentrated on providing access to basic care, including a rapid expansion of a network of maternal and child health services, a large group of community health workers trained to provide basic care, drugs, family planning services, and attendance to deliveries, and the full political support of the government to improve women's literacy and the Institution of laws increased the minimum legal age for marriage. However, the level of maternal mortality has not declined much in the past nine years. Furthermore, the difference in the level of morbidity and mortality varies with the economic status of the region and access to health services. A strategy to improve maternal health would include developing a comprehensive approach to strengthen the epidemiological, clinical, and managerial expertise of the health system. Interventions would also have to be tailored to local health priorities. Most maternal deaths in rural areas occur at home as a result of hemorrhage. In the cities, almost all deliveries occur in hospitals, and the major cause of death is toxemia. Resources can be used better If targeted to programs that match these problems. The maternal and child health centers must avoid overexpansion of curative services that duplicate the existing network of hospital services. Early intervention to decrease the risks of maternal deaths, such as correcting anemia, providing tetanus toxoid immunization, and managing excessive weight gain or hypertension, require patient cooperation and compliance. Thus, health education is necessary to Increase patients' awareness of the progression of normal pregnancy and the early signs of risk factors. Maternal deaths are preventable. So is most of the morbidity related to pregnancy. To further reduce the maternal mortality rate and reduce morbidity, China needs to provide basic maternal health care in the poorest regions, and needs to experiment with innovative planning and management methods, such as the 'risk approach', to match Interventions with priority health problems. © 1989.
