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Anne CC Lee, MD¹, Karen Deutsch, MPH², Sonam Drogha, MD³, Phuntsok Dundrop, MD³, Maria Freytsis, RN, MPH³, Alan Mease, MD⁴, and Lee Weingrad³. (1) Department of Pediatrics, Boston University, One Boston Medical Center Place, Boston, MA 02118, 617-414-3301, cc.lee@bmc.org, (2) University of California, San Francisco, 500 Parnassus Ave, San Francisco, CA 94143, (3) Surmang Foundation, Dharma Saghara Clinic, Surmang, China, (4) Department of Pediatrics, Beijing United Family Hospital, 2 Jiang Tai Lu, Beijing, China

BACKGROUND: Surmang is a rural, Tibetan region of China with limited access to maternal health services. The purpose of this study is to describe maternal health care and practices during pregnancy and childbirth. METHODS: We conducted a cross-sectional survey of women of reproductive age in Surmang, Qinghai Province, China. Due to the sparse nomadic population, we attempted to identify and survey all subjects within 3 days travel of a local clinic. Survey content included obstetrical history, child-birthing practices, and health-seeking behaviors. RESULTS: Of 470 eligible women, 409(87 %) responded. Among the respondents, 242(59%) reported a history of pregnancy. The total fertility rate was 2.6 (median 2, range 0-11). Half of subjects reported at least one pre-natal visit during their last pregnancy. The tetanus vaccination rate was 14%. Of the 242 respondents' most recent births, 207(86%) occurred in the home, 24(10%) in a tent, 9(2.7%) in an animal shed, and 2(0.8%) in a hospital. Two hundred and thirty seven births (98%) occurred without a skilled attendant. The umbilical cord was cut with a clean instrument in 14 births (3.4%). Delivery complications included: fever(41%); prolonged labor(33%); postpartum hemorrhage(15%); and retained placenta(8%). For pregnancy-related complications, 84 women (35%) sought assistance from a health care provider: 73(87%) from traditional Tibetan physicians, 6(7%) from western-trained physicians and 5(6%) from religious leaders. Traditional remedies to assist during pregnancy included: Tibetan herbs(29%), chanting(23%), butter pills(13%), and burning incense(11%). In the sample community, there were 3 maternal deaths and 97 live births in 2003 (estimated maternal mortality ratio 3,092/100,000). CONCLUSIONS: In Surmang, inadequate maternal care during pregnancy and childbirth in association with high estimates of pregnancy-related complications and maternal mortality indicate the urgent need for an intervention.

Learning Objectives:

• Describe maternal care in pregnancy and childbirth in a rural Tibetan region of China
• Describe common Tibetan childbirthing practices in childbirth and delivery
• Recognize maternal outcomes in this region

Presenting author's disclosure statement:

Not Answered