In China’s rural and ethnic minority areas, women often don’t deliver their babies in hospital due to tradition, distance or economic difficulties. The low hospital delivery rate is partly to blame for the high infant and maternal mortality rate in rural China. The latest (2013) statistics from the National Health and Family Planning Commission show that the rural infant mortality rate was more than double the rate in urban areas, while the rural maternity mortality rate was 5.4 per cent higher. ©UNICEF/China/2016/Xia Yong

UNICEF knows from experience that hospital delivery is a critical strategy for reducing mortality among mothers, newborn babies. ©UNICEF/China/2016/Xia Yong

To improve maternal, newborn and child health in remote communities, the National Health and Family Planning Commission and UNICEF launched an Integrated Maternal and Child Health (IMCH) Programme in 2011, covering 35 poverty-stricken counties in seven provinces and regions. The programme aims to get pregnant women and parents of children younger than 5 years to engage with the available maternal and child health services, including making five antenatal visits during pregnancy, ensure hospital delivery at birth and breastfeed for two years or beyond of which six month exclusively. ©UNICEF/China/2016/Xia Yong

When the programme first started, it wasn’t easy to persuade the target population to use the services. Yuexi County in Liangshan Yi Autonomous Region, an ethnic minority area in Sichuan Province, is one of the pilot sites. The majority of the population in the mountainous county are of Yi ethnicity. Yuexi is designated as a poverty-stricken county, with more than 39,000 people living below the national poverty line. Most Yi people live in the mountains, where transportation is limited. Some villages don’t have electricity. ©UNICEF/China/2016/Xia Yong

Most Yi women can’t read or speak Mandarin. They have little experience with the ‘outside world’ and are reluctant to meet strangers. This keeps them from seeking medical services. And in the traditional Yi culture, having a baby is embarrassing for women; they don’t want others to know about the pregnancy and thus will not go to hospital for delivery. In Yuexi, the hospital delivery rate was only 43 per cent in 2010, leaving mothers and babies at risk of grave illness or death. ©UNICEF/China/2016/Wang Ya

Through the IMCH Programme, local government and health departments in Yuexi County mobilized women cadres to promote hospital delivery among rural households. They also developed a way to locate pregnant women and get them to hospital. After receiving training, the women cadres go house to house to visit with pregnant women and track every stage of their pregnancy. Sometimes they also ask other women who have had a hospital delivery experience to become a peer educator to help others understand the importance of having a baby in hospital. ©UNICEF/China/2016/Xia Yong

Axi Emu has served as a woman cadre in her Hongqi village in Yuexi for 36 years. Three years ago, she started working with the IMCH Programme to encourage pregnant women and their families to use the government services. She visits them regularly at home, which sometimes takes her hours by walking to reach. At first, it was hard to win people’s trust, she says. When she asked newlyweds whether they were planning to have a baby, people often gave her a chilly reply, saying, “It’s our own business. Why do you care?” Some families told her they are used to delivering babies at home so “it doesn’t matter if we continue doing that”. Plus, they couldn’t afford the costs of delivering a baby in hospital. With the women cadre’s relentless efforts, it changed over time. ©UNICEF/China/2016/Wang Ya

Axi Emu gradually convinced villagers of the benefits of antenatal check-ups and delivering babies in hospital. It helped to add that they would receive a government subsidy for each hospital delivery—rather than having to pay for it. For families in remote areas, Axi Emu helps them find transportation to the hospital. Over the past three years, she has persuaded more than 200 women to use the government health services. “Some of the pregnant women in our village still refuse to listen to us, but most of them take our advice and are conscious about the benefits. They always make their antenatal visits on time,” says Axi Emu. ©UNICEF/China/2016/Wang Ya

Moluo Erbu, 36, is a mother of three children. Only the youngest child was born in hospital. “When I had my first baby, our family had no money to send me to hospital. So I delivered at home. The second one was the same,” she says. “When I had my third child, the women cadre told me it is risky to deliver at home, and it’s not only free to give birth in the hospital but also we will receive subsidies. The women cadre reminded me for each antenatal visit and took me to the hospital for delivery.” After her third birth, Moluo Erbu discovered “delivering in the hospital is much safer for me and my child.” ©UNICEF/China/2016/Xia Yong

The county’s health workers regularly organize community activities in villages to promote awareness of how to better protect women’s and children’s health. ©UNICEF/China/2016/Xia Yong

Health workers give onsite guidance for prenatal or postnatal care and breastfeeding to mothers. They also hand out free folic acid supplements to women who are planning to have a baby. ©UNICEF/China/2016/Xia Yong

With the programme’s intervention, women from Yi communities have become more aware of the importance of hospital delivery. Those who give birth in hospital later voluntarily help the women cadre in explaining the benefits with their relatives and friends, thus encouraging more women in the village to deliver in hospital. ©UNICEF/China/2016/Xia Yong

The mountainous terrain and poor infrastructure in the county’s remote villages make it difficult for pregnant women to travel to hospital when in labour. Some villages cannot be accessed by car or even horse cart. Through the IMCH Programme, a team was set up in each village that is responsible for sending women in labour to hospital. Women who have a difficult labour or complications are carried on a stretcher down the hills and picked up by horse cart or vehicle. A referral group at the township level then coordinates with the hospital for use of the ambulance. No payment from the family is required for any of the transportation. ©UNICEF/China/2016/Xia Yong

In the Yuexi County MCH Hospital, a young Yi couple celebrate the birth of their first child. Thanks to the IMCH Programme, the county’s hospital delivery rate increased to 87 per cent in 2015, almost double the rate for 2010, which represents many mothers’ and babies’ lives saved. ©UNICEF/China/2016/Xia Yong