Gipson 2012 (headshot)_0Jessica Gipson, Assistant Professor in the Department of Community Health Sciences in the UCLA Fielding School of Public Health, conducts research on maternal and child health, women’s empowerment, and sexual and reproductive decision-making. A current project, which focuses on a newly constructed Tibetan birth center in western China, furthers her ongoing research on reproductive health issues in lower-income settings.

On a national level, China is on track to meet the Millennium Development Goal to reduce maternal mortality, but maternal mortality rates remain high in rural, disadvantaged, and ethnically diverse areas of western China. Gipson recently co-authored an article in Reproductive Health Matters on an intervention that was developed based on her Tibetan colleagues’ previous research on barriers to hospital births for rural women in the Qinghai Province. They found that the barriers to hospital delivery included transportation difficulties, lack of accommodation by the hospitals for accompanying families, cost of hospital delivery services, and language and cultural barriers.

Repkhong birth centerTherefore, the research team developed and evaluated a three-level intervention, which took place at county, community, and individual levels. At the county level, they launched the Tibetan Natural Birth and Health Training Centre, where women who would not normally deliver in a hospital could receive accessible, culturally appropriate medical care before, during, and after delivery. At the community level, the team recruited and trained health-care workers in basic obstetrics, in order to provide care to women who deliver at home. Lastly, at the individual level, the Birth Centre provided a Maternal and Child Health Education Handbook to midwives, health workers, and village residents, who were asked to serve as peer educators in their communities.

image001Gipson and her colleagues found this three-level approach to be effective, not only in terms of the number of health-care workers trained and the increased utilization of formal delivery services,  but also in terms of the perceptions of maternal health-care and delivery options among the target population of women in the region. The team indicates that although this study was not designed to measure potential reductions in maternal mortality rates, results indicate that the birth center is providing services that the community is utilizing. In fact, when the researchers conducted a survey of the women who had received services at the birth center, 98% of the women reported being “highly satisfied” or “satisfied” with their experience, and 95% of the women reported that they would refer a family member or friend to the birth center in the future.

There are several points that the authors see as potentially applicable or of interest to other communities. First, the study highlights the barriers faced by women who are giving birth in rural and lower-income communities. It also provides a successful demonstration of a collaboration between an international nonprofit organization, a provincial university, local government agencies, and UCLA. Lastly, it is an example of a “bottom-up” approach, in which community members and local health workers are essential to improving knowledge and utilization of maternal health services in these more remote areas.

image003Gipson and her co-authors recently completed another article reporting on findings from the project, “Tibetan Women’s Perspectives and Satisfaction with Delivery Care in a Rural Birth Center,” which will appear in International Journal of Obstetrics & Gynecology. This article uses quantitative and qualitative data to describe the perceptions about delivery care and the characteristics of women who have delivered at the center.  Findings from this study provide preliminary insight into alternate models of care, such as the Tibetan birth center, which may begin to address disparities in maternal care particularly in low- and middle-income countries.


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