Maternal and Child Health Journal

, Volume 17, Issue 2, pp 208–221 | Cite as

Impact of Financial and Educational Interventions on Maternity Care: Results of Cluster Randomized Trials in Rural China, CHIMACA

  • Elina Hemminki
  • Qian Long
  • Wei-Hong Zhang
  • Zhuochun Wu
  • Joanna Raven
  • Fangbiao Tao
  • Hong Yan
  • Yang Wang
  • Reija Klemetti
  • Tuohong Zhang
  • Elena Regushevskaya
  • Shenglan Tang


To report on the design and basic outcomes of three interventions aimed at improving the use and quality of maternity care in rural China: financial interventions, training in clinical skills, and training in health education. Community-based cluster randomized trials were carried out in one central and two western provinces between 2007 and 2009: (1) financial interventions covered part of women’s costs for prenatal and postnatal care, (2) training of midwives in clinical skills was given by local maternity care experts in two- or three-group training courses, (3) health education training for midwives and village doctors were given by local experts in health education in two- or three-group training courses. A survey was conducted in a stratified random sample of women who had been pregnant in the study period. 73% of women (n = 3,673) were interviewed within 1–10 months of giving birth. Outcomes were compared by the different intervention and control groups. Adjusted odds ratios were calculated by logistic regression to adjust for varying maternal characteristics. Most of the differences found between the groups were small and some varied between provinces. The financial intervention did not influence the number of visits, but was associated with increased caesarean sections and a decrease in many ultrasound tests. The clinical intervention influenced some indicators of care content. There was no consistent finding for the health education intervention. Financial and training interventions have the potential to improve maternity care, but better implementation is required. Unintended consequences, including overuse of technology, are possible.


Financial intervention Educational intervention Maternity care Rural China Cluster randomized trial 



This work is part of the output of the CHIMACA project (015396), which is funded by the European Commission INCO Programme and is co-ordinated by the National Institute for Health and Welfare, Helsinki, Finland. We thank the local health authorities for their help in carrying out the interventions and organizing the interviews: in Anhui province, Li Guoping, Wang Zhi, Wang Haibao, Lu Xiufu, Yan Hongqiao, Fang Tie, Chen Suping; in Chongqing, Huang Junxia, Long Min, Ou Zhong; in Shaanxi, Wang Zhongyi, Gao Changliang, Liu Hualin, He Xiaoyan, Li Ping, Wei Lanhuai, Zhu Juan, Xiang Qing, Liu Jianping, Zhang Shuhe, Xu Genghui, Lu Bofeng, Li Li. We also thank the township managers, midwives, village doctors, family planning workers and women participating in the intervention and surveys. We thank the local experts for clinical skills training and health education training. We thank interviewers for data collection: in Anhui province, Long Xiang, Xiao Yannan, Liu Liu, Wu Xiaoyan, Zhao Yuanyuan, Liu Feng, Xiao Limin, Cheng Daijuan, Jiang Xiaomin, Xing Xiuya, Xing Chao, Huang Zhaohui, Zhang Anhui, Wang Hong, Zhang Jingli, Chu Zhou, Huang Lei, Zhang Yan, Cao Hui, Sun Lu, Gong Xiangjun, Xu Rong, Liu Fang; in Chongqing, Liu Xiaoxue, Ding Yinting, Song Hong, Liu Tie, Chen Qing, Zhang Zhuan; in Shaanxi, Zeng Lingxia, Zhao Yaling, Tang Aiping, Xing Yuan, Dong Lifang, Liu Xiaoning, Li Chao, Yang Yang, Li Jiangping, Wang Zhenjie, Hu Meiqin, Zheng Xueli, Li Qinli, Zhou Qin.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Elina Hemminki
    • 1
  • Qian Long
    • 1
    • 2
    • 3
  • Wei-Hong Zhang
    • 4
  • Zhuochun Wu
    • 5
  • Joanna Raven
    • 6
  • Fangbiao Tao
    • 7
  • Hong Yan
    • 8
  • Yang Wang
    • 3
  • Reija Klemetti
    • 1
  • Tuohong Zhang
    • 9
  • Elena Regushevskaya
    • 1
  • Shenglan Tang
    • 10
  1. 1.National Institute for Health and WelfareHelsinkiFinland
  2. 2.Department of Public HealthUniversity of HelsinkiHelsinkiFinland
  3. 3.School of Public HealthChongqing Medical UniversityChongqingChina
  4. 4.International Centre for Reproductive Health (ICRH)Ghent UniversityGhentBelgium
  5. 5.School of Public HealthFudan UniversityShanghaiChina
  6. 6.Liverpool School of Tropical MedicineLiverpoolUK
  7. 7.School of Public HealthAnhui Medical UniversityAnhuiChina
  8. 8.School of MedicineXi’an Jiaotong UniversityShaanxiChina
  9. 9.School of Public HealthPeking UniversityBeijingChina
  10. 10.Duke Global Health InstituteDuke UniversityDurhamUSA

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