Privatisation of health services and the reproductive health of rural Chinese women.

China's rural health care system has undergone major changes since the early 1980s, when the country began privatising rural health services. Following fiscal devolution, the rural primary health service was transformed into a fee-for-service system, dependent on the availability of local resources. This article reports some of the results of a study undertaken in 1994-96 to examine the impact of privatization on financing, provision and use of reproductive health services by women in two rural counties in Yunnan Province, China. The most common self-reported symptoms of reproductive morbidity were abnormal vaginal discharge and vaginal tears during home delivery, which went mostly untreated. Hospital-based delivery and use of antenatal care was very low, adversely affected by costs and perceived low quality. Service quality was affected by low investment in training, maintenance and supervision of workers. Most of the burden for maternal and child health care fell on local health workers, yet resources for these services had declined from 1985 to 1995. Only support for family planning services, which were funded and provided separately, had increased. Rural women's reproductive health needs were inadequately attended to by rural health services following reforms. Our data has helped to increase attention to those needs within planned reform efforts.