Changes and equity in use of maternal health care in China: from 1991 to 2003.

To examine changes and equity in use of maternal care in different types of rural and urban areas in China from the early 1990s to early 2000s. Data were drawn from three National Health Household Interview Surveys conducted in 1993, 1998, and 2003. Analysis was based on married women aged between 15 and 49 who had live births within the 24 months prior to the survey. Nationally, the proportion of women receiving their first pre-natal visit within 12 weeks of gestation and the hospital delivery rate increased rapidly from 20.56 and 37.61% in the early 1990s to 52.60 and 74.02% in the early 2000s, respectively, while the proportion of women receiving at least one post-natal care visit dropped slightly from 56.46 to 54.12% in the same time period. There were large disparities in use of maternal care between urban and rural areas and among different sized cities and rural areas with different levels of socio-economic development. But the disparities narrowed over time, especially among different types of rural areas. The proportion of delivery out of hospital attended by trained staff in rural areas decreased considerably from 68.01% in 1991-1993 to 51.57% in 2001-2003. Maternal care utilization made remarkable progress in the study period, and the gap between rural and urban areas and among different classes of cities and rural areas significantly narrowed. This was probably due to both socio-economic development and targeted investments in improving health services. However, significant gaps remained, requiring attention.