China has made substantial progress in improving mother and child health but great disparities remain, experts said at a World Health Day ceremony on Thursday.

The theme of this year's World Health Day is, "Make every mother and child count."

China's efforts to improve health care for women and children are apparent in the marked drop in the maternal mortality rate (MMR), which plummeted from 15 per 1,000 in 1949 to 0.5 per 1,000 in 2003. In the same period, the infant mortality rate (IMR) fell from 200 to 25.5 per 1,000.

China now ranks 88th among 191 countries in these areas.

However, gaps between the eastern and western regions, between urban and rural areas and between the floating population and residents in cities remain. These gaps and the lack of easy access to medical services for the poor may affect China's efforts to meet its Millennium Development Goals, said Henk Bekedam, the World Health Organization representative in China.

According to the 2004 Child Development Report of China issued by the State Council's National Working Committee for Children and Women, 29 million poverty-stricken people lived in the countryside in 2003, most of them in western areas. The 2003 MMR in these areas was 5.8 times higher than in more developed eastern coastal areas, and the IMR 4.4 times higher.

In Shanghai, for example, the IMR has dropped to 0.1 per 1,000, almost as low as in developed countries, while in Tibet the rate is still 1 per 1,000.

The gap between rich and poor in the cities is wide as well.

"Two-thirds of maternal deaths in urban areas appear to be of migrant women, who account for only 10 percent of total pregnancies. And more than 75 percent of maternal deaths are preventable," Siri Tellier, the United Nations Population Fund (UNFPA) representative in China, pointed out.

She also warned that improvements may be slowing and there are worrying signs that the child mortality rate may be declining more slowly for girls than for boys.

Koenraad Vanormelingen, senior program officer for health with the United Nations Children's Fund (UNICEF), agreed. "Different indicators have shown remarkable declines, but changes are slowing down. Take IMR, for example. Little progress has been made in the past five years in poor regions."

All the experts urged the Chinese government to invest more money to ensure that everybody, especially those in poor, remote or ethnic minority regions, has access to medical services and knows how to make use of them.

In 2004, China spent 84.8 billion yuan (US$10.2 billion) on public health, but urban areas remain the biggest beneficiaries, Bekedam said. "China has incorporated market strategies very well, but health should not be made a market commodity."

The high cost of medical services has kept many of the poor from getting sound care. WHO figures indicate that 39 percent of China's rural population and 36 percent of its urban population in need of medical care do not have access to it for financial reasons.

"It's important for the government to think about what should be done in ten years' time and rethink where to focus its attention on health," said Bekedam.

To improve the health and safety of women and children in rural and western areas, the Ministry of Health (MOH) began a program in 2001 to offer medical care, purchase equipment, train personnel and set up a fund to help needy pregnant women. So far, 400 million yuan (US$48.0 million) has been invested in the program.

"The program covers 300 million people in 1,000 counties in all 23 provinces and regions in central and western China," said Yang Qing, director of the Department of Maternal, Pediatric and Community Health at the MOH.

But the money spent is far from enough to cover medical expenses of all rural families.

"The government needs to ensure a minimum package of medical services for those in need, for free or at subsidized rates," Vanormelingen said.

(Xinhua News Agency April 8, 2005)