Background

General

Saving the lives of Tibetan women and their children is of utmost urgency for the survival of the Tibetan people and culture. Improving maternal health and reducing child mortality have globally been recognized as vital to promoting development and eradicating poverty, as set out in the United Nations Millennium Development Goals.

The Tibetan society is one of the few in the world where there is no tradition of trained birth attendants. Poor nutrition, lack of trained health personnel, long travel distances and limited access to emergency care place Tibetan women and infants at high risk of birth-related deaths.

Geography and Demographics

The Tibetan Plateau covers a total area of 2.5 million square kilometers; one fifth of the People's Republic of China (PRC). The Plateau is comparable in size to Western Europe. Tibetan-populated areas of China are administratively divided into the Tibetan Autonomous Region (TAR) on the one hand and Tibetan autonomous prefectures and counties in the Provinces of Gansu, Qinghai, Sichuan and Yunnan on the other. Each province is divided into prefectures. Each prefecture in turn is divided into counties, townships and villages. A cluster of ten to fifteen villages or nomadic settlements formsa township. According to the 2000 census, the estimated population of Tibetans living in China is 5,416,021 million people. Approximately, 45% of the Tibetan population is rural, while 40% is nomadic or semi-nomadic, and only about 15% live in urban areas. The harsh climate, an average altitude of 4,000 meters, inhospitable and rugged mountainous terrain and lack of infrastructure in vast parts of the Plateau are all adverse factors that have contributed to the isolation of the region, as well as particularly dire living conditions for the overwhelming majority of the population.

General Health and Health Care

Health and health care on the Tibetan Plateau are among the worst in China. In Tibet, there is a high incidence of diseases resulting from malnutrition and generally a serious lack of medical infrastructure, vital resources and basic education in the health area. The central government, as well as international health organizations often fail to report on the statistical disparities that exist between the wealthier and densely populated regions of Eastern China and the more underserved and scattered areas of Western China, including the Tibetan Plateau. No official data on morbidity and mortality exist for the Tibetan Plateau. According to some experts, the rate of maternal, child and infant mortality is so high that "Tibet can be categorized as one of the least developed regions on earth." In addition to diarrhea, arthritis and pneumonia, they also report that the TAR has the highest rate of tuberculosis in China, and one of the highest incidences in the world of the rare Kashin-Beck (Big Bone) disease, which causes deformities and stunted growth.More than half a century after the incorporation of Tibet into China, adequate and affordable health care is still not available to the majority of Tibetans. Beijing's economic development policy for the Western regions of China, including the TAR, tends to focus on large-scale infrastructural projects, such as roads, railways, dams d power stations, while neglecting "soft" infrastructure, such as the provision of health care and education.

Maternal and Newborn Health on the Tibetan Plateau

The Tibetan society is one of the few in the world where a tradition of trained birth attendants does not exist. Poor nutrition, lack of trained health personnel, long travel distances and limited access to emergency care place Tibetan women and infants at high risk of birth-related deaths. The vast majority of births take place at high altitude, in a cold environment and without access to electricity or health care. In spite of activecampaigns by the Chinese Government to encourage women to give birth in a medical facility, more than 95% of Tibetan women give birth at home. Most babies are delivered with the help only of the mother or the mother-in-law whose sole assistance is the cutting of the cord. Amazingly, many Tibetan women deliver their babies completely on their own.

It is believed that Tibet has one of the highest newborn and infant mortality rates in the world. Tibetan women are three hundred times more likely to die than women in developed countries from various pregnancy and delivery complications. Postpartum hemorrhage is the leading cause of death. Likewise, babies are far more likely to die in Tibet than anywhere else in the world.Like in other cultures, a mother's death is devastating to her family for it often threatens the health of her children and impacts on the family for generations. The mother is the thread that holds the family together. When a mother dies, her surviving children are three to ten times more likely to die within two years. When a Tibetan mother dies, her surviving children are more likely to die young and less likely to attend school or complete their education. Also, many Tibetans believe that a mother's death during childbirth is a sign of bad spirits that brings misfortune to her family and community.

Improving maternal and child health is therefore essential to preserve the Tibetan people, their social fabric and cultural identity.

Maternal Mortality: Current Worldwide Perspectives

There are an estimated 585,000 maternal deaths worldwide each year. 99 % of these deaths occur in developing countries. This translates to a worldwide mortality rate of slightly more than one mother dying every minute.

24% of those deaths occur prior to labor, 15% during labor, and the majority, 61%, happens in the first week after delivery.

The two most effective means of reducing maternal death in developing countries are i) the presence of a skilled birth attendant at the delivery, and ii) timely access to emergency obstetrical care. Over half of maternal deaths are due to severe bleeding, infection or obstructed labor.