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The expansion of solar energy in high density cities highlights the crucial need for optimal capacity planning in building-integrated photovoltaic (BIPV) systems. However, uncertainties present significant challenges for robust planning in these systems. Addressing this challenge, this paper proposes a distributionally robust optimization (DRO) model employing scenario robust ambiguity sets for BIPV system expansion planning to handle uncertainties in both demand and solar irradiance. This model stands out for its comprehensive incorporation of factors including the dynamics of climate change, the properties of building geometry, the intricate non-linear correlation between solar generation potential and global horizontal irradiance and uncertainty handling. The model can be transformed into a tractable formulation using the linear decision rule approach. In evaluating the model's performance in data uncertainty handling, the study compares it against three alternative approaches – deterministic optimization, stochastic programming, and robust optimization – in a case study for BIPV system expansion planning for a college in Singapore. The findings demonstrate the superiority of the proposed model: it achieves a 5%–12% reduction in grid reliance, saves electricity cost by 3%–10% and reduces carbon dioxide (CO 2) emission by 3%–10% compared to the benchmark approaches. These results underscore the capability of the proposed model in effectively handling data uncertainties in demand and irradiance in the BIPV system expansion planning. [Display omitted] • Consider weather patterns and geometry property in demand and solar power estimation. • Formulate power potential with global horizontal irradiance, capturing non-linearity. • Develop a distributionally robust optimization model to handle uncertainties. • Integrate the non-linearization into the optimization model. • Compare the solution performance from the proposed model to other benchmark models. [ABSTRACT FROM AUTHOR]

Accurate wind speed forecasting ensures the controllability for the wind power system. In this paper, a structure with density-weighted active learning (DWAL)-based model selection strategy from the perspective of meteorological factors is proposed to improve the accuracy and stability for wind speed deterministic and probabilistic forecasting. To improve training efficiency and accelerate the sample selection process, DWAL is employed. The multi-objective flower pollination algorithm is used to combine best models selected from model space with optimal weights for higher accuracy and stability. Except deterministic forecasts, as large-scale wind power generation integrated into power grid, the wind direction should also be forecasted and the estimation of the wind speed and direction uncertainty is vital, offering various aspects of forecasts for risk management. Thus, both deterministic and probabilistic forecasting for the wind speed vector are included in this paper. Eight datasets from Ontario Province, Canada, are utilized to evaluate forecasting performance of the model selection and the proposed structure. Results demonstrated: (a) the proposed structure is suitable for wind speed vector forecasting; (b) the proposed structure obtains more precise and stable forecasting performance; (c) the proposed structure improves the accuracy of deterministic forecasting and provides probabilistic information for wind speed vector forecasting. • Propose a novel forecasting structure based on meteorological analysis. • The model selection is employed. • The multi-objective flower pollination algorithm is used. • Density-weighted active learning algorithm is applied. • Both deterministic forecasting and probabilistic forecasting are applied. [ABSTRACT FROM AUTHOR]

Highlights • Set multi-objective for electrical load forecasting. • Propose a hybrid model contains based on the multi-objective optimization. • Use data processing technique to pre-process original data. Abstract To ensure the safe operation of electrical power systems, short-term load forecasting (STLF) plays a significant role. With the development of artificial neural network (ANN), many forecasting models based on ANN are proposed to enhance the forecasting accuracy. However, forecasting stability is also an important aspect when considering a forecasting model. Both forecasting accuracy and stability are affected heavily by the random initial values of weights and thresholds of ANN. Thus, in this paper, a new hybrid model based on the modified generalized regression neural network (GRNN) is proposed for short-term load forecasting (STLF). Meanwhile, a non-dominated sorting-based multi-objective cuckoo search algorithm (NSMOCS) is proposed to realize accurate and stable forecasting simultaneously. To utilize the similarities and reduce interference existing in the original data, some data pre-processing techniques are also incorporated. With half-hourly load data from five states in Australia, experimental results clearly show that the proposed hybrid model could obtain more accurate and stable forecasting results, compared with the comparison models. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Several maternal demographic factors have been identified to influence the timing of starting prenatal care and its adequate use. However, how the content of prenatal care modifies these factors has not been studied previously. Using a representative sample collected for other purposes in rural China, we examined the factors predicting the uptake of prenatal care by taking into account the content of care (advice: on nutrition during pregnancy, diseases and pregnancy-related problems, and on child care after birth; and routine tests: blood pressure, blood tests, and ultrasound). We studied 1,479 women who answered a house-hold KAP (knowledge, attitude, and practice) survey (97% response rate) collected after a prenatal care intervention from 2001 to 2003 in 20 townships located in a county in Anhui Province. A multinomial logistic regression was used for the analysis. The most prominent factors that predicted late start of prenatal care and inadequate care were younger age, low maternal income, and having more than one child. When we adjusted for the content of care, the influence of these factors on the use of prenatal care attenuated to varying degrees: in some cases there was up to 20% reduction in the values of the risk estimates, while in other cases the statistical significance of the estimates were lost. It is important to take into account the content of prenatal care when assessing the factors predicting women's use of prenatal care. [ABSTRACT FROM AUTHOR]

This study analysed the relative contributions of three possible determinants to the high sex ratio among newborns in rural China – under-reporting of female births, abortions of female fetuses and excess early female neonatal mortality. A cohort of 3,697 pregnancies collected at village level in 20 rural townships from a county in Anhui province in 1999 was followed from pregnancy registration to seven days after birth. The cohort was later completed with 267 retroactively registered pregnancies. In the original cohort, the sex ratio at birth was 152 males to 100 females and in the supplemented cohort 159 males to 100 females, being similar to the sex ratios in the census data of the same townships. The risk of death for girls was almost three times that for boys during the first 24 hours of life. A comparison of the estimated number of missing girls by parity and pregnancy approval status to the recorded abortions and stillbirths suggests that selective abortions of female fetuses contributed most to the extremely high sex ratio among newborns. The under-reporting of female live births and neglect or poorer care of female newborn infants seemed to play a secondary role. New technology has helped the one-child policy to become, in practice, an "at-least-one-son" practice. Cette étude a analysé la contribution de trois facteurs pouvant expliquer le rapport de masculinité élevé chez les nouveau-nés en Chine rurale : sous-déclaration des naissances de filles, avortement des fétus féminins et mortalité néonatale féminine précoce excessive. Une cohorte de 3697 grossesses dans 20 agglomérations rurales d'un comté de la province d'Anhui en 1999 a été suivie depuis l'enregistrement de la grossesse jusqu'à sept jours après la naissance. La cohorte a été complétée par 267 grossesses enregistrées rétroactivement. Dans la cohorte originale, le rapport de masculinité à la naissance était de 152 garçons pour 100 filles et de 159 garçons pour 100 filles dans la cohorte complétée, semblable aux données du recensement pour les mêmes agglomérations. Pendant les 24 premières heures de vie, le risque de décès des filles est près de trois fois supérieur à celui des garçons. Une comparaison du déficit de filles par parité et statut d'approbation de la grossesse avec le nombre d'avortements enregistrés et d'enfants mort-nés suggère que l'avortement sélectif des fétus féminins a contribué à l'essentiel de la masculinité extrêmement élevée. La sous-déclaration des naissances vivantes de filles et le manque ou l'absence de soins aux nouveau-nés féminins semblent jouer un rôle secondaire. Les nouvelles technologies ont permis à la politique de l'enfant unique de devenir, dans la pratique, une politique « d'au moins un fils ». Este estudio analizó las contribuciones de tres determinantes a la alta tasa de proporción de sexos entre los recién nacidos en las zonas rurales de China: el de nacimientos de niñas, el aborto de fetos femeninos y el exceso de mortalidad neonatal de niñas. En 1999, se dio seguimiento a 3,697 embarazos en 20 municipalidades rurales en la provincia de Anhui, desde el registro del embarazo hasta siete días después del nacimiento. Se añadieron 267 embarazos registrados de manera retroactiva. En el grupo original, la proporción de sexos entre recién nacidos fue de 152 niños por cada 100 niñas y en el grupo complementado de 159 niños por cada 100 niñas, similar a las proporciones de sexos en los datos del censo de las mismas municipalidades. Durante las primeras 24 horas de vida, el riesgo de muerte de las niñas fue casi tres veces mayor que el de los niños. Al comparar el número aproximado de niñas que faltaban por paridad y aprobación del embarazo con los abortos y mortinatos registrados, se observó que el aborto selectivo de fetos femeninos fue el mayor contribuyente a la altísima proporción de sexos entre los recién nacidos. Aparentemente, el subreportaje de las niñas nacidas vivas y el descuido o cuidado inferior de las niñas recién nacidas desempeñó una función secundaria. Debido a la nueva tecnología, la política de un solo hijo ha pasado a ser práctica de "un hijo mínimo". [ABSTRACT FROM AUTHOR]

Abstract Objectives: To explore the use of local civil registration data to assess the perinatal mortality in a typical rural county in a less developed province in China, 1999-2000. Design: Retrospective cohort study. Pregnancies in a cohort of women followed from registration of pregnancy to outcome of infant seven days after birth. Setting: Routine family planning records in 20 rural townships in eastern China. Subjects: 3697 pregnancies registered by the local family planning system during 1999. Main outcome measures: Abortions, stillbirths, early neonatal mortality, perinatal mortality. Results: Only three cases were lost to follow up. The average age of the women at pregnancy was 25.9 years. Three hundred and twelve pregnancies were aborted and 240 ended in miscarriage (total 552, 15%). The perinatal mortality rate was 69 per 1000 births, the rate of stillbirth was 24 per 1000 births, and the early neonatal mortality was 46 per 1000 live births. The early neonatal mortality was 29 in boys and 69 in girls per 1000 live births. The perinatal mortality rate increased notably with parity and was higher in townships having lower income per capita. Conclusions: The family planning system at the most local level is a useful data source for studying perinatal mortality in rural China. The perinatal mortality rate in the study county was higher than previously reported for both rural and urban areas in China. The results by parity and sex of the infant raise concern over the impact of the one child policy. [ABSTRACT FROM AUTHOR]

• Use secondary decomposition-model selection method. • Use non-agnostic uncertainty sampling-active learning-sample selection strategy. • An advanced multi-objective optimization is used. • Offer both deterministic forecasting and probabilistic forecasting information. • Multi-step forecasting is considered. Wind power forecasting plays a significant role to ensure the safe operation of power systems. However, due to the stochastic nature and dynamic uncertainty of wind power, accurate and stable forecasting faces challenges. In this study, a modified combined structure with secondary decomposition-model selection and non-agnostic uncertainty sampling-active learning-sample selection strategy is proposed for multi-step deterministic and probabilistic wind power forecasting. Secondary decomposition-model selection strategy is used before experiments, selecting better forecasting models from the initial model space to the selected model space, and secondary decomposition methods are applied for decreasing the interference in initial data. Non-agnostic uncertainty sampling-active learning-sample selection strategy is employed to accelerate the sample selection process and enhance the testing efficiency, indirectly promoting the final performance. To further promote the forecasting precision and stability simultaneously, an advanced multi-objective optimization is applied, automatically selecting the top best models into the combined models from the selected model space. Except deterministic forecasting, uncertainty estimation is vital, offering different aspects of forecasting information for risk management, as the grid system absorbs large-scale wind power generation, therefore, probabilistic forecasting is considered too. Multi-step forecasting is also considered. Eight datasets from Elia, Belgium, are applied to assess the forecasting performance of secondary decomposition-model selection and the proposed combined models. According to results, compared with comparison models, the proposed combined models obtain higher accuracy and stability of multi-step deterministic forecasting (improving the forecasting skill by more than 90% in accuracy and stability for 1-step to 3-step forecasting) and also offer multi-step probabilistic information. [ABSTRACT FROM AUTHOR]

The ability of a system to tolerate disruptions and mitigate against malicious attacks is crucial in many applications, especially when a failure of the system can have huge economic and social consequences. The concept of system resilience has drawn increasing research and practical interest, and in this article, we propose a framework to define system resilience based on modelling of fortification strategies in the context of network interdiction problems. Specifically, we consider fortification strategies that address disruptions in two ways: immunization, where a certain disruption is not permitted to take place, and mitigation, where the disruption occurs, but is unable to impair significantly the system performance. We then propose the resilience optimization problem (RES-OPT) to maximize the capability of a system in fortifying against disruptions through immunization and mitigation strategies. The flexibility of this approach lies in that instead of assuming a fixed set of disruption scenarios, we fortify the system against as powerful an attacker as possible. In addition, we propose a cutting plane methodology to effectively solve the resulting optimization problem, and apply it to a network flow with transmission-links fortification and an electricity transmission network problem in Southern China. The results show that RES-OPT yields good quality solutions in terms of both resilience and average costs, compared to other benchmark approaches. [ABSTRACT FROM AUTHOR]

Background China is experiencing increasing pressure from issues relating to an ageing population. The rationality of different eligibility criteria of the benefits within the social security system has been widely challenged; however, to date, no previous study has explored its association with the availability and affordability of long-term care (LTC). Aim This study evaluates the availability and affordability of Long-Term Care (LTC) services for disabled older people (aged 65 and above) in China, with special attention to the differences among groups in receipt of specific social security benefits. Methods The data of availability and affordability of LTC services for disabled older people is from a nationally representative sample Chinese Longitudinal Healthy Longevity Survey (CLHLS). Three different social security benefits were identified and their effects on the long-term care services for disabled older people were explored. Results The overall proportions of disabled older people who have only limited or no available or affordable LTC services were remarkably high, especially for those who have moderate or no social security benefits. Compared to those who are entitled to generous social security benefits, older people who have no social security benefits are 18.45 times more likely to be unable to afford health care expenses. Conclusion The findings imply that policy makers in China could focus on the LTC needs for the social security and socioeconomically disadvantaged (who have limited or no social security benefits and in low household income) disabled older people which could reduce the gap between them and those who are entitled to generous social security benefits. [ABSTRACT FROM AUTHOR]

Objectives: To describe the pattern and determinants of working during pregnancy in rural China. Methods: A cross-sectional survey was carried out in 2009 in three provinces (Anhui, Chongqing and Shaanxi) in rural China among 3966 mothers who had recently given birth. Multilevel logistic regression was used to examine the determinants of work behaviour during pregnancy. Results: Overall, 39% of the women stopped working during early pregnancy, 32% worked the same throughout pregnancy and the rest decreased their work or stopped later in pregnancy. Women from Anhui (53%) and Chongqing (54%) provinces were more likely to stop work in early pregnancy than women from Shaanxi province (20%). Older women [odds ratio (OR) 0.74, 95% confidence interval (CI) 0.56–0.99], those having two or more children (OR 0.55, 95% CI 0.43–0.69) and non-farmers (OR 0.50, 95% CI 0.65–0.99) were less likely to stop working on the first trimester, but those with higher education (high school OR 1.43, 95% CI 1.05–1.94) were more likely to stop working. Stopping work early was not related to household income and adequacy of prenatal care. Women with two or more children, non-farmers and those from Shaanxi province were more likely to continue to work to the same extent during pregnancy. But those with higher household income and middle and high school were less likely to work the same. Conclusions: Women’s working patterns during pregnancy in rural China were polarized: many women stopped working already in early pregnancy, but others continued to work as before. The key determinant of the working patterns was the province of residence. [ABSTRACT FROM PUBLISHER]

Aim: The aim of this study was to examine the effects of home and educational environments on children's motor performance in China.Method: We conducted a cross-sectional study of 4001 preschool children selected from 160 classes. The children's motor performance was assessed using the Movement Assessment Battery for Children, 2nd edition (MABC-2). Home and educational environments were evaluated using validated checklists. The effects of home and educational environments on motor performance were analysed using mixed and multilevel logistic regression models.Results: The results showed that one score increase in the outside space of the family home was positively associated with the increase in total test score (0.104) subtest score of aiming and catching (0.037), and balance (0.034) of the MABC-2, after adjusting for potential confounders (each p<0.05). Possession of motor toys at home and parental rearing behaviours were also related to total test score, manual dexterity, and balance (β=0.022-0.104, each p<0.05). Space and furnishings, activity, and interaction in the classroom had a significant positive association with total test score (β=0.069-0.201), and with subtest scores of manual dexterity, aiming and catching, and balance respectively (β=0.115-0.206). Space and furnishings of classrooms and possession of toys in the household were protective factors for 'at risk' or significant poor performance (odds ratio 0.942-0.973, each p<0.05).Interpretation: A permissive and accepting family and educational environment made a positive contribution to children's motor performance. Access to sufficient space and furnishings within the classroom, as well as toys in the family, were protective factors for poor motor performance. Future assistance is needed to support an advantageous environment in early childhood programmes in China. [ABSTRACT FROM AUTHOR]

Background: In low- and middle-income countries, many women continue working later into pregnancy. In our recent study on some areas in rural China, most women stopped working already during the first trimester (≤3 months) of pregnancy. In this paper we aimed to explore whether stopping work during early pregnancy has changed over an 8 year period (between 2001-03 and 2009); we also studied whether the reasons for stopping work early were the same in the two time periods.Methods: A population-based cross-sectional survey with a representative sample of new mothers was carried out in one rural county in Anhui Province in 2001-03 (N = 1479 respondents) and in two other rural counties in 2009 (N = 1574 respondents). Both surveys were used to evaluate prenatal care interventions not related to work behavior. The surveys targeted all women who had recently given birth. Multilevel logistic regression analysis was used to examine the determinants of work behavior in the two time periods.Results: There was a big change in the working behavior between the two survey years: in the period 2001-03 6 % and in 2009, 53 % of pregnant women stopped working at ≤3 months (percentage change 839, 95 % CI -15.90 to 1694.49). In 2001-03, 30 % and in 2009, 23 % of pregnant women worked the same as before pregnancy (percentage change -22.30, 95 % CI -90.28 to 45.68). In both time periods women with two children were less likely to stop work at ≤3 months of pregnancy. Non-farmers were more likely in 2001-03 but less likely in 2009 to stop work at ≤3 months of pregnancy. Women with medium township-level income were more likely to maintain the same level of work as before pregnancy in 2001-03, while in 2009 women with high township-level income were less likely to work the same.Conclusion: Stopping work very early during pregnancy appeared to have become very common from 2001-3 to 2009 in rural Anhui, China and was not explained by women's background characteristics. [ABSTRACT FROM AUTHOR]

We conducted a population-based study on Developmental Coordination Disorder (DCD) in mainland China to explore the influence of one-child status in Chinese families on DCD. A total of 4001 children selected from 160 classes in 15 public nursery schools. The Movement Assessment Battery for Children assessed motor function. The prevalence of DCD in Chinese one-child families (8.7%) was higher than that in multi-child families (5.9%). Chinese one-child family status (compared with younger children in multi-child families) were negatively related with total score (−1.793), Manual dexterity (−0.228), Aiming and catching (−1.145), Balance (−0.433) of MABC-2 and DCD (OR = 2.294) when adjusted for the children's and family's characteristics, and perinatal factors (each p < 0.05). As one of the studies in this Chinese context, it provides a platform for future intervention programs in one-child families in preventing children's developmental disorders. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Abstract: The aim of this paper was to examine the validity and reliability of age band 1 of the Movement Assessment Battery for Children-Second Edition (MABC-2) in preparation for its standardization in mainland China. Interrater and test–retest reliability of the MABC-2 was estimated using Intraclass Correlation Coefficient (ICC). Cronbach''s alpha for each item and Item-total correlation were used to determine internal consistency. The content validity was determined by the Item-level content validity index (I-CVI). Confirmatory factor analysis was used to examine the factorial validity of the MABC-2 test. The correlation coefficients between the MABC-2 and the Peabody Developmental Motor Scales-2 (PDMS-2) were used to assess the criteria-related validity. The Cronbach''s alpha values of all eight items together were moderate but acceptable. The correlation coefficients between each test item and the total score were moderate except for two items. The ICC of interrater and test–retest reliability for each test items was good. The I-CVI of each item was excellent (each above 0.78). The result of confirmatory factor analysis showed that the goodness-of-fit indices of the adjusted model were good (each above 0.9), indicating a satisfactory fit of the data to the model. The total score on MABC-2 and PDMS-2 was correlated well (r =0.631). It is concluded that the reliability and validity of age band 1 of MABC-2 were fair in this study based on a large sample. However, there was a need to adjust part of items to improve the test''s psychometric properties when it is used in Chinese children. [Copyright &y& Elsevier]

Background: The conceptualization and measurement of socio-economic status (SES) is difficult in developing settings. In the absence of SES indices for women in rural China, we constructed SES indices for prenatal care research, and examined their relation to perinatal care and outcomes. Methods: This study utilized data of 4364 rural women having recently given birth, collected by a cross-sectional survey in three rural Chinese provinces in 2007. Principal component analysis (PCA) was used to construct the SES indices and multilevel logistic regression was use to relate the indices to low birthweight, short exclusive breastfeeding (≤4 months), childbirth at the county or higher level health facility, caesarean section, inadequate prenatal care and no postnatal care. Results: Three separate SES indices (wealth, occupational and educational indices) were obtained from the PCA analysis, capturing maternal, paternal and household SES characteristics. After adjusting for individual level factors, village and township wealth, higher levels of the indices were inversely associated with inadequate prenatal care. Higher occupational status was positively associated with short exclusive breastfeeding and childbirth at the county or higher level health facility, but inversely associated with no postnatal care. Higher educational status was positively associated with no postnatal care. Conclusion: Three SES indices (wealth, occupational and educational) were obtained from this study for prenatal care research. The indices gave mostly varying results on their associations with perinatal care and outcomes, indicating that SES measures may be outcome-specific. [ABSTRACT FROM AUTHOR]

Objectives To describe the use of maternity care in rural China by the legal status of the pregnancy. Methods Cross-sectional survey wherein information was obtained about 2576 women who gave birth in 2006. Logistic regression was used to compare women having an unauthorised pregnancy with those having an authorised second birth, adjusting for confounding factors. Results Almost all respondents had antenatal care and most deliveries occurred in hospitals. Women with unauthorised pregnancies were significantly less likely to have had maternity care, particularly prenatal care, postnatal care, to have been hospitalised during pregnancy, and to have been reimbursed for hospital delivery costs than women with an authorised second birth. They were also more likely to have been hospitalised for seven or more days after delivery. Primiparous women used maternity care services and received financial support more often than women with an authorised second birth. Among the women with an unauthorised pregnancy an important reason for not using hospital care during pregnancy or delivery was financial constraint. Conclusions Women with unauthorised pregnancies use less maternity care, although pregnancy in such circumstances may adversely impact their health. Primiparous women benefit from more financial support than multiparous women. [ABSTRACT FROM AUTHOR]

Objective To investigate changes in the expenditure of giving birth in health-care facilities in rural China during 1998-2007, to examine the financial burden on households, particularly poor ones, and to identify factors associated with out-of-pocket expenditure. Methods Cross-sectional data on births between 1998 and 2007 were obtained from national household surveys conducted in 2003 and 2008. Descriptive statistics and log-linear models were used to identify factors associated with out-of-pocket expenditure on delivery. Findings During 1998-2007, the proportion of facility-based deliveries increased from 55% to 90%. In 2007,60% of births occurred at county-level or higher-level facilities. The Caesarean delivery rate increased from 6% to 26%. Total expenditure on a facility-based delivery increased by 152%, with a marked rise from 2002 onwards with the introduction of the New Cooperative Medical Scheme. In 2007, out-of-pocket expenditure on a facility-based delivery equalled 13% of the mean annual household income for low-income households. This proportion had decreased from 18% in 2002 and differences between income groups had narrowed. Regression models showed that Caesarean delivery and delivery at a higher-level facility were associated with higher expenditure in 2007. The New Cooperative Medical Scheme was associated with lower out-of-pocket expenditure on Caesarean delivery but not on vaginal delivery. Conclusion Expenditure on facility-based delivery greatly increased in rural China over 1998-2007 because of greater use of higher- level facilities, more Caesarean deliveries and the introduction of the New Cooperative Medical Scheme. The financial burden on the rural poor remained high. [ABSTRACT FROM AUTHOR]

Background: The Midwife-led maternity services have been implemented in China in response to the high rates of primiparous women and Caesarean Sections (CS) which may be related to China's one-child policy. However, few studies in China have been reported on the effectiveness of Midwife-led Care at Delivery (MCD) and the Continuity of Midwife-led Care (CMC) on postpartum wellbeing and other clinical outcomes. Therefore, evidence-based clinical validation is needed to develop an optimal maternity service for childbearing women in China.Methods: A concurrent cohort study design was conducted with 1730 pregnant women recruited from 9 hospitals in Shanghai. Among the 1730 participants at baseline, 1568 participants completed the follow-up questionnaire, with a follow-up rate of 90.6%.Results: Compared with the routine Obstetrician-led Maternity Care (OMC), Midwife-led Care at Delivery (MCD) was associated with CS rate (OR were 0.16; 95%CI: 0.11 to 0.25) and a higher total score of postpartum wellbeing (βwere 2.70; 95%CI: 0.70 to 4.70) when adjusting for the baseline differences and other confounders during delivery or postpartum period. Moreover, continuity of Midwife-led Care (CMC) was associated with CS rate (OR were 0.30; 95%CI: 0.23 to 0.41), as well as increased rate of breastfeeding within the first 24 h (OR were 2.49; 95% CI: 1.47 to 4.23), higher postpartum satisfaction (β = 4.52; 95% CI: 1.60 to 12.68), lower anxiety (βwere 0.66; 95% CI: 0.16 to 1.17), increased self-control (βwere 0.39; 95% CI: 0.02 to 0.76) and a higher total score of postpartum wellbeing (βwere 3.14; 95% CI: 1.54 to 4.75).Conclusion: CMC is the optimal service for low-risk primiparous women under China's one-child policy, and is worthwhile for a general implementation across China. [ABSTRACT FROM AUTHOR]

Background: Studies on prenatal care in China have focused on the timing and frequency of prenatal care and relatively little information can be found on how maternal care has been organized and funded or on the actual content of the visits, especially in the less developed rural areas. This study explored maternal care in a rural county from Anhui province in terms of care organization, provision and utilization.Methods: A total of 699 mothers of infants under one year of age were interviewed with structured questionnaires; the county health bureau officials and managers of township hospitals (n = 10) and county level hospitals (n = 2) were interviewed; the process of the maternal care services was observed by the researchers. In addition, statistics from the local government were used.Results: The county level hospitals were well staffed and equipped and served as a referral centre for women with a high-risk pregnancy. Township hospitals had, on average, 1.7 midwives serving an average population of 15,000 people. Only 10-20% of the current costs in county level hospitals and township hospitals were funded by the local government, and women paid for delivery care. There was no systematic organized prenatal care and referrals were not mandatory. About half of the women had their first prenatal visit before the 13th gestational week, 36% had fewer than 5 prenatal visits, and about 9% had no prenatal visits. A major reason for not having prenatal care visits was that women considered it unnecessary. Most women (87%) gave birth in public health facilities, and the rest in a private clinic or at home. A total of 8% of births were delivered by caesarean section. Very few women had any postnatal visits. About half of the women received the recommended number of prenatal blood pressure and haemoglobin measurements.Conclusion: Delivery care was better provided than both prenatal and postnatal care in the study area. Reliance on user fees gave the hospitals an incentive to put more emphasis on revenue generating activities such as delivery care instead of prenatal and postnatal care. [ABSTRACT FROM AUTHOR]