中国1990 — 2013年妇幼卫生政策进程系统评价

目的 了解家庭针对孕产妇导致的高额费用以及劳动力丧失采取的应对策略，为中国农村地区发生重大负性事件家庭进行有针对性的扶贫和保障工作提供基础数据。 方法 采用前瞻性研究设计，从2009年6月 — 2015年1月对河北、河南和云南省农村地区共183个孕产妇死亡家庭在知情同意后进行了入户基线调查和1年后的随访调查，收集家庭的收入支出、通过何种措施筹集资金、以及家庭应对措施的相关数据。 结果 每个家庭平均需要支付孕产妇死亡造成的直接费用为27 597元。为弥补高额的直接经济损失，孕产妇死亡发生后短期内，家庭通过亲友接济和借款作为最常使用的应对措施，从不同渠道所筹资金的比例主要为借款53.82 %，医院赔偿23.20 %，亲友接济10.13 %。基线调查1年后家庭以选择减少生活支出和继续借款作为最主要的应对措施。为应对孕产妇死亡造成的严重劳动力损失，家庭通过加入新成员、将新生儿寄养在别人家或者请亲戚帮忙照顾替代原孕产妇的部分职能。 结论 农村家庭通过一系列措施来应对孕产妇死亡对家庭经济造成的负面影响，形成了一定的应对策略，但这些应对策略可对家庭未来的经济生活产生进一步的影响。

Household catastrophic health expenditure: a multicountry analysis

Objective To examine the status of and coping strategies for maternal death related major medical expense and productivity loss among households in rural areas of China and to provide evidences for poverty alleviation among the households experiencing catastrophic events. Methods We recruited 183 households experiencing maternal death between June 2009 and January 2015 in rural areas of Hebei, Henan, and Yunnan province using stratified cluster sampling; then we conducted base line survey (3 months within the incident of a maternal death) and follow up survey (one year after the maternal death) with household questionnaire interview to collect information on maternal death related expenditure and financial activities to cope economic difficulty of the households. Results For all the households surveyed, the median direct expenditure related to a maternal death per household was 27 597 RMB yuan and averagely 53.82%, 23.20% and 10.13% of the payment to the direct expenditure was covered by borrowing from relatives and friends, hospital compensation and financial support from relatives and friends, respectively. Accepting financial support and borrowing money from relatives and friends were the most frequently used measures to cope the immediate catastrophic financial burden during the short period after the incident of maternal death. Reducing living expense and borrowing money continuously were major ways to cope with the maternal death related financial difficulty one year after the incident of catastrophic event; while, admission of new family member, letting a motherless newborn to be fostered or cared by relatives or others were main ways to cope with maternal death related productivity loss among the households. Conclusion In rural China, families with maternal death adopt several measures to cope with financial burden and productivity loss caused by the incident but these initiatives may result in subsequent adverse impacts on livelihood of these families later on.