IN China, where hospital delivery is the norm in most parts of the country, a growing number of Tibetan mothers-to-be are turning to natural birth centers where they can both access modern medical services while preserving their cultural traditions.

Private natural birth centers that emphasize cultural practices have proven appealing to Tibetan women who reside in poor rural areas and are reluctant to let go of home birthing traditions that can be risky without proper medical help, according to Drolkar Ja, an official in charge of health and family planning in Huangnan Prefecture of western China’s Qinghai Province.

In 2014, one year ahead of schedule, China met the Millennium Development Goal objective to reduce maternal mortality by 75 percent from 1990 levels. Now, the pressure to improve delivery care and reduce maternal mortality comes mostly from the country’s ethnically diverse western interior.

Official statistics show the maternal mortality rate in western China was 2.6 times higher than that in eastern areas in 2014. The national average maternal mortality rate was 21.7 per 100,000 last year, compared with a rate of 88.8 per 100,000 in 1990.

Lowering maternal mortality in poor, under-resourced rural regions to levels found elsewhere in China is a challenge, and some medical experts recommend incorporating cultural practices to improve care in less developed areas.

The Tongren Natural Birth Center, the first of its kind for Tibetans, was launched by local gynecologist Tsering Kyi and Lama Kunchok Gyaltsen in August 2009 in Qinghai Province. Drolkar Ja hopes it can provide a good model for others to follow.

Traditional touch

“The biggest obstacle to promoting hospital delivery in rural and pastoral areas often comes from a family’s mother-in-law, as it was normal for older generations to deliver three or four kids at home back in the 1960s and 1970s. Many mothers-in-law insist pregnant women are not medical patients and do not need to go to hospitals for delivery, especially when there could be medical expenses incurred,” says Drolkar Ja.

At the Tongren Natural Birth Center, however, it is not unusual to see a mother-in-law accompanying her expectant daughter-in-law during the childbirth process.

Dodan, an expectant mother from nearby Zeku County, gave birth at a local clinic in 2012. This time she traveled 80 kilometers with her mother-in-law and husband to the birth center.

“Many of my friends referred me to this place. My mother-in-law also prefers this place. It is a better choice as the doctors and nurses speak Tibetan and we can stay in home-like suites for a couple weeks. Cooking and showering are very convenient. Monks also chant scripture during the birth,” she says.

Rural women have been discouraged from hospital delivery for a number of reasons, including a lack of beds, extra expenses for family lodging and Tibetan cultural prohibitions against men’s involvement during pregnancy and childbirth, which leads to reluctance to be treated by male doctors.

“Many Tibetan women view pregnancy and childbirth as a normal process and see hospitals as places to treat illness and emergencies. Thus, going to a hospital to deliver a baby is seen as counter-intuitive,” says Kunchok Gyaltsen, honorary president of Arura Hospital in Qinghai, who holds a doctorate in public health from the University of California at Los Angeles.

Tibetan women who have delivered at the Tongren Natural Birth Center say they appreciated the large rooms with heated beds, the choice of traditional delivery positions and the presence of their families during the birthing process.

The mothers also praised the center’s adherence to cultural practices such as scripture chanting by Tibetan monks, placing amulets and Tibetan thangkas on the wall and giving newborns butter pills.

“As the birth center offers a home-like atmosphere that helps expectant mothers relax, it is much easier for them to give up home birth traditions that can be highly dangerous to both the mother and child if they fail to access proper medical help in time,” says Tsering Kyi.

In addition to the rural Tibetan women who make up the majority of its patients, the center has also received a few expectant mothers of Han and Hui ethnicities in Qinghai. In 2010, 53 percent of the province’s residents were Han, 24 percent were Tibetans, 15 percent were Hui and 8 percent came from other groups.

According to Drolkar Ja, the value of the birth center goes beyond offering a safe and culturally sensitive delivery. It also functions as a training workshop to help the local public health authority unleash the power of non-public resources in under-served regions.

“When the concept of the natural birth center was first proposed to us in 2006, we didn’t expect it to play such a big and positive role,” recalls Drolkar Ja.

“Our biggest concern at that time was that rural and pastoral women might not accept it since they don’t even want to go to hospitals. But considering there is only one hospital in Tongren, the medical resources are too limited. We thought it would be worth a try,” he says.

With a population of 89,000 scattered over 3,275 square kilometers, Tongren faced a difficult task in improving women’s health.

Self-sustaining

“The birth center remains a rare facility today as many people doubt it can survive. Our initial aim is to realize sustainable operations, attract more people to join the work and help more low-income families,” says Kunchok Gyaltsen.

With US$90,000 in donations from Kunchok Gyaltsen in start-up funds, Tsering Kyi, who is in charge of the center’s operations, says she is proud to see the center is self-sustaining.

“In the beginning we lacked money and publicity. There was a time when I felt I could not make it, but when I thought of Kunchok saving money by giving lectures on Tibetan medicine and selling Tibetan calligraphy for charity while studying in the United States, I told myself to hang on,” says Tsering Kyi.

To improve the center’s publicity and spread health information to rural areas, Kunchok Gyaltsen wrote a script called “Lost Happiness,” which was made into a TV series. Tsering Kyi played the role of a doctor to spread maternal and childcare knowledge through the program.

Kunchok also compiled a handbook of Tibetan-style drawings and pictures for illiterate Tibetan women to understand basic medical information.

In collaboration with local health authorities, more than 300 workshops have been held so far at the center to teach village and pastoral doctors and midwives as well as cadres belonging to grassroots women’s federations how to handle emergencies during childbirth.

Another significant push to their operation has been from the government, according to Tsering Kyi. Since Chinese authorities included natural childbirth expenses to the new rural medical scheme, rural and pastoral expectant mothers in Tongren will receive subsidies of 500 yuan (US$80.62) each for delivery in medical institutions.

“With this subsidy, almost all childbirth expenses here are covered. That inspires more rural women to choose delivery in institutions,” says Tsering Kyi.

Drolkar Ja thinks it is time to spread natural birth centers throughout the country as its operational model proves sustainable.

Kunchok Gyaltsen says the center could serve as a model for poor, rural, hard-to-reach and ethnic minority areas elsewhere in China, as well as Nepal, northern India, Southeast Asia, Bangladesh and other middle- and low-income countries to achieve high-quality care.