Annual UN Inter- Agency Support Group on
Indigenous Peoples Issues
22 November 2011
55 ethnic minorities - 105 million people (8.1% total pop)
Southwest China:
Yunnan 14.5 m. ethnic minority pop.
Guizhou 13.6 m. ethnic minority pop.
Constraints: less developed, poorer, geographical challenges
Higher MMR and IMR
among minorities: home
deliveries unattended by
skilled providers, poor
uptake of ANC & PNC, high
anemia in pregnant women
Cultural barriers – traditional
beliefs & practices
UNFPA supported base & end-line qualitative studies in 6
counties, among 6 ethnic groups: Miao, Dong, Jingpo, Dai,
Hui and Tibetans
Ethnic minority researchers used wherever possible
Data collected on:
• traditional & spiritual practices relating to maternal and
child health and health-seeking behaviour
• harmful practices (delivery-related, dietary restrictions,
feeding practice for infants and young children etc.)
• perceived barriers of minorities to uptake of MCH services
• community suggestions for increasing uptake of services
Manual developed on culturally sensitive service provision;
each training includes inputs from minority people in person
IEC materials in local languages developed; MCH messages
transmitted through ethnic cultural media
Local religious/spiritual leaders consulted & involved
Advocacy at local and national
levels: resulted in the National
Centre for Women and Children’s
Health recognizing value of
‘culturally sensitive’ programming &
adopting the tool for minority areas
Achievements: Improved access to and uptake
of MCH services in project counties
Data source: Baseline survey & endline survey; & China Health Statistical Abstract, 2011
10-15% total population (between 6.5 and 12 million people)
are IPs comprising 110 ethno-linguistic groups
National MMR is 162 per 100,000 live births
MMR among IPs (data is available in 3 IP Provinces:
Bukidnon (2009 FHSIS): 18 deaths/ 1,000 pop.; North
Cotabato 14 deaths/1,000 pop. ; Misamis Oriental 8 deaths/
1000 population
Challenges: securing availability of FP supplies & other life
saving RH commodities, geographical isolation, difficult
terrain, security
Participatory Community Needs Assessment
Strengthening of IP organizations for RH service delivery and
referrals for FP and EmONC cases
RH and gender education informed by needs assessment
findings, designed to use IP community health systems
Federation building of IP organizations as a sustainability
Network of community RH advocates established
Mechanisms in place for dialogue between health providers &
community leaders to ensure inclusive community health
Revitalization of the “Ayod” system (indigenous term for
hammock, also system for transporting sick people to
traditional healer or health clinic)
Emergency health fund from livelihood incomes established
for women with pregnancy-related complications
IEC developed in local languages, used for awareness raising
Increased male involvement (adoption of non scalpel
13.7% population ethnic minorities, located mainly in remote
mountainous and coastal regions
Socio-economic and health status of EMs low compared to
national average, especially in mountainous areas
National MMR is 69 per 100,000 live births (MOH, 2010)
MMR is over 200/100,000 live births in mountainous and
remote regions
Diff. terrain & cultural barriers affect access to services
Health services in general, and RH services in particular, are
under-utilized in ethnic minority regions
A 2009 national maternal mortality assessment identified major
causes of high maternal deaths:
 shortage of skilled birth attendants
 poor capacity of service providers in EM regions
 cultural barriers limited access to RH services (even when basic
EmOC services were available, they were under-utilized).
National Safe Motherhood Master Plan 2003-2010 was developed by
MoH supported by UNFPA (in collaboration with UNICEF and WHO).
Focusing on reduction of maternal mortality, the following approach
was adopted:
Improve skills and competencies of RH providers to deliver BEmOC and CEmOC
in mountainous and difficult-to-reach regions: network of ethnic minority midwives
established; their work is monitored by the MOH
Conduct culturally sensitive community-based activities using behavior change
approach to create demand for RH services
Develop and implement appropriate local human resource policies to ensure
availability of trained birth attendants in mountainous and difficult-to-reach villages
Why special training programmes?
Home deliveries are common, and unsafe
for women
Poor socio-economic status results in
high drop out rates amongst ethnic
minority girls
Few people from local communities
complete high school (minimum condition
for formal midwifery training courses)
Two training programmes developed for
ethnic minority with low education levels;
participants selected by communities
6 month training programme :
Focuses on normal deliveries, early detection of complications and
referral of complicated cases to higher levels.
So far, the programme has trained 783 ethnic minority midwives, most
of whom have returned home to serve their local communities
18 month training programme:
Initiated in 2007, this 18-month programme has been piloted in three
mountainous and coastal provinces.
Building on the 6-month programme, it focuses more on skills required
for management of complicated deliveries.
By the end of 2011, the first 78 ethnic minority women graduated and
returned to work at their community
Retention and recognition from
Supportive supervision and quality
assurance of services
Way forward:
Document cost effective evidence of
the interventions
Support development and
implementation of evidenced-based
policies on human resource policies
including ethnic minority midwives
Support the government to scale up
best practices of the interventions in
ethnic minority regions

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