Objective To describe the status of women's maternal health care use and its influencing factors in Western China. Methods 544 women have been investigated by questionnaire,44 health providers and 42 women have been interviewed to collect data. Results 70.6％ participated in local New Rural Cooperative Medical Scheme(NRCMS)in this area,only 32.9％ got reimbursement,and 66.0％ haven't got it because of family planning policy. The NRCMS was important for women in emergency or with severe complications. Reimbursement for migrants was too complicated. Most of the maternal health human resource was concentrated in County Hospital and Maternal and Child Health Care Hospital. One quarter of health personnel in township hospital had education under secondary school level. Among total maternal health income from 2005 to 2008, fund from government occupied only 5.0％. One fifth of the women’ s total maternal cost accounted for more than 20％ of their family income. 39. 8％ of the women chose county hospital and 58.6％ chose township health center for delivery,and service quality and transport were the main reasons. Geographic accessibility of some mountainous townships was hindered by transport problems. The social and cultural accessibility was impeded by Zuoyuezi’ phenomenon, boy priority and language island’. Conclusion NRCMS has increased maternal care use to some extent. Geographic accessibility has been improved except in remote area. Many social and cultural factors influenced maternal health care.%目的 了解西部农村地区某县妇女孕产期保健利用现状及影响因素.方法 对544名妇女进行问卷调查,对44名卫生服务管理者/供者以及42名妇女进行访谈.结果 70.6%的孕产妇参加了新型农村合作医疗(新农合),32.9%获得报销,未获报销的66.0%是因为超生.新农合缓解了具有产科危重症或并发症的孕产妇的经济负担.流动人口的报销手续复杂.卫生人力资源主要分布在县医院和妇幼保健院,在乡镇卫生院,中专以下学历占1/4.2005年至2008年的保健总收入中,政府拨款仅占妇幼保健总收入的5.0%.近1/5妇女的孕产期保健总费用超过家庭年收入的20%.选择县级医院、乡镇卫生院分娩的分别占39.8%和58.6%,服务质量和交通方便是选择的主要原因.偏远山区交通不便影响地理可及性."坐月子"、重男轻女、为挑时辰而择时剖宫产、"方音岛"现象阻碍了孕产妇保健利用.结论 新农合政策在一定程度上提高了该地区的孕产期保健的服务利用度,偏远乡镇的地理可及性亟须提高.目前尚有多种社会文化因素制约孕产妇保健利用.
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