Reducing urban-rural disparities in maternal and child mortality in China: a 33-year analysis and projection to 2030.

Background: Despite substantial progress in maternal and child health (MCH) in China, achieving equitable outcomes across urban and rural areas remains elusive. To this end, this study investigated long-term trends in urban-rural disparities in maternal and child mortality rates in China from 1991 to 2023 and projected future trajectories for the 2024-30 period. Methods: We obtained data on national, urban, and rural maternal mortality ratios (MMRs), under-five mortality rates (U5MRs), infant mortality rates (IMRs), and neonatal mortality rates (NMRs) for the 1991-2023 period from the National Bureau of Statistics of China. We analysed and predicted mortality rates during this period by utilising rate differences (RDs), rate ratios (RRs), average growth rates, and estimated annual percentage changes, along with the autoregressive integrated moving average model. Results: From 1991 to 2023, the national MMRs declined from 80 per 100 000 live births to 15.1 per 100 000 live births. Over the same period, U5MRs decreased from 61.0‰ to 6.2‰, IMRs declined from 50.2‰ to 4.5‰, and NMRs declined from 33.1‰ to 2.8‰. During this period, urban MMRs decreased from 46.3 per 100 000 live births to 12.5 per 100 000 live births. Correspondingly, urban U5MRs declined from 20.9‰ to 3.9‰, IMRs declined from 17.3‰ to 2.9‰, and NMRs declined from 12.5‰ to 1.7‰. In rural areas, MMRs declined from 100 per 100 000 live births to 17.0 per 100 000 live births, while U5MRs declined from 71.1‰ to 7.2‰, IMRs declined from 58.0‰ to 5.2‰, and NMRs declined from 37.9‰ to 3.2‰. The RDs and RRs of MMRs, U5MRs, IMRs, and NMRs exhibited overall downward trends, while the autoregressive integrated moving average model predicted continued declines in mortality rates across the country, including in urban and rural areas, from 2024 to 2030. Conclusions: China has achieved substantial progress in MCH, with mortality rates and disparities falling in both urban and rural areas, yet urban-rural disparities persist. Future MCH services should shift from broad coverage to precision quality improvement. These experiences also offer valuable insights for low- and middle-income countries (LMICs) undergoing rapid urbanisation, highlighting the importance of coordinated development of urban and rural health systems to achieve equitable and accessible health outcomes.