Ethnic differences in maternal health care preferences in rural Yunnan, China: a discrete choice experiment

This study aimed to quantify ethnic differences in preferences for maternal health services in rural Yunnan province and provide insights for patient-centered service delivery. A total of 248 women who experienced childbirth between 2017 and 2021 were selected using stratified cluster sampling from 12 villages across three impoverished counties in three prefectures. A Discrete Choice Experiment was conducted, presenting hypothetical scenarios described by several attributes and levels to elicit preferences for maternal health services, including prenatal examination, hospital-based childbirth, and postnatal visits. Conditional Logit regression models were employed to evaluate the relative importance of attributes within the choice sets. Subgroup analyses were performed among the Han majority, Zhiguo ethnic groups, and other ethnic minority populations. All participants received prenatal examination and opted for hospital-based childbirth. Approximately 62% of them utilized county-level hospitals, leading to relatively higher medical expenditures. However, only 86% of women received postnatal visits, with the majority accessing these services at hospitals. Compared to others, the Zhiguo ethnic group faced longer travel times to reach hospitals and demonstrated lower awareness of national basic public health services. Overall, women preferred services provided by female doctors at hospitals of county level or above, located within a 30-minute drive. Specifically, the Zhiguo ethnic group preferred free prenatal examination at prefecture/municipal level-hospitals (OR: 5.266, 95% CI: 1.473–18.832), but favored hospital-based maternity waiting room services before childbirth (OR: 2.917, 95% CI: 1.066–7.983). Other ethnic minorities preferred less expensive hospital-based childbirth (OR: 0.999, 95% CI: 0.998–0.999), but accepted hospital-based postnatal visits despite higher costs (OR: 1.902, 95% CI: 1.395–2.592). Diverse preferences may contribute to disparities in maternal health service utilization. If primary-level maternal health services fail to meet women’s needs, they may seek care at higher-level facilities, potentially resulting in inadequate or delayed treatment. Consequently, for specific groups such as the Zhiguo ethnic minority groups, enhancing the quality and cultural appropriateness of primary healthcare is a prerequisite for achieving equitable, patient-centered maternal healthcare. In light of these findings, future public health policies must strategically adjust resource allocation.