Newborn deaths fell sharply in China between 1996 and 2008, researchers have found.

Nearly all babies in China are now born in hospital, except in the country's poorest regions. (Aly Song/Reuters) Since 2000, China has encouraged hospital deliveries. Nearly all babies are now born in hospital, except in the country's poorest regions.

Researchers surveyed 1.5 million births over 12 years.

They found deaths in the first month of life fell 62 per cent, according to the analysis published in Friday's online issue of the medical journal The Lancet.

"Where you give birth really matters," said one of the study's authors, Carine Ronsmans, a professor at the London School of Hygiene and Tropical Medicine.

There were 24.7 deaths of newborns in China per 1,000 live births in 1996 but by 2008 that figure had fallen to 9.3 per 1,000.

Unlike other countries that turned to trained community health workers such as midwives to assist home births, the Chinese government has improved hospitals instead, Ronsmans said.

Improving quality and access to obstetric care in hospitals has reduced maternal deaths. But until now, little was known about the impact on neonatal deaths.

Babies born in poorer rural areas remained almost four times more likely to die than those born in urban hospitals, which the study's authors suggested could be the result of a lack of resources and skilled personnel in rural areas. People in rural areas may have also sought care at facilities too late, they added.

"Other countries can learn from China's substantial progress in reducing neonatal mortality. The major effect of China's facility-based strategy on neonatal mortality is much greater than that reported for community-based interventions," the study's authors concluded.

"Improvements are still needed. As China approaches universal hospital delivery, the quality of care in hospitals is the prime concern. Hospital delivery does not save babies' lives unless high-quality neonatal care is available and accessible in the crucial first few days after delivery."

Other factors could also be helping to prevent deaths, said Maria Pawlowska, a healthcare analyst based in London, specializing in reproductive health. She was not involved in the study.

"Women who were able to give birth in urban hospitals might have come from more privileged socio-economic backgrounds and therefore could have had better nutrition during pregnancy — an important factor in neonatal mortality," Pawlowska said.

The rate and magnitude of the increase in the proportion of deliveries in hospitals during the study period varied substantially across China's five socioeconomic groups.

That variation does suggest that factors other than facility-based delivery could be involved, Dr. Diego Bassani and Dr. Daniel Roth of Toronto's Hospital for Sick Children said in a journal commentary.

Inaccurate estimates of the number of births or increases in the completeness of birth reporting over time might have skewed the analysis, the commentators said.

Despite those shortcomings, the Chinese data and experience could offer contributions to worldwide public health knowledge, they added.

The study was funded by UNICEF and the China Medical Board, a New York-based non-governmental organization.