A Community-based Intervention Study Of Informed Choice On Contraceptives Among Married Women Of Reproductive Age

【BACKGROUND】 In recent years, informed choice on contraceptives has become a consensus in the field of family planning all over the world. The traditional policy framework centering on population size has been gradually supplanted by a new one aiming at reproductive health. With the stable low fertility level in China, it has become a significant issue for the transition of family planning program to implement and promote informed choice on contraceptives effectively. So far, research on informed choice has been restricted to exploring management mode of family planning program in China. There are no sufficient evidences for the impacts of informed choice on family planning program and the problems probably occurred during the implementation of informed choice and its countermeasures.【OBJECTIVES】This study aimed to evaluate the impacts of informed choice on contraceptive needs of women at reproductive age and current family planning program, to explore appropriate model of Information, Education and Communication (IEC) and service provision, and to establish the strategy for the promotion of informed choice. 【METHODS】A community-based intervention study was conducted in Deqing County, Zhejiang Province, Liuyang County, Hunan Province, and Linghai County, Liaoning Province. In each county, several villages were randomly assigned to either intervention group or control group. In the intervention group, informed choice on contraceptives was implemented, while routine family planning program was conducted in the control group. By conducting questionnaire survey among women of reproductive age and focus group discussions among FP managers, service providers and clients before and after project implementation, the study evaluated the impacts of informed choice on people's knowledge, attitude, belief and practice (KABP).The fieldwork intervention of informed choice was composed of IEC programand standardized family planning services. The subjects of IEC program included women at reproductive age, family planning managers and service providers. With national policy of population and family planning, knowledge of common contraceptives and information on informed choice as its main components, IEC program among women at reproductive age was implemented through disseminating reading materials, offering video and VCD, giving expert lectures, providing face-to-face counseling and conducting peer education. Intervention on FP managers was focused on connotation and significance of informed choice, and the establishment of proper projects according to local situtation. The IEC program among FP service providers was emphasized on the latest progress on theories and practices of informed choice, skills of interpersonal communication and counseling as well as the recent progress on contraceptive techniques. The standardized family planning service included principles, topics and steps in the counseling process, essentials of tailored services and requirements of follow-up. In each intervention community, counseling rooms and counseling hotlines were set up with full-time counselors. The intervention lasted 18 months.KABP Model was applied to exploring the correlation among knowledge, attitude, belief and practice. Univariate and multivariate statistical analyses, including chi-square test, t test, Mixed Linear Model, General Evaluation Equations and Logistic Regression Model were used to evaluate the impacts of intervention. 【RESULTS】1. General information All together, 2,973 subjects were enrolled in the baseline survey, among whom 1,478 were in the intervention group and 1,495 in the control one. 2,540 subjects were investigated in evaluation survey with 1,278 in the intervention group and 1,262 in the control group. The follow-up rate was 85.44%.. 2. The implementation of intervention project has improved the counseling service of family planning and thus enhanced clients' satisfaction level. The evaluation score of counseling service quality increased from 56.65 in baseline survey to...