Demand For And Service Of Reproductive Health Among Rural-to-Urban Female Migrants

ObjectiveReproductive health, a relatively new concept formed and developed with society, economy and culture progressing and feminism thriving in 80s of twenty century, has become indispensable component of integration of overall health, the contents of which involves all matters relating to the reproductive process, its function and system. Under the regime of dualistic structure between rural and urban in China, rural-to-urban migrants are one of the most active populations in terms of mobility from their inhabitancy places in new millennium. And accordingly, the variety of their demands for reproductive health has made up of substantial part of sustainable development of population, employment, living and family planning in modern cities. This study, therefore, aimed to analyze their knowledge, attitude and practice of reproductive health in rural-to-urban migrants, as well as their demands and service utilization for reproductive health on the basis of baseline survey. It also explored the main factors that influenced reproductive health service for rural-to-urban migrants, and provided evidences for policies making by government departments in accordance with the conclusions and suggestions from this study to reform accessibility and equity to reproductive health service for rural-to-urban migrants.MethodsThe theoretical bases in this study came from classical theories of both behavioral science and health education. With the research guideline of "theory -evidence- policy making" and proposition of the current status and demand service of reproductive health among rural-to-urban migrants in China, this study conducted quantitative and qualitative baseline survey in Wuhan, Guangzhou and Chongqing city, the subjects of which included rural-to-urban migrants aged from 16-19 who migrated to above -mentioned three cities as temporary worker from around country, the heads and professional staff in floating population administration offices and reproductive health service institutions.Quantitative data were collected with the questionnaire of "reproductive health demands and services among rural-to-urban migrants from poverty-stricken areas", the contents of which included knowledge, attitude, behavior, service utilization and accessibility about reproductive health among migrants; for qualitative survey, the interview, focus-group discussion, selected topic panel discussion typical case study and related policy documents were conducted.In the process and analysis of the data, quantitative data were established into databases by using Foxpro6.0, and were statistically processed and analyzed with statistical software such as Microsoft Excel 2003, SPSS12.0 and LISER8.70. Comprehensive analysis methods were employed, including descriptive statistics, ANOVA, Logistic regression, sorting and ranging analysis, correspondence analysis and PEST, etc.ResultsRural-to-urban female migrants from poverty-stricken areas were characterized with the following particular social demography: young age structure, the most of age ranged 20-40; cultural poverty, 68.9%of female migrants and 82.2% married female migrants had senior high school and below education; their employment fields were mainly in business, restaurants, factories, and social services with long work time and intensive labor; most of them inhabited in renting houses and dormitories with simple and crude conditions; low income and lack of social and medical assurance, a part of their income was transferred to their families in rural areas.Rural-to-urban female migrants from poverty-stricken areas were deficient of knowledge about menstruation, pregnancy, peripartum, contraception and birth control, etc. Especially in unmarried female migrants, the correct response rate to "the optimal conceiving time during menstrual period" was only 14.2%, 19.8% of them did not know any contraception methods, and 39.1% of them were not clear about the hazard of induced abortion. Generally, the female migrants just heard about the sexual transmitted diseases and acquired immune deficiency syndrome (AIDS) with lack of scientific cognition. The correct understanding to the above-mentioned knowledge in female migrants rose with their education background.The traditional "Notion of Chastity" of Rural-to-urban female migrants was changing: 50.0% female migrants owned approved or neutral attitude to pre-marriage sex intercourse; 72.4% Of unmarried female thought that it was necessary to take measures for contraception; 90.6% married female migrants supported the methods of contraception taken by them; 41.0% of married female and 69.3% of unmarried female could not judge which one was more cheap between "buying contraception drugs in long run" and "induced abortion after pregnancy"; 81.4% of married female migrants thought that contraception consulting services should be supplied to unmarried females, which the more self-determination they had, the more they approved that. Meanwhile, unmarried females showed obvious attitude to the demand for contraception consulting services; 48.1% of married females were satisfactory with their sex life, which the degree of satisfaction of sex life was correlated with the degree of concern from their partners; the rights of self-determination on sex life in female migrants enhanced with their education background; above 80 percent female migrants fear of and rejection to AIDS and its infectors, which the education level of married females increased at one grade, the proportion of them with discrimination on attitude to infectors with AIDS fell down by 0.323 times; the proportion of married females migrants who thought it was necessary for physical pre-marriage examination increased with their education; the female migrants preferred to go to public general hospital in response to the question of "the medical institutions chosen providing that you were infected with STDS.Although the prevalence in two weeks of married female migrants was not high, the rate of their visiting doctors was rather low, which one third of females with gynecological disease had never gone to hospital for check-up; the main measures of contraception taken by married females were intrauterine contraceptive device (52.5%) and tubal ligation (21.8%). At the same time, one third of married females took contraception measures in accordance of the acquirement of family planning cadres, which their choice for safe and scientific conception measures increased with their education. In survey of this study, 20% unmarried female migrants reported that they had sex intercourses, which they used condom and safe period for contraception; the rate of induced abortion in married females was 36.1%, unmarried females 3.4%, which they chose primarily township hospitals and district-level hospitals for induced abortion; only 50.8% of married females took physical pre-marriage examinations, which the tendency that their education influenced those went up; the average pregnancy, delivery and the number of children of married females presented decreasing tendency with their education increasing; 23.8% of married females conceived in the location of their work, half of which chose to go home for delivery. 30 percent married females did not have do antepartum check-up after pregnancy; three fourth of female migrants did not know that there were institutions providing contraception drugs and health education free of charge, and most of unmarried did not know that either; three fourth of female migrants reported that they had never gotten free contraception services and four fifth of those had never obtained free contraception drugs; only 9.0% of married females and 2.0% of unmarried females were satisfactory with the free services of contraception provided by the communities and departments, and 8.0% of married females and 1.4% of unmarried females were content with the services of free contraception drugs. But, 50% of married females and two third of unmarried females selected the answer of "not clear" in response to above-mentioned questions; the reproductive health knowledge that rural-to-urban migrants longed for and its' acquiring ways showed some cohesion with their social and economical indicators; the unmarried females presented extensive demands for the knowledge about reproductive health, and desired physical examination in reproductive health and free (reduced-price) contraception drugs.In summary, major reasons that influenced the supply and utilization of reproductive health services among rural-to-urban female migrants included the following: deficiency of motivation and practice for them to use reproductive health services actively owing to the combination of intrinsic and extrinsic factors; difficulty in providing services because of their mobility and escaping from supervision, unsound policies and regulations, insufficient coordination among sections and imperfect information system of reproductive health; a paucity of manpower source in providing reproductive health care in urban at present, and insufficiency of compensation for cost of reproductive health care services, resulting in less encouragement for supplier to provide reproductive health services for rural-to-urban migrants.ConclusionsRural-to-urban migrants presented specific social and demographic characters: ages of the majority ranging from 20-40 for optimal reproduction and labor; poor education; frequent mobility and bad inhabiting environment; limited employment fields, intense labor and low income; lack of formal social support channels and their psychological feeling of "isolated from urban life". All these features caused intrinsic factors affecting the utilization of and demand for reproductive health services in female migrants.Rural-to-urban female migrants lacked of knowledge about reproductive health and had weak awareness of self-care, and their sexual moral concept had changed gradually in an open-up social environment, which resulted in an increase in pre-marriage sexual behaviors, infectious diseases of gential tract, unintentional pregnancy and induced abortion.Due to rural-to-urban migrants' deficiency of social and medical insurance, high cost in terms of economy and time when visiting doctors, and their poor health information, they utilized the basic health services seldom. For example, the rate of hospitalized delivery, prenatal health care, postnatal interview and health education were obviously lower in female migrants than that in local registered population.Under the social regime of dualistic structure between rural and urban in our country, the management of "being responsible only in local departments" is contrary to the mobile feature of rural-to-urban migrants, enlarging the difficulty in providing a fixed continual services for them.All in all, rural-to-urban migrants had disadvantage on supply and utilization of reproductive health services, resulting from complexity of factors such as government policies, administrative level, manipulation departments and themselves. Therefore, providing basic reproductive health services should be on the top list of agenda of both local government and medical administrative departments. Suggestions1. To change the system of individual identification gradually, from census register management to identity management system, in order to solve the problem of resources' shift with rural-to-urban migrants from system level, providing that the social regime of dualistic structure between rural and urban in our country did not changed substantially;2. To further deepen finance system renovation, so as to build up a sort of management system, which is dually financed by central and local governments. From long run, this will help to realize the basic demand for and services of reproductive health among rural-to-urban migrants;3. To set up a comprehensive management system among rural-to-urban migrants and reproductive health service network involved in communities;4. To perfect the related management regulation and policies, and strengthen its implementation and supervision, which will protect the legal right of rural-to-urban migrants;5. To establish the management notion and service pattern of "Human-centered, Service-cored", and intensify health education, complete its contents and enhance its efficiency, striving for the understanding and support from rural-to-urban migrants;6. To found and improve the system of reproductive health management and service information, so as to improve the service quality and efficiency, which will ultimately facilitate information communication on reproductive health services among provinces by the way of sharing the related information.