A Policy Study On The Maternal And Child Health Care Utilization Of Migrant

1. Research Background and ObjectivesWith the large economic development in China after reforming and opening, the number of migrant from rural areas to city is increasing year after year. The number of migrant woman and migrant child increase with the number of migrant. Meanwhile they also produce many maternal and child health care problem to migrating area. The government and society have paid more attention to the woman and child's survival, safeguard and development in migrant. China Women Development Program 2001-2010 and China Children Development Program 2001-2010 promulgated by the State Council put forward two objectives for migrant women and children' health, one objective is "same health care service both migrant and registered permanent resident", another is "enhancing and improving health care level for girl and migrant child". The policy makers also pay more attention to the following question: Whether or not can the above two objectives achieve? How to achieve the above two objectives? How many difference between registered permanent resident and migrant? Both National Working Committee on Children and Women Under the State Council and Ministry of Health supported the policy study on the maternal and child health care utilization of migrant in 2003. Through the system investigation on the current situation of maternal and child health care services utilization of migrant and registered permanent resident in four representative cities, to find out registered permanent resident's current situation of maternal and child health care services utilization and relative policy; to realize migrant's current situation of maternal and child health care services utilization, main problems and reasons; to analyze the gap of maternal and child health care services utilization between migrant and registered permanent resident; to seek the strategy on improving migrant's maternal and child health care services utilization and achieving the two objectives put forward by China Women Development Program 2001-2010 and China Children Development Program 2001-2010.2. Research MethodologiesRepresentative investigation was carried out in Beijing, Shanghai, Guangzhou and Hangzhou. The data-collecting content includes registered permanent resident's current situation of maternal and child health care services utilization and relative policy, services will on the maternal and child health care of migrant from migrant women, services will on the maternal and child health care of migrant from migrant governors and health care service providers et al.Data-collecting method includes literature review, group discussion, insider interview, intention survey, on-the-spot representative investigation, will survey and reasoning, second data picking-up and questionnaire survey.Quantitative and qualitative research methods such as aim-gap model, single factor analysis, multi-factors analysis are used. Database is built through EpiData 2.0 and Excel 2000. SPSS 11.5 and Excel software are used in analysis.3.Main Research Result3.1 Current Situation of Maternal and Child Health Care in Four Cities3.1.1 Basic Indices for Maternal and Child Health Care1) Infant mortality rate and maternal mortality rateInfant mortality rates of Beijing, Guangzhou, Hangzhou, and Shanghai in 2002 are 5.91‰, 6.5‰, 8.05‰, and 5.01‰ respectively, while maternal mortality rates of these four cities are 18.4/100,000,18.5/100,000,11.46/100,000,9.99/100,000.2) Ante-marital exam rateAnte-marital exam rates of Beijing, Guangzhou, Hangzhou, and Shanghai in 2002 are 99.29%, 97.72%, 98.38%, and 98.69% respectively.3) Maternal system management rateMaternal system management rates of Beijing, Guangzhou, Hangzhou, and Shanghai in 2002 are 90.09%, 89.39%, 83.66%, and 75.72% respectively.4) Delivery rate in hospitalDelivery rates in hospital of Beijing, Guangzhou, Hangzhou, and Shanghai in 2002 are 97.83%, 98.90%, 99.36%, and 99.90% respectively.5) General exam rate for gynaecological diseasesGeneral exam rates for gynaecological diseases of Beijing, Guangzhou, Hangzhou,and Shanghai in 2002 are 53.80%, 70.61%, 76.13%, and 78.44% respectively.6) Child system management rateFor the three out of four cities, child system management rates all exceed 95% except that rate of Guangzhou is 94.70%. System management rates of child under 3 years of age are 86.58% and 88.59%, while 93.70% and 97.84% in Hangzhou and Beijing respectively.7) Child immunizationChild immunization coverage rates of "BCG, OPV, DPT and MV" of the four cities are all high, with 98.40%, 99.00%, 99.40%, and 99.56% in Guangzhou, Shanghai, Beijing and Hangzhou (including HBV) in 2002.3.1.2 Comparison of Basic Indices for Maternal and Child Health Care of Four Cities in 2002 with Goals of China Women Development Program 2001-2010 and China Children Development Program 2001-2010Data of the four cities by the end of 2002 indicates that ante-marital exam rate, maternal mortality rate, infant mortality rate, child system management rate and child immunization coverage rate of these four cities all have reached 2005 goals of "Two Programs". Birth defect rates of Guangzhou and Beijing in 2002 have reached the goal, while the difference between those of Hangzhou and Shanghai and the goal is no more than l‰. Maternal system management rate of Hangzhou has reached the goal, while the difference between Beijing and the goal is 5.61% and over 10% for Shanghai and Guangzhou.3.2 Current Situation of Maternal and Child Health Care Services Utilization of Migrant3.2.1 Migrant women health care51.13% of the pregnant women had the maternal system management cards; the meanof the number of prenatal examination is 5.87Delivery rate in hospital is 82.44%31.05% of the women accepted the health care service after childbirth.3.2.2 Migrant children health care45.27% of migrant children set up child health system management card, 47.18% of them did not take part in any health examination in 1.5 years.95.21% of migrant children set up immunization card, but their immunization rates of HBV,BCG,OPV,DPT and MV were 89.12%, 87.84%, 84.20%,79.98% and 69.45%respectively, the immunization coverage rate of BCG,OPV,DPT and MV was 67.60%.3.3 Influence Factors of Health Care Services Utilization of Migrant Women and Children3.3.1 The education of migrant women, the education of their husband, the income of their family are the most important influencing factors on the health care services utilization of migrant women.3.3.2 Parent education degree, income level, maternal employment status and maternal age have significant influences on the utilization of system child health care services, parent education degree and income level have significant influences on the instauration of immunization card, maternal employment status and maternal age have significant influences on the immunization coverage rates.3.4 Willingness-to-service on the Maternal and Child Health Care of Migrant from Migrant WomenMigrant's maternal and child health care service utilization are lower level, main influence factors are income level, health concept, health service information and violation of family planning regulation.3.5 Willingness-to-service on the Maternal and Child Health Care of Migrant from Migrant Governors and Health Care Service ProvidersIt is necessary to strengthen migrant's maternal and child health care service management, main obstacles are the unclarity of the number of the migrant, a shortage of health resource and special health financial support for migrants. To improve the migrant's maternal and child health care service utilization, three measures such as constructing compositive migrant's management mechanism, changing the health expenditure allotting mode and enhancing the access to the migrant's maternal and child health care service should be introduced.4. Main Problems and Suggestions4.1 Main Problems in Migrant's Maternal and Child Health Care4.1.1 The migrants had got lower maternal and child health care services including prenatal examination, delivery rate in hospital, immunization coverage rate, et al.4.1.2 95.21% of migrant children set up immunization card, but their immunization rates of HBV, BCG, OPV, DPT and MV were 89.12%, 87.84%,84.20%, 79.98% and 69.45% respectively, the immunization coverage rate of BCG,OPV, DPT and MV was 67.60%.4.1.3 Migrant pregnant women death has become the main part of pregnant women death in the immigrant areas.4.2 Problems and ObstacleSystem investigations show that main obstacles influencing migrant's maternal and child health care service utilization are an absence of national migrant's management policy, the maladjustment of regional migrant's management policy, an insufficiency of health care service supply and management, the restriction of migrant's demand and an inefficacy of striking illegal medical practice.4.3 SuggestionsAccording to the problems and obstacles influencing migrant's maternal and child health care service utilization, the government or relative migrant management organizations should enhance migrant's macro-manage and formulate the law of migrant's management, construct the national migrant's information system, reform current migrant management system, change migrant management to service, increase finance for migrant's maternal and child health care service, reduce migrant's maternal and child health care service cost and enhance migrant's health care service utilization, increase migrant women delivery in the hospital, strengthen family planning management, reinforce health promotion and change migrant's health concept and traditional bearing concept, execute the law severely and forbid illegal medical practice, construct harmonious society condition for migrant.