Study On Gender's Role In Maternal And Child Health Care Service In Rural Areas Of China

Objective: To understand the issue of social gender existing in maternal health care and reproductive health services in rural areas, to discuss the impact of social gender equality awareness on maternal and child health care in rural area, and provide effective strategies on improving maternal health care from social gender perspective. To increase availability of maternal and child health care services, ensure maternal and child's safety and promote their health, for the aim of bringing social gender into system of maternal and child health careservice .Methods: With the method of qualitative and quantitative study to carry out spot investigation. Qualitative study included literature study, personal in-depth interview and focus group discussion. Literature review was to collect the macro-demographic data by large-scale surveys from 1950 to 2005 in China, such as the previous census data, the country's population changes in the sample survey, the data of the country's population and reproductive health survey and other information, obtained from Demographic Yearbook of China's Statistics Bureau and China's Health Statistics Yearbook; personal in-depth interview and focus group discussion were carried out among married women in child-bearing period, their husbands and health workers, community leaders in Chengde county of Hebei province, An county of Sichuan province and Songzi county of Hubei province. Random stratified sampling was adopted to investigate 434 married women whose children were under 7 years old . D SAS9.0 software was use to do data analysis, inculding describing analysis, Chi-square test, nonparametric test, single factor and multi-factor non-conditional logistic regression.Results:1. In China, since 1950 the sex ratio of infant deaths (SR0) had been under 1.20 which was the lowerbound of normal range, which indicated the female infant mortality rate was higher. Before1980, the sex ratio of infant deaths was about 1.10, which was stable; but after 1980, the SR0 fell sharply to below1.00, which suggested that female infant mortality rate suddenly increased, compared with the male infant mortality rate. From 1960 to 1989, the sex ratio of (SR1) was among the normal range, because high mortality of 1 to 4-years-old female infant deaths existed; from 1991 to 2005, SR1 had been fluctuated in the vicinity of 1.0, which showed 1 to 4-year-old sex ratio of infant deaths was relatively stable in this period, and the female infant death was not obviously high. The SR0 and SR1 in rural areas were both below the normal range, and lower than in the city, which illustrated the female infant death in rural areas was more serious.2. Results of qualitative study(1) Female family and social status: Most of female investigated thought,"Female status had improved much, it was basicly equal, sometimes even exceeded male."Some one Still said the social status of male was higher than female, but the family status of female was higher than male, and Female always made decision at home. Most of male objectives interviewed thought that the status of female was equal to male. Some objectives even thought that wives'status were higher than theirs."Women at present are half the sky. The husbands manage the family but can not make decisions. Everything is decided by wives."On the aspect of division of family duty, most male were still tending to think that"male is in charge of outside matters and female is in charge of inside matters". Some husbands thought,"Wife is like a box for keeping money, and how to spend is decided by husband."(2) Fertility concept: Femme thought,"sex discrimination existed ten years ago, but it does not matter now. Before sons need to work and look after elders. Now daughters also have the responsibility of looking after elders. Someone Still thought, the phenomenon of attending boy and belitting girl stillexsits in the older generation. When being asked whether he wanted boy or girl, most male answered boy from heart, especially older male.(3) Census of female disease: Because of the difference of economic status and the weakness of self health care consciousness , the implement of gynecologic examination was not same in different regions. Most women were not content with the service of gynecologic examination in town hospital. Because in the town hospital, the equipments were lack, and the contents of examination were simple."We still need go to big hospital when we are ill."(4) Male participating in family planning: Previous women had thought giving birth to child had been women's matter, and had nothing to do with men. But it was different now. On aspect of birth control, most objectives thought it were themselves to decide how to contracept. They always chose placement of IUD or contraception. Husbands always did not attend. Most male expressed that"it can not be accepted in concept to let man contracept". They all trended to let wives adopt contraceptive. Some males were misunderstood with vasoligation and could not accept it.(5) Birth sex ratio: The village leaders who were investigated reflected that the birth sex ratio in village was a little higher, especially the ratio of boys in second delivery. That was because some peasants still wanted to have boys. Besides, the phenomenon of sex identification and selective abortion still exist in village.3 .Results of quantitative survey(1) The view of investigated women on social gender roles25.81% of objectives had low awareness of social gender equality, person who had general awareness accounted to 44.93%, only 29.26% had high awareness. The social awareness of gender equality among women was primarily affected by their education (OR=1.795), their mothers'participation in family decision-making (OR=1.775), their age (OR=0.581), their occupation for agriculture (OR=0.618) and other factors.(2) The attitude towards resource allocation in family among surveyed womenOn family nutrition and health resources allocation, they first considered their sons, then daughters and husband's parents. The proportion of select themselves first accounted less than 0.5%. On education , sons were priority to daughters.(3) Family status and family decision-making situation of surveyed womenOn the facet of marriage decision, 89.17% of women decided their own marriages, 10.83% were determined by parents. 22.58% of women had low status on family decision-making, 61.75% had common status, 15.67% had higer status.. Women's education (OR = 1.591), their mothers'participation in the family decision-making (OR = 2.495) and the gender awareness of women's social situation (OR = 1.252) were impacting factors on women'family decision-making.(4) Situation of maternal health care service and existing problems of social gender1) Health care situation during pregnancy: 90.32% did prenatal examination, only 38.48% pregnancy women received inspection during early pregnant period, the frequencies of prenatal examination which were more than 5 times (the requested number of prenatal care in rural areas) only accounted to 28.11%; the rate of hospital delivery was 66.36%, 44.01% pregnant women chose hospitals in towns as delivery place.2) Measure of female contraception and birth control: Comprehensive contraception rate was 82.49%, persons who had induced abortion accounted 39.63%. Among various kinds of measures, the rate of IUD use was the highest which accounted 77.65%. The next was contraceptives(7.54%), female sterilization (6.15%), condom(6.98%)。The responsibility which male took was much less, only accounting 6.98%.3) Reproductive tract infections : During the past year, the rate of reproductive tract infections was 32.03%.The treatment rate was 87.05%.The reasons why they didn't visit doctor were that they had no time to go or they thought if was unnecessary.4)Family's expectation to fetus's sex: 14.29% of husbands and 10.83% of grandparents admitted that they want boys. Most families took joy after deliveries , old parents felt better significantly when the baby was a boy than it was a girl, but the couple felt the same.5)Child health care : 93.01% of children were breastfeeding, and 46.28% began within 24 hours since birth. The difference in the rate of breast feeding and the start time between sex had no statistical significance. In the last year, the children prevalence rate was 69.63%. The treatment rate was 86.00%, and the rate of boys (92.14%) was higher than that of girls (79.75%) (χ2=9.237,p=0.0024).The median of interval between visting-doctoc and ill was 2 hours, and that of boys was shorter than that of girls(χ2= 11.665,p= 0.0029).(5) The impact of woman sex consciousness on maternal and child health care servicesAntenatal examination (OR=1.293),early gestation examination (OR=1.291), hospitalization delivery (OR=1.399), men's contraception (OR=3.070) were affected by woman sex-equal consciousness according to multi-factor analysis.Conclutions:Sex difference exists in infant death in rural areas, and there exists higher female infant deaths. Women's role and status in family, perinatal health care, child health care, and reproductive health are not the same as men's. The situation of utilizing maternal and infant health care services is affected by sex consciousness of women in the country. Therefore, in order to increase women's status and health levels , it is called to enhance education, encourage men to participate in, give women more rights, improve maternal and child health care services, and incorporate the theory"women are equal to men"into maternal and child health care.Research Innovation1. From the perspective of social gender, the study discussed the phenomenon of social gender inequality existing in maternal and child health care in rural areas and its impact on maternal and child health, provided a new perspective to evaluate maternal and child health care service in rural, and provided a new ideas to set new services. So, there were some innovation in theories and ideas.2. This study adopted method of epidemiology and sociology, used quantitative and qualitative study to discuss social gender impact on maternal and child health services in rural areas. So there existed certain innovation on methodology.