| [Background]Due to China's fast industrialisation and urbanisation since the early 1980s, the economic gap between the country's urban and rural areas has widened. A massive rural-to-urban migration has taken place, brought about by a large number of employment opportunities in urban areas. The number of internal migrant workers increased dramatically, from 50 million in 1990 to 121 million in 2000, and to at least 160 million in 2010. They account it currently for approximately 25% of the total Chinese working population. Given its large and fast-growing population, contraception and population control are extremely important issues in China. Rural-to-urban migrants are mainly young and middle-aged, and are sexually active. Because they are far from home and thus released from the restraints typically exerted by their families, their attitudes about sexuality have changed radically:their approach is now considerably more relaxed, and both premarital and extramarital sex have become quite frequent. Migrant workers generally have a poor educational background and possess little knowledge about either contraception and reproductive health-related matters or protection against sexually transmitted infections (STIs)5. Therefore, the risk of unintended pregnancy and infection with STIs, including HIV, is considerable. Therefore, it is salient and paramount to understand the current status of contraception and reproductive health among internal migrant workers, and make an effort improving their contraceptive knowledge level, reproductive health behaviour and enabling and encouraging them to make contraceptive informed choices.[Objective]To describe the current status of Family Planning (FP)/Reproductive Health (RH) among internal migrant workers in three Chinese large cities; To implement a series of intervention activities in the pilot areas, and evaluate the intervention effect.[Methods]This study was designed as a community intervention program, with a key point investigation and multistage systematic sampling. In Stage one, three large cities were selected:Beijing in north China, Shanghai in south-east China and Chengdu in south-west China. They are representative of different regions in China, and places where a great number of internal migrants flood to. In Stage two, four factories, four construction sites and four entertainment places with similar scale were chosen in each city. They were randomly assigned to intervention group and control group (two sites in each group). Migrant workers and FP centre personnels were recruited for this study. A series of intervention measures including qualified advocacy, management, education, propaganda, integrated sexuality and reproductive health counselling, professional service, following up and referred if necessary were implemented in intervention group, while routine FP work was conducted for clients in the control group. Information including current status of FP and RH among migrant workers was gathered by quantitative questionnaires, focus group discussion and in-depth interviews. The intervention effects were evaluated through base line survey and end line survey.[Results]In all,161 FP centre personnels and 6304 migrant workers were recruited in base line survey. After 1 year's intervention,144 FP centre personnels and 5503 migrant workers were followed and recruited for end line survey.1. Current status of FP management and serviceThrough interviews with FP managers, FP technical service personnels and migrant workers, current questions and suggestions of FP management and service were listed below:·Migrant workers in large cities can enjoy basic FP service, but comprehensive RH service is insufficient;·FP policies and regulations towards migrant workers were not completely implemented;·Migrant workers FP information administration system should be improved;·"Lack of power and coercive means" is the most urgent problem need to be conquered in the FP management among migrants;·FP management and service standard for migrant workers is not uniform in different locations;·FP and RH services for unmarried migrants are often neglected;·The paramount barriers in FP services for migrants need to be overcome including: "strengthen propaganda", "provide free and convenient medical service", "leaders of all levels takes seriously", "cooperate with department of health" and so on.2. The results from questionnaire investigation among FP technical service personnels:The FP technical service personnels recruited in this study were mainly aged 30-40. More than 90% of them are female. Most of them had a college graduate background and a monthly income of 2000-4000. About half of the respondents had obtained the FP service certificate or doctor's qualification.In the latest year,60.78% of FP technical service personnels in Shanghai had received training. The proportions were 23.81% in Beijing and 82.98% in Chengdu. Most respondents were familiar with migrants FP policies and regulations. The average scores of contraceptive knowledge test exceeded 80 points. Although most respondents had strong willingness to serve migrant workers, the FP service provided to migrants was considerably less than domicile population. Most of the respondents know little about the sex and RH integrated counselling. Less than 50% of respondents know the details about principles, topics and steps in the counselling process.3. The results from questionnaire investigation among migrant workers:Most respondents were aged 20-40. Nearly 80% of respondents were rural-to-urban migrants. Most of them lived in collective dormitories or rented houses. The majority of these migrants pay their medical fee completely by themselves. About 35.76% of respondents were unmarried, while 64.24% were married. Of the unmarried respondents, 16.64% were sexually active. When they had their first sexual intercourses, the youngest was 12 years old and the average was 22 years old. The maximum number of sexual partners they have is 30 and the average number is 1.29. Nearly 20% of respondents had more than one sexual partner. Respondents knew little about the 9 commonly used contraceptives, including proper use of each method, its efficacy, mechanism of action, advantages, disadvantages, side effects and complications.The mean score of the test of migrants' contraceptive knowledge was less than 30 (full mark:100). Contraceptive prevalence was 86% among unmarried sexually active migrant workers and 91% among married workers. The main contraceptive methods used by married migrants were the intrauterine device (51%), condoms (25%) and female/male sterilisation (17%); the main methods resorted to by unmarried, sexually active migrants were condoms (74%) and oral contraceptives (11%). The contraceptive method applied by 20% of married respondents had been selected by other people, without they themselves having their share in an informed choice. Adopting the contraceptive decisions made by others was associated with being a married migrant, a construction or service worker, a rural-urban migrant, a migrant living in collective or rented rooms, or a migrant with more children. More than 70% of migrants were not clear what kind of IUDs they were using, and the most widely used IUD were uterine style IUDs, O style 165 rings and Tcu220C. Only 55.71% of those who used IUDs had examined their IUDs in the current cities. Nearly 90% of migrants who use condom as their main contraceptive methods used condoms consistently during their last 3 sexual intercourses. There were 163 migrants who used oral contraceptive pills and most of them were using Marvelon and NO.1 oral contraceptive pill. Of the sexually active respondents,11.20% have ever used emergency contraceptive pill. Migrants have very poor knowledge on emergency contraceptive pill usage. Only 17.44% and 6.12% of them know the utmost times of emergency contraceptive pill can be used in a month or in a year. There were 31.27% of migrants who had received free family planning examination in their native places and the proportion decreased to 23.13% after they had come to current city. Less than 50% of migrants received FP services such as counseling, education, propaganda and follow-up. Up to 40% of them were unsatisfied with FP services.4. Intervention effect on FP centre personnelsAfter intervention, FP centre personnels'contraceptive knowledge and understanding of migrants FP policies and regulations were slightly increased. The understanding of principles, topics and steps in the counselling process was extremely increased. Moreover, the FP centre personnels provided services to migrants more regularly than before.5. Intervention effect on migrant workersThe respondents' contraceptive knowledge was significantly improved. Migrants' demands for FP/RH services were enlarged. The proportion of migrants who had received free family planning examination in current city increased.[Conclusion]The implementation of birth control among migrant workers was previously considered an arduous task. The FP system promotes contraceptive use among this population subgroup. This survey suggests that low income, little education and poor living situations may be a barrier to informed choice concerning contraceptive methods. Therefore, the following policy changes may be needed. First, the FP system should focus more on offering comprehensive RH services and counselling rather than simple birth control. Second, RH intervention programmes based on the idea of enabling and encouraging migrants to make an informed choice are necessary to weaken the influence of the current policy-driven programme on contraceptive choices. |
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