A Hospital-based Study On Birth Control And Unintended Pregnancy In Female Non-residents

Industrialization and urbanization drove transient population from rural areas to urban areas after the Open-door policy in 1970's,which has been considered as a proxy of social development and advancing of China.The population floating became more significant in the 21th century.It was reported that Shanghai became the leading area absorbing transient population across provinces in China,of which the population of non-residents increased from 0.6 million in 1984 to 5.87 million in 2005,the latter one was almost one third of registered residents of Shanghai.In this population,about 63.1% aged between 20-39 years old,gender ratio(male vs.female) was close to 1.Issues related to sex and reproduction were the most prominent to female non-resident among the economic and cultural conflicts which non-resident could encounter.Other studies showed that the rate of artificial abortion has remained high in female non-residents,while the rate declined in female residents in Shanghai for years.With quantitative and qualitative analyses,the current study summarized the status of birth control,unintended pregnancy and knowledge on birth control in female non-residents.Factors affecting knowledge and birth control options were also evaluated to discover causes of artificial abortion.Community health center based services and related management approaches on family planning for female non-residents were also discussed to improve maternal health care in this target population.PartⅠPrevalence study on birth control and related factors in female non-residentsObject:To describe status of birth control options and related contributors in female non-residents to improve family planning service for the target population.Methods:430 females at reproductive age visiting the gynaecology department of the Ban Song Community Health Services Center,Huang Pu District,Shanghai,were recruited during the period from July of 2007 to December of 2008.Cases with repeated visiting were excluded.A structured questionnaire was used to collect information on general information,maternal history,birth control options of the participants.Multiple Logistic regression models were constructed to analyze factors contributing to birth control options.Results:The average age of the 430 participants was 29.17±6.19 years old(mean±sd). 79.3%participants were currently employing a birth control option or employed a birth control option before.The leading birth control option was interuterine devices(IUD, 50.8%) in married females and condom(61.3%) in unmarried females.In making decision of birth control options,64.8%of participants picked options after spouse consultation, 24.3%by female partner,4.7%by male partner,6.2%by family planning services.90.3% of unmarried female purchased contraceptive devices,and only 9.7%obtained free devices from family planning services.71.3%of females were satisfied with the birth control option employed,which were lower than the results from other domestic studies. With univariate analysis,rates of satisfaction to birth control options varied by options employed.In the results of multivariate analysis,females with no more than one abortion showed higher possibility to employ a birth control option comparing to those with more than two abortions(OR=2.367).The possibility of employing IUD increased by age (OR=1.804),as well as ratio of decision on options by female(OR=1.136).IUD was more employed by female resident registered in rural areas than in urban areas;Unemployed females have significantly lower conceptive application than employed females (OR=0.307).Conclusions:Birth control options were not determined by all female non-residents and the satisfaction rate to birth control options was lower than the results from previous studies.Low utility of free conceptive devices and services by family planning institutes were also found.Free conceptive services(including conceptive devices offering,birth control verification) should be enhanced in publicizing,which may improve the rate of conception employment and lower the unintended pregnancy rate.PartⅡA Survey on knowledge and attitude to birth control options in female non-residentsObjective:To understand the knowledge and attitude to birth control options in female non-residents for improving efficiency of health education on birth control to the target population.Methods:430 females at reproductive age visiting the gynaecology department of the Ban Song Community Health Services Center,Huang Pu District,Shanghai,were recruited during the period from My of 2007 to December of 2008.Cases with repeated visiting were excluded.A structured questionnaire was used to collect information on knowledge and attitude on birth control options which were assessed by a scoring system.Student t-test,oneway anova and dichotomous Logistic regression were applied to the data analysis.Results:The average score was 7.17±2.65(range 0-12) in the 430 participants.52.8%of participant agreed on pre-marital cohabitation;65.1%obtained knowledge on birth control options;84.7%were willing to have further knowledge,in which 86.7%preferred face-to-face consultancy by professionals.In the results of multivariate analysis,the scores of knowledge on birth control options were higher in females aged less than 25 than in aged over 35(OR=2.19).However,the scores were lower in female having not-higher-than-primary school education than having at-least-junior-high-school education(OR=0.210).The same pattern was also presented in scores of knowledge to EC (OR=0.180).Females adopted emergency conceptions showed higher score in knowledge to EC than females without conceptions(OR=2.137).Conclusions:The knowledge on birth control options was not comprehensive in female non-residents.The target population showed highly possibility to adopt pre-marital sex behaviors and cohabitations.The results suggested that health education services should provided by professionals via multiple channels and with broader contents.PartⅢA survey on unintended pregnancy and cause analysis of abortion in female non-residentsObjective:To describe unintended pregnancy in female non-residents and discover causes of abortion to improve basic information for policy making in birth control aiming female non-residents.Methods:127 females at reproductive age requested abortion(vacuum extraction) in the Ban Song Community Health Services Center,Huang Pu District,Shanghai,were recruited during the period from July of 2007 to December of 2008.Face-to-face interview was performed with a structured questionnaire collecting information on general information,maternal history and unintended pregnancy of participants.Chi-square test was applied to comparison between groups and correlation analysis was to discover relationship among demographic characters,pregnancy,maternal history and abortion. Results:A total of 127 participants with average age of 27.93±6.73 years old were recruited.3.9%of participants were younger than age of 20.The average frequency of abortion was 1.98±1.46 times with a maximum of 14.The average gestation period was 52.23±9.65 days.The leading cause of operation was intercourse without conceptions (63.0%),in which take-a-chance was the leading cause for not adopting conception (53.8%).The following cause of operation was failure of conception(33.9%),in which the major contributor was failure of condom(34.9%).Genital tract infections were found in 52.0%of participants.55.9%of them learnt about emergency conception.In the results of univariate analysis,females aged over 35 showed higher possibility to have twice or more abortion than other age groups(P＜0.001);married females experienced more abortions than unmarried females;females having child/children had more abortions than females without child(P＜0.001).The average age performing abortion of unmarried females was younger than married females(F =26.533,P＜0.001).There were more married females with under high school education or unemployed experienced abortions than unmarried female with P value of 0.012 and 0.041 respectively.Conclusion:Intercourse without conception was the major cause of abortion,in which take-a-chance was the leading cause to not taking action.Condom failure accounted for the majority of conception failure.The average age having abortion was much younger in unmarried females than married females.High infection rate in genital tract was found in female non-residents.The target population also showed lack of knowledge in emergency conception and corrective usage of birth control devices.The current study suggested that health education should be enhanced on reproductive health and birth control,expand scope of family planning service to unmarried group and spouses of married females.