The Study Of The Peri-marital Health Counseling Impacts On Newly Married Women's Knowledge And Behaviors About Contraception And Better-birth

Premarital health care is an essential component of reproductive health services, which plays an important role in promotion maternal and child health, improving the quality of the new-born population. Since the implementation of renewed "Marriage Registration Ordinance" on October 1, 2003, the premarital medical examination report was no longer regarded as the necessary document for marriage registration. It became a voluntary health choice and behavior for premarital people to decide whether or not to receive premarital medical examination. The premarital examination rates dropped substantially and dramatically throughout the country. For example, the premarital examination rates dropped from 98% in 2003 to 3.17% in 2004 in Shanghai. On September 1, 2005 the new premarital health services model was initiated which included free peri-marital health counseling and free premarital medical examination in Shanghai. According to the new model, each district was required to establish marriage and family health consultation rooms at the location of each district marriage registration departments under District Civil Affairs Bureau and to arrange one or more counselors to provide peri-marriage health counseling there. Meanwhile, the free and voluntary premarital medical examination was provided either at original premarital medical examination institutions or at newly set-up premarital health services center near or next to the marriage registration departments.According to the annual national maternal and child health statistics, the average annual rate of disease detection through premarital medical examination from 1992 to 2002 was 7.43%. All kinds of diseases detected in sequence were as follows: reproductive system diseases, other organ and system diseases, specified infectious diseases, serious genetic diseases, and mental illness. Premarital health care can detect the diseases which might have adverse effects on marriage and child rearing (especially through medical examination), but also can improve clients' reproductive health knowledge through systematical health education or individualized counseling and instructions.Up to the present, the evaluation of the functions and effectiveness related to the premarital health care were carried out generally by retrospective summaries, data analysis, and cross-sectional surveys. However, it is relative deficient to have prospective studies to evaluate the impacts of premarital health care on clients' reproductive health knowledge, related behaviors and practices. Peri-marriage health counseling is the new focus in the new premarital service model advocated and implemented in recent years. So far the related research on continuous effects of peri-marital counseling on brides' knowledge and behavior/practice about contraception and better-birth has not been found.OBJECTIVES:To identify the effect of free peri-marital health counseling implemented in Shanghai on brides' knowledge and the behavior/practice about contraception and better-birth.METHODS:The investigation was designed with Pre-test/post-test with control group design. The research subjects were those women first-time registered for marriage in Shanghai. The sampling method was stratified and cluster sampling. In accordance with the outer ring road, the 19 districts were divided into urban and suburban groups. Then based on the various levels of peri-marriage health counseling rates in April 2007, premarital counseling rate of each district was defined as high (if the counseling rate more than 70%), medium (if between 70% and 40%) or low (if less than 40%) level. At last six districts were randomly selected as research sites. Baseline surveys were conducted at marriage registry of each selected district. The investigation method was face-to-face questionnaire. Then according to women whether participated in the peri-marriage health counseling or not, they were divided into the counseling group and the non-counseling group. Six months after marriage registration, telephone follow-up was carried out. At baseline. 1253 valid samples were recruited. Six months later 1091 women's follow-up data were collected. The data from questionnaires were analyzed with aids of SPSS 11.5.RESULTS:1.Factors affect women to participate in peri-marriage health counseling. Women's educational attainments and male income would affect their participation in peri-marriage counseling; Women who planned to have preconception examination soon were more willing to participate in peri-marriage health counseling. 2. Comparison of general contraceptive knowledge between the counseling group and the non-counseling group after 6 months of marriage registration. The difference of contraceptive methods that women knew how to use between baseline and follow-up in the two groups had not statistic difference. Regarding to the question "If you do not intend to be pregnant temporarily, do you need to use contraception?" the correct answers are improved in the two groups. It was related to whether to participate in the counseling, the educational attainments of women.3.Understanding of emergency contraceptive knowledge after 6 months of marriage registration. Emergency contraceptive knowledge score increased 0.945 point in the counseling group, but in the non-counseling group only increased 0.542 point with statistically significant difference. Emergency contraceptive knowledge scores increase were concerned to whether to participate in the counseling.4. Understanding of better-birth knowledge after 6 months of marriage registration. Regarding to the question "Supplement of folic acid can prevent fetal neural tube defects", there are 41.7% and 61.0% women answered correctly at baseline and at follow-up respectively in the counseling group. While there are 41.7% and 51.9% women answered correctly at baseline and at follow-up respectively in the non-counseling group. There is statistically significant difference, which is caused by factors as whether participated in the counseling and women's educational attainment.5. Contraceptive behaviors after 6 months of marriage registration. At follow-up, there were 559 (60.2%) women using contraception. The common used method was condom, which consisted of 82.3%. There are 37 women (7.0%) who did not take any contraception because they didn't know contraception, feared troublesome, or thought not to get pregnant. There was no distribution difference between two groups.6. Emergency Contraceptive behaviors after 6 months of marriage registration. There were 91 people (8.3%) had used emergency contraception, with the maximum time of 5 in a half year. Two people experienced induced abortions because of emergency contraception failures.7. Abortion after 6 months of marriage registration. There were 21 women (1.8%) had an induced abortion and 8 women (0.7%) had a spontaneous abortion. In the non-counseling group, the rate of abortion was higher due to no contraception.8. Health behaviors in preconception and gestation periods after 6 months of marriage registration. At follow-up there were 234 women who were pregnant after marriage registration. Among these, 105 women (44.9%) were conceived as they planned. About 121 people (51.7%) women had the folic acid supplements. The folic acid supplement proportion was higher in the counseling group, and were conceived as they planned. There were 39 women (32.4%) started to take folic acid before being pregnant, 82 people (67.8%) took folic acid after being pregnant. In the counseling group the proportion of folic acid supplement in preconception period was higher than that in the non-counseling group.9. Knowledge of women came mainly from books, newspapers, magazines, internets, friends and family. Means of access to knowledge they desired were: doctors, internets and magazines.CONCLUSIONS:Peri-marital health counseling could help clients improve their awareness of contraception (including emergency contraception) and supplement of folic acid, but had no effects on knowledge of contraception before conception, most appropriate ages to conceive for both male and female, and external factors affecting pregnant outcomes.The study also showed that peri-marital health counseling facilitated women to plan their conception and supplement of folic acid, but did not make women use regular contraception to avoid unplanned pregnancies, and to use emergency contraception correctly and appropriately.SUGGESTIONS:1. Strongly advocate peri-marriage health counseling and improve rate peri-marriage health counseling.2. Improve the peri-marriage health counseling quality. The measures included improving the quality of the doctors, enhancing research on the key information provided and developing useful tools in counseling process.3. Establish continuous services, such as setting up hot line, network consultation, training courses and so on. At marriage registration some information about related professional institutions could be provided to newly-weds in order to facilitate them access to information and services after marriage.4. Publicize the importance and necessity of premarital health care (esp. medical examination), enhance the awareness of the whole society, and ultimately increase the rate of premarital medical examination.