Cross-Section Investigation On Status Quo Of Intergrated Sexual And Reproductive Health Counseling Among Women Of Childbearing Age

【Background】Reproductive health is a basic human right, and family planning is an important way to protect people's reproductive health rights, while informed choice of contraceptive methods is the core of quality of care on family planning. The aims of carrying out informed choice on family planning are to meet the popular service demand, to meet the clients'demand of making their own decisions, and also to provide the personalized services for different groups. Therefore, the integrated counseling on sexual and reproductive health is especially important. In 2003, NPFPC has set up a national programme of sexual and reproductive health counseling capacity building. With the achievement of the programme, in 2007, NPFPC build up a new occupation of reproductive counselor. At present, China's sexual and reproductive health counseling status is still far from being satisfactory. As the family planning service providers are lack of sufficient knowledge, counseling skills and active attitudes. In addition, service providers and the clients are lack of awareness of the importance of sexual and reproductive health counseling, these bring great obstacles to informed choice of contraception and the improvement of the quality of service. It can not satisfy the masses'comprehensive and multiple needs for sexual and reproductive health.【Objectives】This cross-sectional epidemiological study aimed to study the status quo of the sexual and reproductive health, the informed choice on contraceptive use, the integrated sexual and reproductive health counseling and service needs among reproductive women in Guangdong, Henan, Chongqing, Inner Mongolia, and to proffer tentative recommendations to policy-makers.【Methods】A cross-sectional study was carried out in Foshan in Guangdong, Jiaozuo in Henan, Chongqing, Baotou in Inner Mongolia. Reproductive women were selected by random sampling from the sub-population who had a temporary residence permit or permanent residents in townships in 4 project sites. A face-to-face interview to women of childbearing age was conducted with self-designed structured questionnaire by trained interviewers. Quantitative data was input into the dataset established by using the Epidata 3.1 software and analyzed by using SAS 9.13 software. Data were analyzed both by univariate and multivariate analysis. The major statistic methods used in the study are Kruskal-Wallis test, Pearson X2 test, CMH X2 test and unconditional logistic regression. 【Results】A total of 1600 women were enrolled,1453 qualified questionnaires were got, with an effective rate of 90.08%. Most subjects were young and middle-aged. And 35 years old was the largest, accounting for 25.81%. The education level with middle school was more than other group, accounting for 38.98%. Most reproductive women (40.74%) were farmers. Most of these subjects'average monthly income of last year were below 1000 (56.85%), between 1,000-2,000 yuan (26.15%). A total 1386 of the people of childbearing age in the survey were married, accounting for 95.39%.In this study,97.80% of subjects were using three commonly used contraceptive approaches. The three main contraceptive approaches were IUD (66.64%) condom (20.85%), and rhythm method (10.31%). Among women of reproductive age, contraception currently used were mainly from family planning service stations (880, 66.52%), followed by hospitals (126,9.52%). About 74.53% of the subjects whose contraception currently used were free of charge.The rate of contraceptive approaches decided by the couples was 52.55%, while by subjects themselves was 34.27%. In the meanwhile, there were still 7.01% of the subjects whose contraception was decided by family planning/health services providers. Multivariate Logistic regression analysis showed that education and regions are the main factors affecting the decision making.About the awareness of nine common contraceptives, the first three were respectively IUD(1357,93.52%), condom(1348,92.97%)and rhythm method(1314, 90.56%). The lowest awareness rate was Norplant (63.70%). The rate of subjects who knew all the nine approaches was 54.03%. Subject's awareness of pill and Norplant were relatively lower. It should be noticed that some subjects didn't know much about using principle, advantages, disadvantages, possible side efeects of common contraception, even if contraception they currently used.The knowledge on integrated contraceptive included common knowledge on contraceptive and some knowledge related to condom usage. The highest score was 97.73 points, the lowest was only zero, and the median was 65.91 points. Multivariate analysis indicated that subjects'age, occupation, education, marital status and regions were main influencing factors about the total scores of knowledge on integrated contraceptive.The rate of the awareness of contraceptive informed choice was 77.84%. Family planning service providers (759,67.71%), and TV and radio (243,21.68%) were the top two means by which subjects picked contraceptive knowledge.In the whole, family planning service providers television and radio remained main sources of contraceptive knowledge. Two categories logistic regression analysis showed that marital status, education, occupation, scores of contraceptive informed choice and area were main influencing factors about the awareness rate of contraceptive informed choice.Among 1453 women of childbearing age,1246 showed their agreement about informed choice on contraceptive, accounting for 85.75%. After conducting the service on contraceptive informed choice,538 subjects (37.03%) indented to change their contraceptive approaches, while 414 subjects (71.50%) didn't indented to change. Logistic regression analysis indicated that age, household, regions, awareness of informed choice on contraceptive and scores of contraceptive knowledge were possible influencing factors to the intention of changing contraceptive approaches.Informed choice on contraceptive services were mainly conducted in the form of missionary activity (34.63%), followed by consulting services (29.44%) and technical services (24.88%), only 8.42% by regular seminars. The forms of informed choice on contraceptive services were still relatively monotonous and limiting. And 57.67% (838) subjects had received face to face counseling during last year. There were still some shortages in counseling:a small number of family planning providers (8.35%) could not take the initiative to inform clients to decide by themselves which contraceptive methods to use; And 6.80% of service providers could not introduce three or more contraceptive approaches to the clients; close to 1/3 (29.95%) of the service providers tended to let clients use a certain contraceptive approach; even 12.53% of service providers defined clients to use a certain contraceptive approach.If clients had some sexual and reproductive health problems,44.83% chose the family planning service station, followed by hospitals (43.84%) and maternal and child care service centre (10.67%). The results showed that the majority of clients trusted family planning service stations. The main reasons for choosing family planning service stations were good environment (35.57%), followed by a high level of equipment and technology (28.04%).Only 60.29% subjects heard of sexual and reproductive health rights and human rights. But 86.44% subjects said that they were willing to know some relevant knowledge about sexual and reproductive health rights and human rights. The results of logistic regression analysis showed that age, education, occupation, monthly income, scores of contraceptive knowledge and regions were the main influencing factors.Only 62.97% subjects had heard of sexual and reproductive health counseling. Only 57.81% clients thought that there were local integrated sexual and reproductive health counseling services, and 22.02% said they had no idea. Among provider organizations, family planning service ranked first (84.76%), followed by the street or the RC (8.21%), hospitals (3.93%) and community service centers (2.86%).Logistic regression analysis showed:After adjusting the account of the nature, education and other factors, age, occupation, monthly income, marital status, region were major factors.About 85.48% of people thought it were necessary to carry out integrated sexual and reproductive health counseling services in the area. Data showed that the people of childbearing age had the need of integrated sexual and reproductive health counseling services. If integrated sexual and reproductive health counseling services were carried out,1294 people (89.06%) expressed their willingness to accept the service. The site that clients mostly wanted to carry out integrated sexual and reproductive health counseling services were family planning agencies (37.33%), followed by the professional advisory body (28.97%) and hospital (21.98%). The forms in which clients want most to carry out integrated sexual and reproductive health counseling services was lectures (48.47%), followed by face-to-face counseling (41.92%). The services of integrated sexual and reproductive health counseling services what clients want most to provide were contraception (53.43%), followed by reproductive tract infections accounted for (22.98%).Among all subjects, there were 706 people (48.59%) had recently received integrated sexual and reproductive health consulting related services during last six months. The major sites in which they received the services were family planning service station (583,82.23%), followed by hospitals (53,7.48%). A recent counseling service mainly due to general counseling (43.29%), followed by genital infection (37.71%). Clients who received services expressed their satisfaction with the service, 474 (67.14%) were very satisfied and 205 (29.04%) were satisfied.【Conclusions】Women of childbearing age in four provinces had some understanding of contraceptive knowledge, but they knew little about the principle, advantages and disadvantages of common contraceptive methods; They had incomplete knowledge about informed choice of contraception; The form in which informed choice of contraceptive services carried out was IEC materials; Their awareness of sexual health knowledge was low and their sense of sexual and reproductive health rights was weak; The awareness of integrated sexual and reproductive health counseling services was low; About 85.48% of people thought it was necessary to carry out integrated sexual and reproductive health counseling services in the local, and it showed great need from people of childbearing age-for integrated sexual and reproductive health counseling services; Family planning providers had one-side understanding of knowledge on integrated sexual and reproductive health counseling services, this would also lead women of reproductive age directly to misunderstand informed choice on sexual and reproductive health.Therefore, based on national RH counselor's capacity building, it helps to improve people's knowledge of, attitudes towards and practice on sexual and reproductive health.