| [Background] In 2001, contraceptive informed choice was formally written into the "Regulations of family planning technical services" promulgated by central government. "Law on Population& FamilyPlanning"launched in 2002 also formulated that contraceptive service must follow the principle of informed choice. Dongcheng district was in the center of Beijing, among 625,000 resident population, the number of childbearing age women was 183,000, and the number of married women was 131,000. Since the implementation of informed choice, family planning working had made some achievements, contraceptive rate was 82.3%. However, induced abortation was still a severe problem, married women's abortion rate was 46.5%, which was induced by without contraceptive measures and contraceptive failure.[Objectives] To understand the current situation of informed choice on contraception among childbearing-age women in Dongcheng district in Beijing, including the situation of contraceptive use, common contraceptive and informed choice knowledge, informed choice and family planning service acquiring, and so on, and to explore potential influencing factors to proffer tentative recommendations to policy-makers.[Methods] A cross-sectional study was carried out in Dongcheng District in Beijing, both quantitative research and qualitative research were adopted. In this study, two streets (Donghuamen, Dongzhimen) were selected by cluster random sampling, and 300 childbearing-age women were assigned in each street. By conducting questionnaire survey among these selected women, the study can understand the current situation of informed choice on contraception. In addition, questionnaire survey would be conducted in all service-providers from these two streets, while in-depth interviews and focus group discussions would be carried out in women, family-planning managers and service-providers respectively, so as to evaluate the service quality that childbearing-age women received.[Results] 600 women were enrolled,579 valid questionnaires were got, with an effective rate of 96.50%. In addition, questionnaire survey had been conducted in all 49 service-providers.1. The general condition:Most objects were between 35 and 49 years old. The maximum age, the smallest age and the median age were 48,20 and 39.62 years old respectively. The eduction level with college or above was more than other group, accounted for 45.08%. Most (36.27%) of these objects'average monthly income of last year were between 1,000～2,000 yuan.2. Contraception Knowledge:About eight common contraceptive methods, The first three places in awareness rate were respectively condom (97.75%), IUD (87.91%) and oral contraceptives (82.90%), the lowest awareness rate was norplant (46.98%). The number of objects who knew all the eight methods was 239 (41.28%). Objects knew how to use contraceptive methods, but knew little about contraceptive principle, advantages and shortcomings, and the correct answer rate was below 60.00%.The correct answer rate of condom usage ranged from 10.36% to 95.68%. Logistic regression analysis showed that education was factor influencing the knoeledge related to condom usage, and score increased along with the increasing of education(ORhigh=1.684,95%CI:1.078～2.630; ORcollege=1.895,95%CI:1.233～2.914).The total contraceptive knowledge included common contraceptive knowledge and some related to condom usage (the total score was 40 points), the highest score was 36 points, the lowest was only one point, and the average was (20.15±7.27) points. Multivariate analysis indicated that compared with objects with primary education level, the total contraceptive score below 15 points accounted for less percentage among objects with high school/secondary school and with college or above (ORhigh=2.302,95%CI:1.495～3.545;ORcollege=3.631,95%CI:2.212～5.962).3. Induced Abortion:Among 579 childbearing-age women,339 (58.55%) had experienced abortion, and 330 (56.99%) had experienced induced abortion. Most objects (66.97%) had got one abortion, and the average times of abortion was (1.36±0.67). The main two reasons for induced abortion were contraceptive failure (51.66%) and without using contraception (36.56%). The abortion ratio of childbearing women with high school/secondary school was higher than that with junior school or below (OR=1.754,95%CI:1.063～2.895); compared with farmers/ workers, unemployed objects had higher abortion proportion (OR=2.213,95%CI: 1.063～4.608).4. Contraceptive Using:In this study,91.94% of objects were using contraceptive methods. The main three contraceptive methods were condom(58.33%), IUD(35.61%) and rhythm method (2.65%). Multivariate Logistic regression analysis showed that the rate of condom using was higher among local women, while the rate of IUD using was lower(P<0.05); compared with the group between 18 years old and 30 years, the group between 40 and 45 years old and the group between 45 and 49 years old accounted a lower percentage of condom using (OR40～45=0.260,95%CI: 0.135～0.501; OR45～49=0.157,95%CI:0.080～0.307).The survey indicated that only 74 objects used emergency contraception, accounted for 14.02%. About emergency contraception knowledge, objects with college education was higher than the objects with a primary education (OR= 2.183,95%CI:1.159～4.109).The contraceptive methods deceided by the couple jointly accounted for 58.14%, while by objects themselves accounted for 33.14%, and by others (eg. partner, family planning service-providers, doctors) accounted for 8.72%. The characteristic of registered residence and occupation affected the power of contraceptive decision (P< 0.05).5. Awareness Rate of Contraceptive Informed Choice:292 people (50.43%) had heard of informed choice on contraception, and there were 104 (17.96%) women of childbearing age in the past one year received face to face counseling related to contraception knowledge.501 people (86.53%) realized that it was necessary to carry out service about contraceptiove informed choice.The awareness rate of contraceptive informed choice among objects residenced in urban accounted for 60.42%, while residenced in rural accounted for 54.02%, the differences were significant (P<0.05). Compared with the objects whose contraceptive score below 15 points, the objects whose score above 21 points had higher awareness rate, and the higher the score was, the higher awareness rate was (OR21～26=1.909,95%CI:1.192～3.058; OR26～=2.738,95%CI:1.639～4.572).6. The Intention of Changing Contraceptive Methods:After conducting the service on contraceptiove informed choice,165 objects (28.50%) intented to change their contraceptive methods, while 414 objects (71.50%) didn't have this thought. Ecdemic objects had lower intention than local objects (OR=0.333,95%CI: 0.186～0.597); the intention among objects with college or above was higher than objects with junior school or below (OR=2.855,95%CI:1.495-5.454).7. The service-providers'ability of providing contraceptive methods informed choice and their training demands:Service-providers had a good graspe of contraceptive knowledge. In the process of conducting contraception informed choice, propaganda and education(51.16%), counseling service(25.58%) and follow-up service(11.63%) were the main tasks undertook by our service-providers. the majority (75.51%) agreed that we should take further efforts to carry out contraception informed choice.Service-providers had one-sided understanding on contraception informed choice, for example, the misconception that the goal of informed choice was to strictly control the number of our population (30.61%). The family planning services staffs'attitude to informed choice would directly affect the quality of service that childbearing age women received.Among all 49 service-providers, there were 43 service-providers had provided informed choice on contraception. While 41 people thoutht that our service-providers should acquire training, such as counseling skill training and training about how to conduct propaganda, so as to improve their service quality. At the same time, the results of qualitative interviews also reflected that training related to counseling skills should be conducted among service-providers. [Conclusions] Among childbearing-age women who received surveys, the proportion of induced abortion is high; the awareness rate of common contraceptives is low, and they know little about contraceptive principle, advantages and shortcomings; they lack comprehensive understanding of contraceptive informed choice, and the proportion of receiving contraception counseling service is low. Now, Reproductive health counselor professional building will provide a good opportunity to conduct trainings on sex and reproductive health integrated counseling konwledge and skill among service-providers, so as to promote their ability of providing contraceptive informed choice.
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