| BACKGROUND: Nowadays, population problem is one of the significant issues attracted the attention of international society. Chinese government pays great attention to the population problem and makes the family planning policy of controlling the size and improving the quality of population as one important strategy to keep with the goal of China’s modernization campaign and sustainable development. Since the reforming and opening up, population floating in China has become extremely active with the booming of Chinese economy. Data of the fifth Census in 2000 showed that the total number of migrants reached 1200 million in China and will reach 1600 million in the year of 2010 according to the estimation of authoritative agencies. Population floating is the immense driving power of Chinese economy, but considering the specific characters of migrants such as young age, poor education background, low income, weak health sense and sexually active period there are lots of serious reproductive health problems among them including unplanned pregnancy, sexually transmitted diseases and HIV infection and so on. Lots of scientific researches at home and abroad have proved that correctly and insistently contraceptive use, especially condom, can prevent unwanted pregnancy and STD/AIDS. So it is significantly important and meaningful to understand the living condition, marriage and birth history, sexual issues, contraceptive use, contraceptive knowledge, contraceptive informed choice and family planning service acquiring and requiring condition of migrants and to explore potential influencing factors. Later intervention activities will be carried out among migrants accordingly to strength their reproductive health sense, raise the correctly and insistently contraceptive use rates among them, upgrade their contraceptive knowledge condition, strength their informed choice ability, meet their family planning needs, cut down the incidence of unplanned pregnancy and STD/HIV infection among them, and finally to promote the reproductive health condition of migrants.OBJECTIVES: A cross-sectional study was carried out to learn the floating condition, marriage and birth history, contraceptive using condition, contraceptive knowledge, contraceptive informed choice and family planning service acquiring and requiring condition of migrants and to explore potential influencing factors to provide background information and data for the following intervention.METHODS: This is a cross-sectional study. 6 migrant highly concentrated workplaces of Minhang District in Shanghai were selected randomly as study sites. 2001 qualified migrants were face to face interviewed by investigators and questionnaires were finished at the same time. Focused group discussions were carried out by related researchers during the field work period. The main contents of the structured questionnaire include floating characters of migrants, marriage and birth history, contraceptive use condition, contraceptive and reproductive health knowledge, contraceptive informed choice, family planning service acquiring and requiring condition. Quantitative data was input into the dataset established by using the Epidata 3.1 software and analyzed by using SAS 9.1 software. The major statistic methods are Pearson x~2 test, paired data x~2 test, CMH x~2 test, Kruskal-Wallis test, Wilcoxon two sample test, Spearman correlation test, Kappa test, principal component analysis and logistic regression analysis and so on. Focused group discussions were recorded by tape and shorthand, then these materials were classified, labeled and analyzed according to different themes, means and standard deviations were calculated after the ranking.RERULTS: 2001 migrants were surveyed in this study. Of whom 954 were male migrants and 1047 were female migrants.1. The general condition: 36.18% of these migrants are between 18 and 24 years old, 5.15% are more than 45 years old. 29.34% of these migrants’ marriage status is unmarried without sexual life, 10.84% is unmarried with sexual life and 58.87% of them are married. More than half of our subjects are graduated from junior high school, 7.75% of them are graduated from primary school or lower, and just 4.30% of them have a college or above education background. Most of these migrants’ monthly incomes of last year are less than 2000 Yuan. 42.23% of them work in the factory, 21.09% in the construction field and 36.68% of them work in the entertainment and service places. 85.26% of them are agricultural registered permanent residence and most of them are from eastern part of China.2. Floating characters: The largest amount of out-working years of these migrants is 33 and the average number is 6.77. Migrants live in Shanghai for 9.6 months every year on average. The average number of family member is 4 in their home town and 1.74 of them on average are living in Shanghai now. Most of these migrants come here for a job and live in a dormitory, self-rented house or family-rented house. The majority of these migrants pay their medical fee completely by themselves.3. The child-birth history: Among the 1414 migrants who have ever had sexual life, the average number of children they have is 1.09 and the expected number of children is 1.68. Positive correlation and consistence exists between the number of children they have and the number of children they expect. 26.76% of migrants’ first child-birth is unintended and the potential influencing factors are work place and monthly income.4. The sexual life history: When they had their first sexual intercourses, the oldest migrant was 38 years old, the youngest was 15 years old and the average age was 21.97 years old. The maximum number of sexual partners they have is 25 and the average number is 1.31. Most of these migrants have 5.90 times of sexual intercourses every month on average. 66.50% of them had their first sexual intercourses with their spouses, 1.16% with casual sexual partners and 0.22% with commercial sexual partners. There are differences among different migrants in the aspect of first sexual intercourse age, first sexual partner, the frequency of sexual life and the number of sexual partners.5. Contraceptive use condition: 91.94% of Shanghai migrants are using contraceptives now. The potential influencing factors of contraceptive use include age, family monthly income and contraceptive knowledge score. The chief reason for not using contraceptive is willingness to have a child, the following are less contraceptive knowledge, the objection of spouse and so on. The most widely used contraceptive among migrants is IUDs; the following are male condom, sterilization and oral contraceptive pill. IUDs is also the ideal contraceptive of most migrants, the following are male condom and oral contraceptive pill. There is good consistence between the current using contraceptive and the ideal contraceptive among migrants. There are differences among different migrants in the aspect of current contraceptive use and contraceptive fee chargement. The main channel of contraceptive acquirement among migrants is hospital; the following are drugstore and family planning institution. Meanwhile migrants know that they can get contraceptives from drugstore, hospital and family planning institution at current resident area. The efficiency of contraceptive, easy of use and mild side effect are main factors taken into account when selecting contraceptives. 70.63% of migrants don’t know what kind of IUDs they are using, and the most widely used IUDs is O style 165 ring, the next is Tcu220C and uterine style IUDs. 50.09% of them checked their IUDs at the current resident area, education (compared with primary school or below, migrants with college or above education background had a higher rate of IUDs examination) and workplace (migrants who work in the construction field, entertainment and service place had a lower rate of IUDs examination) might affect their IUDs examination condition. The frequency of IUDs checking is one time per year or above which accounts for 42.60%, 29.59% of them check their IUDs less than 6 months. They usually go to family planning institution, hospital or maternal and child care service center to do the IUDs check. The places are usually more than 10 kilometers away from their living places which accounts for 28.11% and 33.73% of them are within 5 kilometers. The main reasons for not undergoing IUDs checking are unnecessary, no time and too far away. 90.77% of migrants who use condom as their contraceptive methods used condoms consistently during their last 3 sexual intercourses, and marriage status was the potential influence factor of condom consistently use. Most of them use condom to prevent pregnancy, STD and AIDS. 48 migrants are using oral contraceptive pills and most of them are using Marvelon and NO. 1 oral contraceptive pill. 11.46% of subjects have ever used emergency contraceptive pill, marriage status and contraceptive knowledge score are the hidden influencing factors. Migrants have very poor knowledge on emergency contraceptive pill usage. Only 11.24% and 5.30% of them know the utmost times of emergency contraceptive pill can be used in a month and a year and the unknown rates are 82.39% and 88.33%, respectively.6. Reproductive health knowledge condition: Migrants know little about the 9 commonly used contraceptives. 67.57% of them have heard about condom which is the highest knowing rate, the knowing rates of the other 8 contraceptives are less than 50%. Subjects have little knowledge on contraceptives’ using methods, principals, advantages and side-effects. The mean score of migrants’ contraceptive knowledge is 27.19±20.93, and the median is 24. Female migrants have better knowledge than male migrants; married migrants and unmarried migrants with sexual life have better knowledge than unmarried migrants without sexual life. Migrants who work in the factory or entertainment and service place have better knowledge than migrants who work in the construction field; migrants who are non-agricultural registered permanent residence have better knowledge; migrants who are from east and south of China have better knowledge than migrants who are from north and west of China; and the better education the better contraceptive knowledge score; the higher personal monthly income and family monthly income the better contraceptive knowledge score. So the age, marriage status, education, workplace, registered kind and personal monthly income of migrants are the potential influencing factors of contraceptive knowledge score. Migrants in our study also have weak knowledge on questions of condom correct use and HIV preventing function of contraceptives. The mean scores are 47.99±35.54 and 39.57±31.77, respectively. The age (compared with less than 25 years old, migrants who are between 25 and 29 years old, 30 and 34 years old have better knowledge), marriage status (migrants who are married have higher knowledge score than unmarried migrants), education, workplace and personal monthly income of migrants are the potential influencing factors of condom correct use knowledge score and contraceptives’ HIV preventing function knowledge score. 36.33% of our subjects have acquired contraceptive knowledge before they came out and the main channels were pamphlet, propaganda board, video, magazine and face to face counseling. 42.73% of them got contraceptive knowledge in the previous year in Shanghai, and the chief ways were pamphlet, video, magazine, propaganda board, face to face counseling and hotline counseling. The contraceptive knowledge conditions are affected by migrants’ gender, age, marital status, education and so on. Side-effect (28.79%) is the most expected Contraceptive knowledge of migrants; the followings are contraceptive correct use method (27.49%), principal (17.89%) and efficacy (9.80%). They want to learn contraceptive knowledge through face to face counseling, pamphlet, a course of lecture and report, video and magazine. 63.27% of migrants want to have reproductive health course periodically, and they want to learn contraceptive methods, contraceptive informed choice, gynecopathy, STD and AIDS through these courses.7. Contraceptive informed choice: Half of migrants’ currently using contraceptives are decided by them and their spouses together, 21.72% are decided by themselves, 6.69% are decided by their partners or spouses, and it is worth noting that the rate of migrants’ currently using contraceptives decided by family planning workers is as high as 19.40%. 50.54% of subjects are satisfied or basically satisfied with their current contraceptives, only 4.71% of them are dissatisfied. High efficacies, easy to use and without side-effects are the main reasons for their satisfaction. The main dissatisfaction reasons are side-effects, partners’ objection and less sexual pleasure. Efficacy of contraceptive, easy to use and accessibility are the factors migrants will consider when selecting contraception. Subjects have less idea of contraceptive fees which supplied by family planning institution, more than half of them believe that contraceptives provided by family planning institution are not free and the unknown rate are all about 40%. 11.81% of migrants received face to face counseling in the previous year and the quality of counseling need to be improved.8. Family planning service acquirement and need: 33.48% of migrants received free family planning examination at their local region and the rate went down to 19.19% when they came to Shanghai for job, there is correlation between them. Locations they acquire free family planning service in Shanghai are family planning institution, community health service center, hospital, maternal and child care service center and so on. 14.54% of migrants have received face to face counseling service at their domicile; meanwhile, 16.19% of them received face to face counseling service at current resident area. The counseling service places were family planning institution, maternal and child care service center, hospital and community health service center. 30.03% of them have received contraceptive knowledge propaganda materials and only 14.81% of them could understand the content completely and 4.33% of them could not understand the materials. Propaganda service, counseling service and technique service were the main family planning services migrants received at their domicile; propaganda service, counseling service and follow-up service were the main family planning services migrants received at current resident area. Most of them were satisfied with these services. Migrants’ favorite counseling service method is face to face counseling which accounts for 34.68%, the following are a course of lecture, telephone hotline, internet and letters and so on. The favorite counseling places for migrants is professional counseling institute; the following are hospital and family planning institute. 48.68% of subjects want medical staffs to provide counseling service and 38.88% of them want family planning service workers to provide counseling service. 58.57% of migrants are willing to fetch free contraceptives provided by hospital and family planning institute and 75.01% of them hope that free contraceptives are provided by hospital and family planning institute. Counseling service, propaganda service and technique service are the main family planning services migrants hope to receive.9. Migrant family planning regulation and service: There are some difficulties in the implementation of family planning regulation and service work among migrants. Migrants at the child-birth age can get basic free family planning service. But problems still exist such as single propaganda method, examination fee and bad attitude toward customers of medical staff and so on. "Current resident area centered two way regulations" is mainly carried out at the district level. There is no routine communication between current resident area and domicile and the responsibility division is also not clear. The establishment of family planning information system has achieved some effect, but for some reasons such as bad propaganda and fee chargement and so on, lots of migrants leave their hometown without the marriage and child birth certificate. "Lack of power, without compulsive methods" is the most difficult promblem need to be conquered in the family planning regulation and service among migrants. They need to cooperate with police, community and domestic family planning service institute to strengthen their abilities. The obstacles need to be overcome including: "strengthen propaganda", "provide free and convenient medical service", "leader attention" and "cooperate with department of health" and so on.CONCLUSION: The contraceptive condition of Shanghai Minhang district migrants seems not to be optimistic. The number of migrants is huge, and they are extremely mobile and sexually active. Non marital sex, sex outside marriage, commercial sex and multi-sexual partners are quite common among this population. The contraceptive using condition is poor; the proportion of contraceptive informed choice is low and the knowing rates of common contraceptives are low. Migrants know very little about contraceptive principals, correct use methods and side-effects. Their condom use knowledge and contraceptives’ HIV prevention function knowledge are also quite bad. Migrants know little about the family planning policy and family planning service items, but they have high requirement for family planning service. |
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