| (Background] The report of China’s migrant development in 2012 shows that the number of immigrants in China has reached as much as 230 million by 2011, accounting for 17% of the national total population, with the average age about 28 years old. New-generation migrant workers who were born in the 1980s constitute nearly half the working-age migrants. Given its large and fast-growing population, contraception and population control are extremely important issues in China. Rural-to-urban migrants are mainly young and sexually active. Because they are far from home and thus released from the restraints typically exerted by their families and experience all sorts of temptation and impact owing to new environment, their attitudes about sexuality have changed radically:their approach is now considerably more relaxed, both premarital and extramarital sexulity have become quite frequent, safe sex consciousness is quite poor. Therefore, the risk of unintended pregnancy and infection with STIs, including HIV, is considerable. To alleviate these problems, it is a very important measure for us to carry out family planning services with informed choice on contraception as the core among immigrants. However, due to migrants have wide distribution, great mobility, complex composition, quickly changed place of residence, employment and family planning information and so on, it is rather difficult and impediment for us to informed choice on contraception in immigrants. With the stable low fertility level in China, it has become a significant issue for the transition of family planning program to implement and promote informed choice on contraceptives effectively. There is rare research on informed choice implemented among immigrants in China. There are no sufficient evidences for the effect of informed choice implemented in immigrants and the problems probably occurred during the implementation of informed choice and its countermeasures.[Objective] A series of intervention have been implemented to evaluate the intervention effect according to the examination of contraceptive, reproductive will, contraceptive knowledge, contraceptive application and service demands from floating population; to explore an appropriate model of informed choice/contraceptive service to generalize effective contraceptives among migrants, and to provide investigative base, scientific evidences for the government to develop strategies to provide contraceptive among migrants.[Methods] A community-based intervention study was conducted in 13 streets in Xuhui District, Shanghai. Six streets were randomly assigned intervention group, sever control group. In the intervention group, informed choice on contraceptives was implemented, while routine family planning program was conducted in the control group. According to baseline survey and final evaluation survey, the researchers have evaluated the impacts of intervention on subjects’ knowledge, attitude, practice, changes in behaviour and the influence factors among migrants. Then an effective model of informed choice on contraception among migrants has been can be explored. Univariate and multivariate statistical analyses have been employed, including chi-square test, t test, general linear model, generalized linear models and multi-level model and so on.[Results]1、General information All together,1763 female subjects were enrolled in the baseline survey, and among whom 902 were in the control group and 861 in the intervention group. There were 1686 subjects who were investigated in evaluation survey with 848 in the control group and 838 in the intervention group.2、The demography and characteristics of subjects Mean age of the migrants was 28.0±6 years. Most of them were between 25±34 years, and 98.3% of them were married or with sexual experience. About 45.2% of them had middle school education and about two thirds of them were agriculture accounts. There were no significant difference between intervention group and control group in age, education experience and registered residence. Over 90% of subject lived in every place for more than 11months a year and the cumulative time for their living in Shanghai has been longer than half a year and labor/work-based is a principal cause of migration for them. About 90% of the subjects take up their residence with a spouse/sex partner. About 75% of the subjects expect 2 children and most had no significantly gender tendency for children. About 64% of the subjects have 1 child and about 18% of them have 2 children.3、Intervention activities improved the subjects’ knowledge on contraceptives The results showed that, in baseline investigation, the mean score of the intervention group was only 51.7; but the mean score rose 65.1 after intervention during the evaluation survey in which there were significant difference between the intervention group and the control group (p=6.3). The rate of awareness of different contraceptive methods among subjects rise over 15%, and the greatest improvement is female condoms (31.3%), followed by emergency contraception (27.1%), coitus and male condoms have minimum improvement, respectively, 16.6% and 16.8%.4、The intervention improved the awareness of contraceptive informed choice of subjects and subjects’ attitude toward informed choice The results showed that the intervention facilitated the awareness of contraceptive informed choice of subjects, and the awareness rates of contraceptive informed choice increased from 80.8% in baseline survey to 93.0% in evaluation survey in the intervention group. The intervention facilitated the agreement of contraceptive informed choice of subjects, and the agreement rates of contraceptive informed choice increased from 81.7% in baseline survey to 93.9% in evaluation survey in the intervention group, the agreement from 6.9% to 1.1%.5、The implementation of intervention project has changed the distribution of contraceptive methods used by subjects and thus enhanced clients’ satisfaction level The contraceptive prevalence rate of subjects increased from 80.7% in baseline survey to 94.1% in the intervention group, about 45.7% of the subjects in the intervention group used male condom in baseline survey, and 54.8% used male condom in evaluation survey; but there was little change in IUD use. The intervention promoted reversible contraceptive methods choice of subjects, and those subjects in the intervention group were 2.54 likely to use reversible contraceptive methods than ones in the control group. The satisfaction level of contraceptive use ascended from 80.3% in baseline survey to 91.5% in evaluation survey in the intervention group in which more subjects in the intervention group reported an elevated satisfaction than ones in the control group [OR=2.46,95%OR:(1.69,3.58)].6、The intervention facilitated subjects to select contraceptive methods by themselves The results of evaluation survey showed that the contraceptive method applied by 61.7% of respondents had been selected by themselves in the control group, and 69.6% of them chose by themselves and the proportion of the method selected by others decreased to 5.5% in the intervention group. Subjects in the intervention group were 2.38 [OR=3.38,95% OR:(2.42,4.84)] likely to choose contraceptive methods by themselves (person, the other, both) than ones in the control group using multi-level model.7、The intervention facilitated subjects to seek the counseling service and thus enhanced clients’satisfaction level During baseline survey, about 20% of subjects seek the counseling service in city, and in the evaluation survey only 40% of subjects in the intervention group have had the service higher than 17.9% in the control group. There were significant difference between them [OR=3.896,95% OR:(3.05-5.16)]. During evaluation survey, the great satisfaction level ascended from 71.7% in the control group to 78.8% in the intervention group; there were no difference about satisfaction between 2 groups.8、A small of number of migrants have accepted management and family planning services, while the need and demand for reproductive health care services in migrant female was unmet During baseline survey, about 20% of subjects have not go through the formalities of migrants’marriage and child rearing and in the current place of residence a small portion of migrants have seeked IPPF check and counseling services. Migrants have kinds of family planning services including free contraceptives, contraceptive methods, informed choice, issuance of sexual and reproductive health knowledge promotional materials, prenatal care, regularly organized sexual and reproductive health knowledge, lectures, Richard ring, prevention and treatment of reproductive tract infections, partner/AIDS prevention and treatment services.9、There were a number of advantages and disadvantages that influenced the implementation of informed choice The advantages included:IPPF staff having good service, concentrated migrants being beneficial to education, all ages of migrants, wide publicity, enough kinds of family planning services in the current place of residence, sufficient kinds of contraceptives, good base of collaborative work between health department and hospital, plenty of promotional materials. IPPF lack of professional knowledge, migrants lack of contraceptive knowledge, poor protection awareness, lack of family planning personnel, poor implementation of policy, lack the necessary equipment, poor understanding of policies and regulations, inadequate propaganda, inspection fees; lack of communication between the current place of residence and domicile place.[Conclusion] Intervention activities promoted people’s knowledge on contraceptives, improved the awareness of contraceptive informed choice of subjects and subjects’ attitude toward informed choice, changed the distribution of contraceptive methods used by subjects and thus enhanced clients’ satisfaction level, facilitated subjects to seek the counseling service and thus enhanced clients’ satisfaction level, helped couples at reproductive age to make self-decision on contraceptives. We should develop further the new family planning working style-contraceptive informed choice in migrants in order to improve the levels of family planning services and the capabilities of mass contraceptive informed choice, and to further improve migrant female’s reproductive health. |
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