The Study Of The Promotion Of Family Planning&Reproductive Health Rights And It’s Influence To Quality Of Care

[Background]Family planning is an inevitable and historical choice as a basic policy of China under the specific status of population and social development, and family planning service is the core of the reproductive health services in China. Since the international conference on population and development held in Cairo In1994, the concepts of sexual and reproductive health&rights (SRHR) which the international society emphasized have been accepted by Chinese government. Both service fields and contents of family planning has shifted from the simple population control to the combination of population control, population and health. The work mechanism has changed from simple administrative management into the combination of high quality service and scientific management. The shift from family planning service to reproductive health service both in knowledge and in practice was made gradually by the family planning system. The women-central reproductive health had played a prominent role in the whole reproductive health field. As the rapid and comprehensive progress of human society, especially since the Fourth World Women Conference in1995, protecting and respecting women’s reproductive health rights had been highly concerned gradually in reproductive health fields, even in national overall routine. In recent years, a lot of research and practice were conducted in reproductive health field worldwide. However, striving for and maintaining human reproductive health rights are still in the process, and more research and rethink are still needed.The support environment of promoting women’s family planning&reproductive health rights was formed based on a series of rules and regulations with the law of the People’s Republic of Population and Family Planning as a representative. Client-centered has been the core concept of strengthening population and family planning service, as well as formatting and perfecting the humanized management and service mechanism. Nationwide high-quality service has been generally carried out. Informed choice helped family planning clients to express their own goals with safety and dignity in the care of quality and improved the reproductive family planning service quality and furthered women’s empowerment in these efforts to in China. However, fully realizing the women’s family planning and reproductive health right still faces severe challenges:On the one hand, there are some contradictions between individual rights and national policies, as well as between the current interests and long-term interests, which should be coordinated. With the constant development of society and the deepening of the economy reform, the desires and requirements of impartial, empowerment and harmony come from the mass are more urgent than before. On the other hand, the service level of family planning service team is rather low, and service concept is still not perfect. Meanwhile, comprehensive and scientific understanding of people-oriented family planning service is not obtained by service personnel, and then the people-oriented family planning service is not conducted by service personnel. Family planning service providers pay no attention to clients’ rights and cannot understand clients’ rights fully with the lack of awareness and skill in realizing of clients’ rights in family planning. At the same time, the women at reproductive age can’t actively participate in service and maintenance of their rights because of the short of knowledge of basic rights in family planning. Therefore, to solve these problems above, it is urgent to re-examine the family planning and reproductive health services in perspective of realizing clients’ rights in family planning. To advocate policy and to implement the administration according to law, the consciousness of service providers should also be enhanced. The urgent needs are to improve the family planning service providers’ knowledge, service awareness and skills related SRHR, but also to provide further publicity, education, advocacy, and comprehensive consulting services related SRHR in public, especially among women at reproductive age.[Objective]The aims include to explore current achievement of reproductive health rights among women of child-bearing age in China and to design the intervention plans and to implement a series of intervention activities of promoting SRHR among providers and women of child-bearing age in the pilot areas, and then to evaluate the intervention effect, and to explore further approach to deepen family planning service from visual angle of child-bearing aged women’s of family planning and reproductive health right. [Methods]This study was designed as a community-based intervention program with the qualitative and quantitative methods to collect data. The multistage systematic sampling was used. In Stage one, four pilot areas including Chongqing City, Guangdong Province, Inner Mongolia Autonomous Region and Henan Province were selected. In Stage two, two counties with similar condition of development were chosen in each pilot area and were randomly assigned to intervention group and control group. The intervention activities mainly including education, propaganda, integrated sexuality and reproductive health rights counselling were implemented among women of child-bearing age in intervention group and the intervention mainly including advocacy, propaganda, SRHR integrated training were implemented among FP staff in intervention group, while routine FP work was conducted in the control group. One town was randomly chosen from intervention group and control group respectively in each pilot area as the site of survey in baseline. And another town was randomly chosen from intervention group and control group respectively in each pilot area as the site of survey in end line. Eligible married women of child-bearing age and FP centre personnel were recruited in these towns selected for survey. Information was gathered by quantitative questionnaires, focus group discussion and in-depth interviews. The intervention effects were evaluated by comparing the results of base line survey and end line survey. The overall impact of the protection and promotion of SRHR on high quality service was evaluated.[Results]Anonymous interviews were implemented among519subjects including individual in-depth interviews with17family planning management personnel, focus group discussion with473family planning service staff and individual in-depth interviews with29married women of child-bearing age. A quantitative questionnaire was used to gather the information of306family planning service providers from intervention group(153subjects) and control group(153subjects) respectively. Another quantitative questionnaire was used to gather the information of married women of child-bearing age including1879subjects from intervention group and1877subjects from control group. After1year’s intervention,153family planning service providers were followed from intervention group and control group. At the same time, married women of child-bearing age including1964subjects from intervention group and2009subjects from control group were investigated by corresponding questionnaire.1. Current fulfillment and achievement of reproductive women’s family planning and reproductive health rights and the problems existedThrough interviews with FP managers, FP service providers and reproductive women, current status and suggestions of protection and promotion of family planning and reproductive health rights were listed below:1) It is generally known by family planning managers that national policy and laws is the basic guarantee of women’s family planning and reproductive health rights.2) The lack of correct understanding of the relationship between national population policy and women’s family planning and reproductive health rights, as well as the lack of the concern on fulfillment of reproductive women’s family planning and reproductive health rights exist. Specific plans, routine and effective assessment are insufficient to realize women’s family planning and reproductive health rights.3) The front line family planning service system is an important public service organization due to its public accessibility."People oriented" quality service is the basic way of improving women’s family planning and reproductive health rights.4) FP service personnel pay more attention to "technical service" of family planning while pay less attention to "humanistic service" of family planning.5) FP service personnel have the wiliness to protect and to promote reproductive women’s family planning and reproductive health rights. But lack of the knowledge, skills and understanding related to fulfillment of reproductive women’s family planning and reproductive health rights among the front line family planning service providers exists.6) The level of social economic development is still an important restricting factor towards full enjoyment of family planning and reproductive health rights of women. And traditional culture and social gender consciousness from both sides of service providers and service subjects has important effect on the realization of women’s family planning and reproductive health rights.7) The lack of the knowledge, self-empowerment and awareness of women’s family planning and reproductive health rights among women is an serious obstacle for obtaining women’s family planning and reproductive health rights.8) The three advantages to improve women’s family planning and reproductive health rights that family planning service providers considered are " the coherence to development direction of FP in China, and the feasibility"," the support and legal protection from government"," perfect network of PF service " successively. Meanwhile, the three barriers are" the contradiction between national policy and reality"," adverse factors such as traditional social culture, support environment and so on"," insufficient investment" in turn.9) PF service personnel put forward three strategies for promoting women’s family planning and reproductive health rights which include" to strengthen the implementation of policy","to strengthen the propaganda and education of reproductive health rights to develop social culture","to integrate consulting service of SRHR into formal comprehensive consulting service’2. The results from questionnaire investigation among married women of child-bearing age in baseline surveyTotal3756married women of child-bearing age were recruited in baseline survey. Most respondents (78.06%) were aged25to40years old. Nearly43%of them had the education level of junior high school. About56.52%of respondents had an average income of below1000(RMB) monthly. The majority of these women (59.11%) were rural registered residents, and the majority of these women (52.37%) had one child. Multivariate Logistic regression analysis showed that age, register of residence, educational attainment and occupation are the main influencing factors of the number of children. Contraceptive prevalence was90.02%. The main contraceptive methods were the intrauterine device (62.41%), condoms (20.47%) and female sterilization (14.11%). And total use rate of the three methods account for96.99%. Multiple corresponding analysis results showed that women with one child tend to use IUDs while women with two or more children tend to use female sterilization. Most contraceptive decisions made by both husband and wife, the proportion were56.55%. And contraceptive decisions made by oneself accounted for31.03%. There was a certain consistency between the contraceptive measures used in current and the contraceptive measures expected. Among the contraceptive user,77.52%understood the advantages of the contraceptive method they used while50.84%understood the side effects of the contraceptive they used. Nearly30%of the IUDs users did not know the type of their IUDs. And16.50%of the subjects did not know all the payment types of the common contraceptives. And32.89%of the subjects wanted to change the current contraceptive they used.All respondents heard the legal rights of family planning in China, and family planning service personnel were the main source accounting for58.97%. Three of the eight legal rights were understood better by respondents which were "the right to bear according to law","the right to equality between men and women in family planning,"’the right to get the contraception, birth control technology and reproductive health services ", and the proportions of the subjects were86.66%,84.74%and83.44%successively. The last two legal rights understood poorly by respondents were respectively "the right to get information and education about family planning and reproductive health"(60.46%) and "the right to obtain legal relief"(59.64%). There were2504respondents (66.67%) who heard of the view of "family planning service subjects possess their rights in the service process". Three of the ten rights were understood better by these women which were respectively "the right to choose"(86.26%),"the right to privacy and confidentiality"(86.26%) and the right to know (80.39%), and only41.29%of them understood the right to security. There were84.05%of the respondents who thought it was necessary to carry out promotion activities of family planning&reproductive health rights in PF system and there were52.85%of the respondents who required propaganda and education about family planning&reproductive health rights.There were74.36%of the respondents who had heard of "quality of care" and67.17%of the respondents knew local quality of care. There were73.80%of the respondents who heard of "informed choice" and67.60%of them knew local informed choice. There were63.23%of the respondents who heard of "integrated reproductive health counseling" and52.93%of the respondents knew local integrated reproductive health counseling. Among2002respondents who received contraceptive counseling,72.38%were satisfied with the latest service process. Among1442respondents who received integrated SRHR counseling,66.99%were satisfied with the latest service process. Among2913respondents who received latest outpatient service, the proportion of the women who were satisfied with service environment, service attitude, medical equipment, technical level and service project were respectively71.88%,83.45%,80.64%,81.67%, and74.53%.There were73.30%of the respondents who thought FP providers should be trained professionally and there were71.47%of the respondents who thought those FP providers who attained professional qualification authentication should be allowed to provide services.3. Intervention effect on married women of child-bearing ageThe knowledge and awareness of family planning and reproductive health rights including the legal rights in China and women’s rights in service process proposed by international family planning association were improved among married women of child-bearing age through comprehensive intervention. Interventions also enhanced positive attitude towards advocacy of family planning and reproductive health rights widely and boosted the individual needs of education services about family planning and reproductive health rights, and the demands of comprehensive informed choice, integrated sexual and reproductive health service, as well as the service personnel professional quality requirements. Intervention contributed to women’s behavior tendency to seeking for services related to family planning and reproductive health rights. Interventions have no effect on proportion of decision-makers of short-acting reversible contraceptive, as well as the proportion of condom user.4. Intervention effect on FP service providersThe legal rights in China and women’s rights in service process proposed by international family planning association were known generally among FP service providers. After comprehensive intervention, the knowledge and understanding of family planning and reproductive health rights among FP service providers were further increased. FP service providers’skills and abilities of SRHR counseling were improved, but still at a low level. Intervention improved service providers’will to perform SRHR education and integrated counseling service. Family plan service personnel have positive attitudes towards carrying out the activities of family planning and reproductive health rights promotion generally. After intervention, there were more service providers’who considered that the promotion of family planning and reproductive health rights was helpful to the clients’independent decision, harmonious relationship between service providers and clients and the realization of the national population development plan. The needs of skills training among service personnel were increased. Service providers’consensus was that the protection and promotion of SRHR played an important role, and then, education and training were major strategies.5. The results of promotion activities of family planning and reproductive health rights in advance of quality of careAfter intervention, there were more married women of child-bearing age who hold positive attitudes towards the promotion of family planning and reproductive health rights. At the same time, the proportion of the women who knew the quality of care, contraceptive informed choice services and integrated reproductive health counseling were increased. And their accurate and comprehensive understanding of the three services was also increased. The promotion activities of family planning and reproductive health rights have a positive effect on standard operation of contraceptive informed choice services and integrated reproductive health counseling. And these promotion activities promote the positive influence to clients’satisfaction for contraception services while these promotion activities had no effect on clients’ satisfaction for outpatient services. As a result, the proportion of the women who knew the side effects, types and payment types of common contraceptives were all increased. But promotion activities had no effect on the proportion of the women who want to change current contraceptive they used.[Conclusion]Not only did advantages but also obstacles towards protecting and improving women’family planning and reproductive health rights through family planning service system exist. The realization of women’ family planning and reproductive health rights was not enough. On one hand, to improve knowledge and awareness of women’ family planning and reproductive health rights among married women of child-bearing age were extremely necessary. On the other hand, to improve awareness of women’ family planning and reproductive health rights and to improve awareness of humanistic meaning of quality of care among FP managers and providers were also extremely necessary. The collection "education and training, advocacy, and counseling service" as one of the participatory intervention integrated with training, advocacy, and counseling service deliver improve the service providers’ understanding of family planning and reproductive health rights and improve the skills and will of service. The intervention integrated with education, advocacy, and counseling service improve the service subjects’understanding of family planning and reproductive health rights had a positive effect on self empowerment consciousness and corresponding behavior tendency. It was significant and necessary way to propel quality of care deeply through realizing women’s family planning and reproductive health rights. The long-term effects of protection and promotion of women’s family planning and reproductive health rights on women’s family planning&reproductive health should be further evaluated.