Effects Of Policy And Socioeconomic Environments And Individual Characteristics On Women's Contraceptive Choices And Reproductive Track Infections In Rural China

[Background and Objectives]Family Planning (FP) has been one of the basic national policies since three decades before. Under the circumstance that fertility level in China has been below replacement level for many years, improvement of FP and Reproductive Health (RH) services is becoming one of the national priorities. Considering China's vast scale and complicated geographical environment, Family Planning policy and socio-economic development is greatly diversified between provinces. However, the effects of the political and socio-economic factors on the FP choices and RH outcomes are little documented. This study is aimed to explore the effect of macro-social factors such as population policy, economical development and social culture as well as individual characteristics on women's contraceptive choices and reproductive track infections (RTIs). Similar researches are rare.[Methods]The data used in this study came from two sources. Population policy and socio-economic factors were from relevant literature, while family/individual characteristics came from the "Eleventh Five-Year" project titled "Behavior changes in choosing contraceptives and reproductive health care technologies in China". By using stratified and random cluster sampling methods, the survey was conducted in 43 rural villages/urban neighborhoods in 9 provinces, where the social and economic development lies at middle level of China in 2009. Structured questionnaire was used to investigate women who were aged between 20 and 49 year-old at the study sites. Information on living conditions, economic status, participants'background, hygiene habits, reproductive and contraception history and symptoms of RTIs during last 12 months was collected. Descriptive methods andx2 test were used in the statistics analysis. Multilevel logistic regression was used to investigate the determinants of contraceptive adoption and to explore potential risk factors of women's RTI. SAS v9.1 and MLwiN 2.22 were used for the analyses.[Results]A total of 10612 married women aged 20-49 years old were interviewed. Of them,94.3% currently used any contraceptive method. IUD was the dominant method, accounting for 69.1 of all users, which was followed by sterilization (22.3%) and condom (7.5%). Women from provinces with higher GDP per capita, lower illiteracy rate or dominated by a one-child policy were more likely to use IUD and condom. Those from provinces with lower GDP per capita, higher illiteracy rate or dominated by a 1.5-child policy were more likely to use sterilization than their counterparts. Compared with IUD users, those from poor families, aged 30 years or older, the less-educated, farmers and those having≥2 live births were significantly more likely to use sterilization; women from richer families, less than 30 years old, the better-educated, non-agricultural workers, and those having no live birth were significantly more likely to use condom. Nearly 31% of respondents reported any symptom of RTIs during last 12 months. The rates of reporting≥2/≥3 kinds of symptoms were 22.23% and 10.4% respectively. Women who lived in provinces with lower GDP per capita or fewer doctors per 10000 people and those who came from poor families with poor sanitation, the older, farmers, the less-educated, sterilization users or non-method users, women having multiple pregnancies or live births and those having an abortion history were significantly more likely to experience RTIs than their respective counterparts.[Conclusions]Political and socio-economic environments have significant influence on contraceptive adoption among married women in rural China. Evidences from this study indicate that the contraceptive pattern in rural areas appears changing, suggesting that rural contraceptive services needs to improve. The prevalence of RTIs is high in rural areas and the likelihood of RTIs is affected by a variety of individual characteristics and provincial level socio-economic factors. Any intervention to prevent RTIs in rural China should consider the effects of these factors.