Investigation On The Reproductive Health Status Among Married Female Migrant Workers In Pinghu City, Zhejiang Province And Nanhai District, Guangdong Province

BackgroundThe status of China’s serious imbalance in economic development between regions results in large-scale population movements. The result of the sixth national population census shows that:there were about221million of floating populations in China in2010, the growth rate was81.03%compared with the fifth national census. Zhejiang and Guangdong Province were the two provinces with the most populous migrants in China, and the migrants had rapidly increased in recent years. According to China’s sixth census, there were more than11.8million migrants in Zhejiang Province which accounts for21.7%of residents and almost31.3million migrants in Guangdong Province accounting for30%of residents.Migrant female workers whose workplaces are factories compose the main part of migrant women. Researches showed that about70%of the labor-intensive jobs are done by female workers. On the one hand, the female workers of childbearing age need to participate in industrial production, on the other hand, they are going through a series of special physiological processes in their life like pregnancy, childbirth, puerperium and breast-feeding period. Lack of health protection will do a lot of harm to their reproductive health. In addition, some features of migrant female workers such as great fluidity, low literacy levels, poor awareness and ability of self-care, make them a vulnerable group to reproductive health (RH) problems.The Chinese Ministry of Health and UNICEF launched and partly sponsored Project of Maternal and Child Health Care Service for Urban Migrants (2011-2013) in Pinghu City of Jiaxing, Zhejiang Province and Nanhai District of Foshan, Guangdong Province. The external evaluation team of Fudan School of Public Health developed and conducted the baseline survey in these two areas. As a part of this baseline survey, we aims to understand current RH status of married migrant female workers, in order to provide better RH services to target population.ObjectivesTo understand current Reproductive Health (RH) status of married migrant female workers of child-bearing age, the implementation and the effectiveness of the existing policies and services of RH care for them, and to explore proper strategies and interventions to promote their RH status through quantitative and qualitative survey in pilot factories from Pinghu City, Zhejiang Province and from Nanhai District in Foshan City, Guangdong Province. MethodsQuantitative Study:Cross sectional design was used in the study. Selection of factories was based on the following principles:with eligible population; the owner and managers of the factories was willing to participate in the investigation and to carry out interventions later on. Three garment factories in Pinghu City, an electronics factory and an underwear factory in Nanhai District (hereafter refer as "pilot factories") were selected according to criteria above.The inclusion criteria for subjects were as follows:married female workers; age20-49(child-bearing age); both she and her husband didn’t hold Hukou (the permanent household registration) in the two project areas; living in the project areas for more than six months. All eligible subjects in pilot factories were included in the study.598valid questionnaire in Pinghu and534in Nanhai were obtained.Qualitative Study:The combination of literature review and qualitative interviews were used. Interviewees were chosed by purposive sampling. Types of interviewees in the two project districts were as follows:(1) Directors and staff of relevant government sectors, including directors of Health Bureau, Trade Union, Women’s Federation or Family Planning Committee,3-4persons per area.(2) Managers of factories,1person per factory.(3) The selected migrant workers groups: Each group was composed of5-7workers, whose youngest child is under5years old, or without a child so far,5-7persons per group.38persons were interviewed in total.Results1. Quantitative results:RH status of the workers(1) The general situation of target population and their families:For most investigated workers and their husbands, they only had the qualifications of junior high school or below. Most investigated workers were in poor family economic situation in the two districts,. In Pinghu, the median of workers per capita household income was￥15000, compared with￥10000in Nanhai. Most of the workers were agricultural, workers who had already had a child accounted for more than95%in two areas.(2) The awareness of knowledge on maternal and child health (MCH):MCH knowledge was divided into three parts in the questionnaire:maternity insurance knowledge, maternal health knowledge, and infant feeding knowledge. The awareness rates on MCH knowledge were37.2%(in Pinghu) and48.0%(in Nanhai). The results showed that the median score were5points (in Pinghu) and6points (in Nanhai). Results of multiple linear regression analysis showed that, the possible related factors of score on MCH knowledge included:Educational level of workers and their husbands, per capita household income, years after marriage, whether had born a child, time since they flowed in and the district flowing in. (3) The status of RH indicators and RH service indicators:Menstrual problems occurred commonly in the two project districts, many of the investigated population suffered from menstrual disorder (43.0%in Pinghu,50.9%in Nanhai) and dysmenorrhea25.9%in Pinghu,34.3%in Nanhai). Some workers reported suspected symptoms of reproductive tract infection (29.6%in Pinghu,39.9%in Nanhai), main symptoms were abnormality of vagina discharge and lower abdominal pain. Nearly1/4of workers were diagnosed with gynecological disease within a year (20.5%in Pinghu,26.2%in Nanhai). A majority of workers had participated in a census of gynecological diseases (67.9%in Pinghu,56.7%in Nanhai), the form of which was mainly factory organization.(4) Factors related to the incidence of RH issues:Results of Logistic regression analysis showed that, to the incidence of suspected symptoms of reproductive tract infection, the possible related factors included:Age, the district they flowed in, scores on MCH knowledge. To the detection rate of gynecological disease within a year, the possible related factors included:Per capita household income, whether had participated in a census of gynecological diseases within1year.2. Qualitative results:From workers, factories and areas.There have been a series of policies and regulations relating to RH care for workers issued by the state and project district governments. Since the mandatory of these laws and regulations were generally not strong, and a few requirements caused conflicts to the enterprise’s interest, some of the regulations were not fully implemented in these factories.From the level of areas, the common problems in the two districts were: Insufficient government input, and the government needs to improve their cooperation with factory. The specific problems in Pinghu including:The effectiveness of the maternity insurance was limited, and RH related publicities and education was lacking. In Nanhai, census of gynecological diseases needs to be popularized and institutionalized in factories, and there was obvious shortage on related staffing.From the level of factories, there were conflicts between the enterprise’s interest and supply of RH services, and managers of factories lacked of attention to workers’ RH status. In addition, the irregular schedule of working resulted in a high incidence of menstrual problems in target population.From the level of migrant workers, the characteristics of them limited their utilization of RH service. Such as great fluidity, low literacy levels, poor family economic situation, and the fertility conditions that cannot meet the requirement of family planning.Conclusions and recommendationsThis study found that, the level on MCH knowledge of target population was low, and RH risks were existed in a large number of migrant female workers. To improve the RH status of migrant workers, our government, factories, and female workers themselves bear their respective responsibility.According to the existing problems, this paper puts forward the following suggestions:No longer use the household registration system as the core of social structure, narrow the differences between town and country; Strengthen the government responsibility through providing the relevant financial and human resource support; Strengthen the cooperation between government and factories by effective measures; Improve social security system and to strengthen the related education to maximize the role of maternity insurance; To update existing RH service policies and to supervise the enforcement of these policies in factories; Provide educational services through accessible and convenient channels.