Contraception and abortion among migrant women in Changzhou, China.

OBJECTIVES: Migrant women in China's industrial cities face particular contraceptive challenges, which have changed in recent years as family planning policy has shifted. Little is known about recent trends in contraception and abortion among China's large internal migrant population. We conducted a survey to examine these issues among factory workers in a large Chinese city. METHODS: Married migrant women (N = 801) aged 20-39 years and working in Changzhou, China, completed an anonymous self-administered questionnaire giving details about their sociodemographic background, work and migration situations, and reproductive health. RESULTS: Current contraceptive use was reported by 86.6% of women. Condoms, which have largely replaced longer acting contraceptive methods in this population in recent years, were being used by 54.9% of contraceptive users. Only 41.2% used a longer acting method, mostly an intrauterine device (IUD). A lifetime history of abortion was reported by 40.4%. In the past year, 5.5% had had an unintended pregnancy and 5.2% had had an induced abortion. Older age, lower level of education, lower income, area of origin and husband's residency were associated with IUD use. Lower income, husband's residency and stronger fertility desire were associated with recent unintended pregnancy. CONCLUSION: The results of the study provide evidence that migrant women in China are relying more than ever on less effective methods of contraception. Unintended pregnancy and abortion are common. China's current informed choice model needs to be improved with the provision of better health education before and after migration and easy access to health and reproductive health care services.

Prenatal care among rural to urban migrant women in China.

BACKGROUND: There is a very large population of internal migrants in China, and the majority of migrant women are of childbearing age. Little is known about their utilization of prenatal care and factors that influence this. We examined this using data from a large national survey of migrants. METHODS: 5372 married rural to urban migrant women aged 20-34 who were included in the 2014 National Dynamic Monitoring Survey on Migrants and who delivered a baby within the previous two years were studied. We examined demographic and migration experience predictors of prenatal care in the first trimester and of adequate prenatal visits. RESULTS: 12.6% of migrant women reported no examination in the first trimester and 27.6% had less than 5 prenatal visits during their latest pregnancy. Multivariate analysis indicated that demographic predictors of delayed and inadequate care included lower educational level, lower income and not having childbearing insurance. Migrating before pregnancy, longer time since migration, having migrated a greater distance, and not returning to their home town for delivery were correlated with better prenatal care. CONCLUSIONS: Many internal migrant women in China do not receive adequate prenatal care. While internal migration before pregnancy seems to promote adequate prenatal care, it also creates barriers to receiving care. Strategies to improve prenatal care utilization include expanding access to childbearing insurance and timely education for women before and after they migrate.

Migration Experiences and Reported Sexual Behavior Among Young, Unmarried Female Migrants in Changzhou, China.

BACKGROUND: China has a large migrant population, including many young unmarried women. Little is known about their sexual behavior, contraceptive use, and risk of unintended pregnancy. METHODS: 475 unmarried female migrants aged 15-24, working in 1 of 6 factories in 2 districts of Changzhou city, completed an anonymous self-administered questionnaire in May 2012 on demographic characteristics, work and living situation, and health. We examined demographic and migration experience predictors of sexual and contraceptive behavior using bivariate and multivariate regressions. RESULTS: 30.1% of the respondents were sexually experienced, with the average age at first sex of 19 years (standard deviation=3). 37.8% reported using contraception at first sex, 58.0% reported using consistent contraception during the past year, and 28.0% reported having at least 1 unintended pregnancy with all unintended pregnancies resulting in abortion. Those who had had at least 1 abortion reported having on average 1.6 abortions [SD=1] in total. Migrating with a boyfriend and changing jobs fewer times were associated with being sexually experienced. Younger age, less education, and changing jobs more times were associated with inconsistent contraceptive use. CONCLUSION: These findings demonstrate there is an unmet need for reproductive health education and services where these women work as well as in their hometown communities. This education must begin early to reach young women before they migrate.

Sexual and reproductive healthcare utilization among women aged 40 to 49 in rural China.

OBJECTIVE: China's national family planning system is mainly directed toward women of early reproductive ages. Most studies of service provision focused on younger women, who almost all receive regular examinations. Little is known about service-seeking behavior among women of late reproductive ages. METHODS: This cross-sectional household survey interviewed 1,811 rural women aged 40 to 49 in seven provinces. We examined sexual and reproductive health, utilization of sexual and reproductive health services, and predictors of receiving a free gynecological examination in the past 2 years. RESULTS: Educational levels were not high, and most women were rural farmers or housewives. More than one-fourth had migrated for work to big cities when they were younger. The mean frequency of sex in the last month was 3.6 times. Approximately 22.7% of women had not received a gynecological examination and 31.2% had not received any health education during the past 2 years. The first choice for where to seek services was township medical facilities (58.4%). On multivariate regression, age, education, migrant working experience, awareness of the need for intrauterine device removal after menopause, health education received, and attitude toward health examinations were significantly associated with receiving a gynecological examination in the past 2 years. CONCLUSIONS: Women of late reproductive age in rural China are not receiving as regular care as younger women. This study identifies sociodemographic and health service correlates for service-seeking behavior, many of which are modifiable. Health services should pay greater attention to this group, including community-based efforts to encourage routine examinations and appropriate use of health services.

What role does transactional sex play in the HIV/STI and reproductive health risk behaviour among high-tier entertainment centre workers in China?

China's rapid economic growth over the last three decades has led to increased population wealth and the proliferation of entertainment centres where people can conduct business, relax and meet new people. Little is known about the sexual risk behaviours of employees at high-tier entertainment centres. This paper addresses this gap in knowledge by comparing HIV risk perception and sexual and reproductive health behaviours among female and male employees at three high-tier entertainment centres in two cities in China, comparing those who report a history of transactional sex to those who do not. In both cities, participants who reported a history of transactional sex were more likely than those without a history of transactional sex to report multiple sexual partnerships, more lifetime sexual partners, a history of sexually transmitted infections (STIs), having anal sex and/or recent abortions, and were more likely to perceive themselves to be at risk for STIs/HIV. However, risk behaviour was also high among those with no history of transactional sex. These findings highlight the need for targeted sexual and reproductive health initiatives for employees in these work settings.

Unmet sexual and reproductive health needs of women aged 50 to 64 years in rural China.

OBJECTIVE: China's family planning program focuses on younger women. Women older than 50 years, especially those in rural areas, are ineligible for free services and often have few other care options. Few studies have examined the sexual and reproductive health demands and unmet needs of these women. METHODS: This cross-sectional, interviewer-administered survey included 1,652 rural women aged 50 to 64 years from seven provinces in China. We examined women's sexual and reproductive health status, knowledge, and service demands, and whether they still had an intrauterine device (IUD). RESULTS: Educational levels were low, and most were rural farmers or housewives. The mean age at menopause was 48.9 years, and 52.4% reported climacteric symptoms. The mean frequency of sex in the last month was 1.8 times. About 47.4% of women had undergone a gynecological examination during the past 2 years. The first choice for care was family planning clinics (31.2%) followed by township hospitals (28.4%). Identified service needs included women's health check-ups (56.5%), sexual health knowledge (54.4%), women's health knowledge (35.4%), menopause counseling (34.8%), and IUD removal after menopause (17.0%). Among 519 postmenopausal women who used an IUD, 19.1% had not had it removed. On multivariate regression, awareness of correct time for IUD removal, beliefs about sex after menopause, receiving formal health education, and undergoing gynecological examination were significantly associated with having had IUD removal. CONCLUSIONS: A large proportion of middle-aged women in rural China lack sexual and reproductive health services, including IUD removal after menopause. A comprehensive program of sexual and reproductive health services is needed for middle-aged women in rural China.

Vulnerability to sexual violence and participation in sex work among high-end entertainment centre workers in Hunan Province, China.

BACKGROUND: China has seen a proliferation of entertainment centres that are frequented by business people. Employees at these centres often are young, female rural-to-urban migrants who may be vulnerable to sexual violence and exploitation. METHODS: Data for this study were collected using a self-administered survey among male and female employees in two high-end entertainment centres in Changsha, Hunan Province, China. We used logistic regression to examine predictors of violent and potentially exploitative experiences (partner violence, forced sex and transactional sex). Predictors included gender, ever having a same-sex partner, migration variables and employment characteristics. RESULTS: Participants reported high levels of partner violence (16.0% ever and 9.0% in the past 3 months) and forced sex (13.9% ever and 5.5% in the past 3 months). Nineteen percent reported sex work in the past 3 months. In the multivariate regressions, ever having had a same-sex partner was associated with higher odds of ever having experienced partner violence (odds ratio (OR)=7.8, P<0.001), partner violence in the past 3 months (OR=9.0, P<0.001), ever having had transactional sex (OR=6.0, P<0.001) and transactional sex in the past 3 months (OR=5.2, P=0.001). After adjusting for transactional sex, the association between having had a same-sex partner and partner violence remained significant. Neither gender nor migration status was associated with any of the outcomes. CONCLUSION: High-end entertainment centre workers in China are at risk for sexual violence and should be targeted with employment-based interventions.