Officials in Shanghai have already granted residency rights to second-born children, giving them access to public education and health care. Any future reforms are likely to be downplayed, however, and coupled with calls for achieving national population targets. Whether or not the census results please Beijing, the government will probably continue its efforts to improve the availability and quality of family planning services, a movement underway since the mids. Family planning service centers have sprung up across China, offering method choice counseling, reproductive health services, prenatal care, and pre-marital counseling.
Increasingly affluent parents can often afford to pay the fines or bribes necessary to have above-quota children, or simply travel to a new area to escape scrutiny. As a result, while the government claims that the national fertility rate is 1. A review of 28 studies of PAC scale-up in 20 different countries found that training of a range of service providers was a critical common element [ 57 ]; a focus on both in-service and refresher training is important to ensure sustained high-quality service provision [ 10 ].
This is one of the very few studies to explore service stakeholder perceptions of post-abortion family planning in China; none have been published in English language journals. Its strengths include our in-depth qualitative approach, which allowed concerns of the relevant stakeholders to emerge, and the maximum variation sampling approach which enabled symbolic representation of key diversities in the Chinese context, including regional income levels, ethnic diversity, rural; and urban, migrant and stable populations, as well as different levels and types of facilities: Although thematic saturation was reached, this relatively small sample cannot be considered representative of all contexts within China.
Another potential limitation is loss of meaning in the translation process; this risk has been mitigated to some extent by analysing all data in Chinese before translating identified themes into English for discussion. Service stakeholders in the three diverse provinces of China generally agreed on the need for post-abortion family planning services and identified key population groups at particular risk of unintended pregnancy. In common with other contexts, including low and middle income settings, the sexual and reproductive health needs of vulnerable and marginalized populations require particular attention.
Fostering non-judgemental and sensitive attitudes towards adolescent sexuality and rural-to-urban migrants and developing appropriate health promotion approaches for these groups should be considered in provider training. Based on current health system functioning, systematic changes are needed to develop high-quality PAFP services, including detailed PAFP service guidelines and standards, financial and human resources investment, performance assessment mechanisms and training for providers.
We are thankful to all partners of the INPAC project and interviewees for their support during the qualitative study. Browse Subject Areas? Click through the PLOS taxonomy to find articles in your field. Abstract Post-abortion family planning PAFP has been proposed as a key strategy to decrease unintended pregnancy and repeat induced abortions.
Introduction Although there is limited evidence on the health risks of repeat abortions, there is some evidence of increased risk of reduced fertility, complications and poor outcomes in future pregnancies, in addition to potential psychological impacts [ 1 — 4 ]. Study design Qualitative methods including semi-structured interviews and focus group discussions were used to explore the views of key service stakeholders in relation to their specific context.
Data collection Before the interviews, the topic guides for different stakeholders were developed and piloted. Download: PPT. This was attributed by the majority of participants across all three provinces, in rural and urban areas, to the increasing acceptability of premarital sex as part of changing social attitudes: ZJ People are very casual towards premarital sex.
IDI with Policy maker, HB province Participants, particularly in YN and ZJ province, saw pre-marital sex as leading to abortion due to young, unmarried people being less likely to use contraception. Lack of understanding or awareness of contraception was one of the main perceived reasons for this: The younger the age is, the less likely they will protect themselves, especially for students or those under 20—situations get a little better for those above IDI with manager, YN province Most couples use emergency contraceptives because they fear being pregnant… Most of them [young unmarried women seeking induced-abortion] did not use any contraception method.
All that you need to do is a short sleep! IDI with service provider, YN Province Furthermore, participants across all provinces perceived that abortions were common among rural-to-urban migrants, the majority of whom are relatively young, and unmarried. Gaps in contraceptive information and provision [for marginalised groups]. IDI with health manager, HB Province Some service stakeholders, across all three provinces, emphasized the lack of effective contraceptive education provided to young people either from their families or through their schools. IDI with health manager, YN Province In YN Province, some participants perceived difficulties experienced by ethnic minorities in accessing services related to communication with providers, especially for older people who are less likely to speak standard Mandarin.
IDI with manager, YN province Distance to family planning stations for remote rural populations was also seen as a physical barrier to accessing services. Positive perceptions of PAFP in principle.watch
Providing PAFP still faces challenging. IDI with policy maker, YN province It is not only our responsibility [to provide reproductive health education to young people]… Education should be provided before sexual behavior happens… School should give reproductive health education to students in junior middle school or even earlier.
HBHealth systems considerations for implementing PAFP Service stakeholders across all provinces described three main considerations regarding the feasibility of developing and implementing PAFP services: policy support, human resources, and financial resources. The need for a policy support. IDI with policy maker, HB province A number of service stakeholders also perceived the need for more detailed clinical guidelines and standards and a clear regulation structure to accompany policy, to address concerns about assuring the quality of services.
Financial and human resource considerations. IDI with hospital manager, HB province The majority of service providers in all three provinces perceived that expansion of PAFP services would substantially increase their workloads and saw this as a likely obstacle to the feasibility of implementation. FGD with service providers, ZJ Province Similarly the majority of hospital and departmental managers and policy makers perceived the need for increased human resources to provide PAFP services.
IDI with service manager, YN province Another issue mentioned by a number of service stakeholders in all three provinces was the importance of motivating providers through an incentive structure. IDI with policy maker, ZJ Province Finally, policy makers and managers in HB and YN provinces also mentioned the importance of physical spaces dedicated to the provision of PAFP services, though some saw these as not essential: It will be best if special IEC is done in a dedicated venue, but it requires provision of both human resource and funding.
IDI with service manager, YN province. Discussion The perceptions of service stakeholders including health policy makers, managers and service providers, suggest a number of important areas for attention in the development of equitable, sustainable and effective post-abortion family planning services. Conclusion Service stakeholders in the three diverse provinces of China generally agreed on the need for post-abortion family planning services and identified key population groups at particular risk of unintended pregnancy.
Acknowledgments We are thankful to all partners of the INPAC project and interviewees for their support during the qualitative study. References 1. Long-term physical and psychological health consequences of induced abortion: review of the evidence.
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PAFP CHINA: Post Abortion Family Planning Services in China
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