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Deputy Director Tianjin Municipal Research Institute for Family Planning China Population and Environment of Tianjin Tianjin is one of the three municipalities directly under the administration of the People's Republic of China and the largest sea port city of industry and commerce in the north of the country. The city is located in the northeast of the North China Plain in the middle of the belt area bordering the Bohai Sea and at the lower reaches of the Haihe River. The city has long been known as a communications hub and extends from latitude 38degrees 42minutes to 45degrees 15minutes north and from longitude 118degrees 04minutes east. Its coastline is about 133 kilometers and its border is over 700 kilometers. The city has a total area of 11,305 square kilometers extending 186 kilometers from south to north and 101 kilometers from east to west and occupying 154 square kilometers of city center area. The administrative area of Tianjin includes 13 districts and 5 counties and the population of the municipality totals about 9.35 million. 1. Mortality Rates, Index of Education and Index of Reproductive Health Since the International Conference on Population and Development (ICPD) in 1994, Tianjin has made progress in family planning, reproductive health and maternal and child health under guidance of city government and mayor. 1.1 Mortality Rates The infant mortality rate of the city significantly decreased, from 18.53 percent in 1990 to 10.21 percent in 1997. Life expectancy at birth in China was 70/67 for female/male from 1990 to 1995. Maternal mortality rate as infant mortality rate also was reduced significantly from 39.38/10,000 in 1990 to 14.54/10,000 in 1997 (see table 1). 1.2 Index of Education Enrollment ratio in primary school of our city is 100 percent every year from 1995 to 1997 for boys and girls. Percentage of children completing primary education is also 100 percent in Tianjin from 1995 to 1997 for both sexes. Enrollment ratios in secondary education are all 100 percent for male and female from 1995 to 1997 in our city. Our education law indicated every Chinese citizen must complete primary and middle education without paying an education charge. The illiteracy rate of people over 15 years old is zero (see table 2). 1.3 Index of Reproductive Health The percentage of people with knowledge of family planning in our city is 85 percent, 90 percent, 92 percent, respectively from 1995 to 1997. Because family planning is our national policy, the percentage of people with knowledge of family planning increased year after year. Number of births by females aged 15-19 is zero. No 15-19 year-old-girls delivered a baby in the city. Percentage of contraceptive use is 91.38 percent, 90.81 percent and 90.76 percent, respectively from 1995 to 1997 (see table 3). 2. Status of Implementation of ICPD Action Programs in Participant's City 2.1 General Physical Examination for Women Employed women have a physical examination including ultrasound examination of uterine, adnexa, breast, vaginal smear examination for cancer cell, blood biochemical test and blood circulation test every year. 2.2 Population It has been China's basic national policy to promote family planning, curb population growth and improve the health and education standards. Some significant achievements have been made in this endeavor along with the development of China's economy. As a change has taken place in the peoples' concept of marriage and childbearing, more and more people have accepted the idea of later marriage and later childbearing, and fewer and healthier births. The fertility level of women has dropped by a big margin. Excessive population growth has, on the whole, been controlled and the quality of people's lives has gradually improved. Births are 21,313, 19,902, 19,585, respectively in 1995, 1996 and 1997. Natural growth rate is -0.63 percent, -1.46 percent and -2.87 percent, respectively in 1995, 1996 and 1997. 2.3 Family Planning Service 1. Contraceptive method The contraceptive method of choice is mainly intrauterine devices, condoms and contraceptive drugs in the city in 1996 and 1997 (see table 4). There is a family planning service station in residential areas and a family planning doctor at the workplace, responsible for family planning of married women in Tianjin. 2. Abortion Abortion is legal in China. If contraception failure takes place, termination of pregnancy should be made. Surgical method with vacuum aspiration is the main method in early pregnancy. Medical abortion with mifepristone and prostaglandin is used in about 20 percent of pregnancies. 2.4 Reproductive Tract Infection and STDs Reproductive tract infections and STDs are not serious problems in Tianjin. Diagnosis of etiologic organisms is conducted in only a few hospitals in Tianjin. 2.5 Maternal and Infant Health Care 1. Prenatal health care In order to protect pregnant women's health and promote fetus development, the Tianjin government made some decisions. Pregnant women must go to see a doctor regularly. The pregnant woman should be examined once a month during the early pregnancy but in late pregnancy should see a doctor once a week. The examination includes physical, blood test and ultrasound. Some congenital malformations are caused by genetic factors (chromosomal abnormalities and mutant genes) and a few environmental factors (infection agents and teratogenic drugs), but most common malformations result from a complex interaction of genetic and environmental factors (multifactorial inheritance). Three viruses and toxoplasma gondii are known to be teratogenic in humans: rubella virus, cytomegalovirus and herpes simplex virus. Toxoplasma gondii, rubella virus, cytomegalovirus and herpes simplex virus are named TORCH. In order to decrease birth defect, women who want to become pregnant need a test for TORCH before conception. If TORCH takes place in pregnancy, treatment or termination of pregnancy should be done. 2. Postnatal health care Mother and child should go to the hospital or clinic to have a postnatal examination 42 days after delivery. In order to prevent and decrease acute infection diseases, a newborn needs vaccine inoculations in Tianjin. They include BCG vaccine for TB, bovin vaccine for smallpox, oral poliomyelitis vaccine for poliomyelitis, measles vaccine for measles, diphtheria combined with whooping cough vaccine and tetanustoxoid for whooping cough, diphtheria and tetanus, encephalitis B vaccine for encephalitis B and hepatitis B vaccine for hepatitis B. 3. Current Situation and Problems of "Family Planning, Reproductive Health and Maternal and Child Health" Policies in Participant's City 3.1 Current Situation of Family Planning, Reproductive Health and Maternal and Child Health 1.General physical examination for women Employed women have a general physical examination yearly. 2. Population The population of the municipality is about 9.7 million and the natural growth rate is negative at present. 3. Family planning service (1) Contraceptive method choice An Intrauterine device is the first choice for contraception in Tianjin. (2) Emergency contraception If contraception failure takes place, emergency contraception is available at present in Tianjin. Emergency contraception is a way of preventing pregnancy without using contraception. The most common method is Emergency Contraceptive Pills (ECPs). In some cases, a copper intrauterine device (IUD) also can be used as emergency contraception. All emergency contraceptive methods must be used within several days of unprotected sex. They are effective and safe for most women. (3) Abortion Two abortion methods are available in Tianjin. First, the surgical method with dilation and vacuum aspiration became established as the standard method for abortion performed at up to 63 days of amenorrhoea. The procedure can be carried out in a clinic operating room and does not usually require an overnight stay in a hospital. The rate of serious complication is low. Second, medical abortion with mifepristone and prostaglandin has been shown to be safe and effective with no more complications than dilatation and vacuum aspiration. At present acceptability of the two methods is 50 percent respectively in Tianjin. (4) Post-abortion family planning A service of post-abortion family planning is available in Tianjin, offering information on how to select a contraceptive method after an abortion. If the clients do not have complications, most methods can be given immediately. Following uncomplicated abortion, there are no medical restrictions for IUD (copper or levonorgestrel-), pill (combined or progestogen only), injectables (combined or progestogen only), Norplant implants, barrier methods (spermicides, condoms), female or male sterilization. Natural family planning is available when a normal menstrual pattern returns. (5) Contraception of late premenopause Our city can deliver services for late premenopausal women. The majority of women in their forties are potentially fertile, yet almost all have achieved their desired family size. Safe, efficacious and acceptable contraception is a high priority for older premenopausal women. Pregnancy in women over 35 causes health risks to both the mother and fetus. Maternal mortality, spontaneous abortion, perinatal mortality and fetal anomalies all increase with increasing maternal age. Combined oral contraceptives containing low doses of an estrogen and a progestogen are suitable for health, non-smoking women over 35. Progestogen-only contraceptives (oral preparations, implants, depot injectable or IUDs) may be suitable for late premenopausal women. Barrier methods may be the method of choice for late premenopausal women whose fertility and frequency of coitus are low. Condoms can reduce transmission of HIV infection. This is an important consideration in areas of high HIV prevalence. Male or female sterilization is an excellent contraceptive option if this approach is acceptable and available at reasonable cost and low risk. 4. Reproductive tract infection and STDs Reproductive tract infections are viral, bacterial and protozoan infections of the lower and upper reproductive tracts, transmitted through sexual intercourse, unsafe childbirth, abortion and other practices, including genital mutilation, or the result of poor hygiene. STDs are a significant global health problem, particularly among the poor. While everyone is susceptible to reproductive tract infections, some population groups are at increased risk. Since STDs in women often do not display obvious symptoms, they are more difficult to detect and treat. The risk of transmission from infected men to women is also greater than from infected women to men, and many women are powerless to take steps to protect themselves. In addition, the health consequences are more serious for women than for men. Complications include pelvic inflammatory disease, infertility, pelvic pain and ectopic pregnancy. Further, there exists a risk of transmission from mother to fetus or newborn. Although STDs are not as common in China as in other Asian countries, it is believed that the prevalence is increasing in China. Our government has paid more attention to prevention and control of STDs/AIDS in recent years. Sixteen HIV primary screening laboratories, an HIV confirmation laboratory and a research institute for sexually transmitted diseases are established in Tianjin. Tianjin Municipal Hospitals have as STDs diagnosis laboratory. The staff members of the laboratory are trained in diagnosis. Etiologic organisms tests include syphilis, neisseria gonorrhoea, chlamydia trachomatis, human immunodeficiency virus, chancroid, candida albicans, ureaplasma urealyticum, mycoplasma hominis and trichomonas. Effective management of STD is one of the cornerstones of STD control, as it prevents the development of complications and sequelae, decreases the spread of those diseases in the community, and offers a unique opportunity for targeted education about HIV prevention. Various antibiotics for treatment of STDs are available in Tianjin hospitals and pharmacies. WHO indicated that a condom is the sole method to protect against pregnancy and STDs. In order to prevent STDs/AIDS, various condoms are available freely in the factories, government department, public institutes, etc. for working people. However, in private units or private sectors, condoms should be bought in drug store or pharmacies in Tianjin. Both male and female condoms are made in Tianjin. 5. Infertility The prevalence of infertility is about 15 percent in Tianjin. Diagnosis and treatment of infertility are hospital responsibilities. Reproductive health includes infertility service. Some family planning clinics and stations undertake male and female infertility services in Tianjin. 3.2 Problems 1.The establishment of a socialist market economy has exposed family planning to new situations and new problems. The promotion of family planning among the more transient population remains a challenge. Many problems are yet to be solved concerning the quality of life and structure of the population. 2. The opulation is getting older and in Tianjin. A child will be responsible for taking care of four older people, e.g. mother, father, mother-in-law and father-in-law, when his parents become older and older. Establishing an old age insurance system requires attention. 3. Adolescent service There are sex education courses in high school and university, but the level is low. If an adolescent needs reproductive health service, finding them is a problem. 4. How to service the poor family in the field of reproductive health 5. It should be noted that we can not afford to remain optimistic about Tianjin's population situation, although natural growth rate remains negative. It is difficult to manage family planning for reproductive-age women who do not live a stable domestic environment. Therefore, the risk of population growth is present in Tianjin. |