Mr. Hou Qingchang
Deputy Director, Tianjin Municipal Research Institute for Family Planning
Tianjin, China

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 the mayor.

1.1 Mortality Rates

The Infant Mortality Rate of our city significantly decreased from 18.53% in 1990 to 10.21% in 1997. 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).

	1990	1995	1996	1997
Infant Mortality Rate Maternal Mortality Rate (per 10,000)	18.53% 39.38	11.94% 18.61	10.75% 15.47	10.21% 14.54

1.2 Index of Education

Enrollment ratio in primary school of our city is 100% every year from 1995 to 1997 for boys and girls. Percentage of children completing primary education is also 100% in Tianjin from 1995 to 1997 for both sexes. Enrollment ratios in secondary education are 100% 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 education charge. Illiteracy rate of people over 15 years old is zero (see table 2).

	1995	1996	1997
Enrollment Ratio in Primary Education Percentage of Children Completing Primary Education Enrollment Ratio in Middle Education Illiteracy Rate of People Over 15 Years Old	100% 100% 100% 0	100% 100% 100% 0	100% 100% 100% 0

1.3 Index of Reproductive Health

Percentage of people with knowledge of family planning in our city is 85%, 90%, 92%, respectively from 1995 to 1997, because family planning is our national policy, percentage of people with knowledge of family planning increased year after year. Number of birth by females aged 15-19 is zero. None of 15-19 years old girl delivered baby in our city. Percentage of contraceptive use is 91.38%, 90.81% and 90.76%, respectively from 1995 to 1997(see table 3).

	1995	1996	1997
Percentage of People with Knowledge of Family Planning Number of Birth by Female Aged 15-19 (per 1,000 persons) Percentage of Contraceptive Use	85.4% 0 91.38	90.3% 0 90.81	92.2% 0 90.76

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 routing 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 people's concept of marriage and childbearing, more and more people have accepted the idea of later marriage and later childbearing, 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. Birth number is 21,313, 19,902, 19,585 people, respectively in 1995, 1996 and 1997. Natural growth rate is -0.63%, -1.46% and -2.87%, respectively in 1995, 1996 and 1997.

2.3 Family Planning Service
2.3.1 Contraceptive method
Contraceptive method choice is mainly intrauterine device, condom and contraceptive drugs in our city in 1996 and 1997 (see table 4).

	1996	1997
Male Sterilization	0.66%	0.43%
Female Sterilization	2.0%	1.34%
IUD	52.7%	38.8%
Implant	-	0.23%
Oral, injection, contraceptive drug	5.8%	29.28%
Condom	39.2%	29.8%
Spermicides	0.15%	0.12%

There is a family planning service station in your living place and a family planning doctor in your working place responsible for family planning of married women in Tianiin.

2.3.2 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% of pregnancies.

2.4 Reproductive Tract Infection and STDs

Reproductive tract infection and STDs are not serious problems in Tianjin. Diagnosis of etiologic organisms is conducted in only a few hospitals in Tianiin.

2.5 Maternal and Infant Health Care

2.5.1 Prenatal health care
In order to protect pregnant women's health and promote fetus development, Tianjin government made some decisions. Pregnant women must go to see a doctor regularly. The pregnant women should be examined once a month during the early pregnancy but in late pregnancy they 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 (infections 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, the women who wanted pregnancy need test of TORCH before pregnancy If TORCH positive take places in pregnancy, treatment or termination of pregnancy should be done.

2.5.2 Postnatal health care

Women with her baby should go to hospital or clinic to have postnatal examination at 42 days of delivery. In order to prevent and decrease acute infection diseases, 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

3.1.1 General physical examination for women
Employed women have general physical examination as before yearly.

3.1.2 Population
The population of the municipality is about 9.7 million in total and natural growth rate is negative at present.

3.1.3 Family planning service

(1) Contraceptive method choice
Intrauterine device is 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 if you have had sex without using contraception or if you had a contraceptive accident. 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, surgical method with dilation and vacuum aspiration became established as standard method for abortion performed at up to 63 days of amenorrhoea. The procedure can be carried out in clinic operating room and does not usually require an overnight stay in hospital. The rate of serious complication is low. Second, medical abortion with mifepristone and prostaglandin has been shown safe and effective with no more complications than dilatation and vacuum aspiration. At present acceptability of two methods is 50% respectively in Tianjin.

(4) Post-abortion family planning
After abortion how to select contraceptive method. A service of post-abortion family planning is available in Tianjin. 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 give service for late premenopause women. The majority of women in forties are potentially fertile, yet almost all have achieved their desired family size. Safe, efficacious and acceptable contraception is high priority for older premenopausal women. Pregnancy in women aged 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 the aged 35. Progestogen-only contraceptives (oral preparations, implants, depot injectable or lUDs) may be suitable for late premenopausa! 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.

3.1.4 Reproductive tract infection and STDs

Reproductive tract infections are vital, bacterial and protozoan infectious of the lower and upper reproductive tract, 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 increasec 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 man) 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 as in China as in other Asian countries, it is believed that the prevalence is increasing in China. Our government paid more attention to prevention and control of STDs/AIDS in recent years. Sixteen HIV primary screen laboratories, an HIV conformation laboratory and a research institute for sexually transmitted disease are established in Tianjin. Tianjin Municipal Hospitals have a STDs diagnosis laboratory. The staff members of the laboratory are trained in diagnosis. Etiologic organisms of test include syphilis, neisseria gonorrhoea, chlamysia 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, decrease 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 condom is 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 institute, etc. for working people. However, in private units or private sectors, condoms should be bought in drug store or pharmacies in Tianiin. Both male and female condoms were made in Tianiin.

3.1.5 Infertility

Prevalence of infertility is about 15% in Tianjin. Diagnosis and treatment of infertility are hospital responsibility. Now reproductive health includes infertility service. So some family planning clinic and station undertake male and female infertility service in Tianjin.

3.2 Problems

3.2.1. The establishment of socialism market economy has exposed family planning to new situations and new problems. The promotion of family planning among the floating population remains a challenging job. Many problems are yet to be solved concerning the quality of life and structure of the population.

3.2.2. Population is getting older and older in Tianjin. A child will be responsible for taking care of four old people e.g. mother, father, mother in law and father in law, when his parents become older and older. How to establish old age insurance system.

3.2.3. Adolescent service
There are sex education courses in high school and university, but the level is low. If adolescent needs reproductive health service who or where can give service for them.

3.2.4. How to service the poor family in the field of reproductive

3.2.5. It should be noted that we can not afford to rest optimistic about Tianjin population situation although natural growth rate remains negative. It is difficult to manage family planning for floating reproductive age women. Therefore, the risk of population growth is present in Tianiin.

| TO TOP |