Family Planning Services: Help Women Exercise Better
Their Reproductive Rights

   Empowering women with the ability to regulate and control their fertility is a basic requirement for women's health, well- being, and quality of life. The Beijing Platform of Action of the Fourth World Conference on Women included concepts that reflected the  reproductive rights and health needs of women, and efforts were to be made in this respect. In order to effectively translate the strategic goals of the Beijing Conference into action, it is important that family planning services be designed to increase women's contraceptive options, ensure proper use of contraception and meet their reproductive health needs. Here I want to share with you some of the approaches adopted by family planning programmes in providing comprehensive contraception and reproductive health care services throughout women's reproductive life, in my Province Jiangsu and China in recent years to help women be better informed and more capable in regulating and controlling their fertility, as well as challenges we are confronted in this respect.
   
    I. Informed choice and regular follow-up
    It is the basic rights of women to decide freely and responsibly the  number, spacing and timing of their children and to have access to information and means to do so. (POA, ICPDC) Contraceptives provided to women for regulating their fertility should be chosen by women, appropriate to women and properly used by women..
    When a woman needs to protect herself from unwanted pregnancy, it is the responsibility of family planning services to provide her with not only a full range of safe and reliable methods, but also information that enables her to choose and employ contraception with satisfaction and technical  competence. In many places in China, the family planning service providers have made efforts to inform in detail and without bias the knowledge about contraceptive methods including mechanism, indication, possible side effects, etc. and how to use them, through face-to-face counseling, information material distribution, mass media and various training courses. This has enabled many women clients to get to know about 4 or more contraceptive methods. Couples, after being informed about various methods, are free to choose and switch among their preferred methods for contraception based on their own decision making. Meanwhile, service providers help the couples select the method that suits their health and family life best by providing counseling and necessary physical examination to screen out unsafe choices for the specific client. Careful counseling and regular follow-up rendered by service providers have ensured that women use contraceptive methods properly and handle problems such as side effects timely.
    Take IUD users for example. They are informed to return for follow- up visits 1, 3,   6 and 12 months after the insertion of IUDs for counseling and examination and an annual check-up examination, and if they have any abnormal symptoms such as irregular bleeding or severe abdominal pain, see the doctors  immediately. The family  planning service providers in Yandu County in Jiangsu Province in 1997 conducted 4 times follow-up for 19973 women who had IUD insertion within the first years (2 times by Ultrasound B machine and 2 times home-visit) , and provide remedy measures for  those with IUD expulsion ( 324 cases) , IUD translocation and IUD in situ with a  pregnancy ( 267 cases) . The effective follow-up has enabled women to  continue  their contraceptive use which is conducive to the prevention of unwanted pregnancy.
    
    II. Infertility and RTI management
    Women have the right of access to appropriate health- care services and the best chance of having a healthy infant. (POA, ICPD) In recent years, China’s family planning services have attached great importance to the promotion of women's reproductive health by providing  knowledge, counseling, and where conditions are permitted, management of  reproductive problems, among which are infertility and RTI (reproductive tract infection). In Jiangsu Province, it is easy to find couples with infertility based on the information from computerized MIS for women of reproductive age at township and county levels. Family planning service providers would make  primary diagnose and treatment for infertile couples and refer those who need further diagnose and treatment to hospitals. Again in Yandu County, Jiangsu Province, thanks to the efforts of family planning  service  providers, 89 of over 2000 infertile couples have conceived and 18 have  given birth. As for RTI, family planning service providers usually make gynecological examination for the clients who want to use a specific contraceptive method or who have complains. Women who are found to have RTI will be treated or referred to hospital.
    
    III. STD prevention
For women, the symptoms of infections from STDs are often hidden, making them more difficult to diagnose than in man and the health consequences are often greater, including increased risk of infertility and ectopic pregnancy.(POA, ICPD) As the incidence of STDs is increasing, STDs information and prevention have been included in China's family planning services. Women are provided with information and counseling about the modes of transmission of STDs and how to protect themselves from contracting STDS. Clients identified with STDs by service providers would be referred to hospital.   
    
     IV. Challenges family planning service confronted
     While much have been done by family planning services in empowering women to exercise better their reproductive rights, there still exist gaps between requirement and  reality, and regional differentials which are correlated with  indicators  of  socio- economic development. The main aspects of challenges China's family planning services are now confronted are as follows:
    1. Sexuality education among teenagers and young adult needs to be strengthened. Nowadays, premarital conception is rising. Many women in their young adulthood  years have to resort to abortion. Family planning services should make greater efforts  to increase the coverage of sexuality education targeted at this population group. In addition, appropriate ways of communication should be designed and used to ensure sensitivity to specific culture and acceptability to both parents and children.
    2. There is much room for improvement in providing  informed  choice of contraceptive methods. A sample survey in 1997 reveals that 57. 98% of IUD users did not know the types of IUDs they were using and 54. 26% of married women did  not  know there is a need for contraception in lactation, indicating that in some areas the practice of informed choice is far from satisfaction. 
    3. With the HIV/Aids epidemic spreading rapidly in China, the task of AIDS prevention is imperative and arduous. Family planning services should make full use of existing resources and to be involved actively in combating HIV/AIDS by providing relevant information and counseling to women clients, in order to enhance their capability to combat AIDS. To achieve this goal, first and foremost, training of service providers should be given priority.
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