A multilevel analysis of the effects of a reproductive health programme that encouraged informed choice of contraceptive method rather than use of officially preferred methods, China 2003–2005

Abstract

Historically, the Chinese government's family planning (FP) policy has emphasized post-partum IUD use after first birth and sterilization after subsequent births. Was the influence of this policy-driven programme on women's contraceptive choices weakened by a reproductive health intervention programme based on the idea of enabling and encouraging clients to make an informed choice? Multilevel analyses of cross-sectional data from baseline (2003) and endline (2005) surveys conducted as part of the evaluation of a large-scale UNFPA RH/FP programme show significant reductions in the uptake of methods emphasized by official policy between the two surveys. But county-level effects are highly significant, suggesting the continuation of a strong exogenous influence on women's choices. The results suggest that, while the intervention had the effect of weakening the top-down approach towards promoting methods, family planning workers continued to be influential in promoting sterilization for women at higher parities.

Keywords:

• family planning
• reproductive health
• China
• programme intervention
• contraceptive choice
• multilevel analysis

Notes

1. James J. Brown is at the Department of Quantitative Social Science, Institute of Education, University of London; Li Bohua is at the China Population and Research Centre, Beijing, China; Sabu S. Padmadas (corresponding author) is at the Southampton Statistical Sciences Research Institute and Centre for Global Health, Population, Poverty and Policy, University of Southampton, Highfield, Southampton SO17 1BJ, UK. E-mail: [email protected]; [email protected]; [email protected]

2. The views expressed in this paper are solely those of the authors and do not represent the official views of the UNFPA, the National Population and Family Planning Commission, or the Ministry of Health, People's Republic of China. We thank Professor John Micklewright and anonymous reviewers for providing us with useful comments and suggestions on an earlier version of this paper. Collaborative work on the original evaluation of the UNFPA Intervention by James Brown and Sabu Padmadas was funded by the UK Government's Department for International Development through UNFPA. A previous version of this paper was presented at the annual meeting of the Population Association of America held in New York, 29–31 March 2007.