Special announcement on family planning and reproductive health in China

Abstract

The International Conference on the Quality of Care for Family Planning, Reproductive Health, and the Three China National Comprehensive Programs (IC-ECQ/NCP) was held in Beijing June 5–9, 2001. The meeting was co-sponsored by China's State Family Planning Commission (SFPC) and the World Health Organization. Its purpose was to promote the Three National Comprehensive Programs (usually referred to as the 3NCPs), improve the programs’ planning and execution, and increase their support domestically and internationally. Wang Zhongyu, State Councilor and Secretary General of the State Council, met with the participants and defined the scope of the Conference. Zhang Weiqing, Minister in charge of SFPC, gave the opening lecture, in which he detailed China's achievements concerning population and family planning, and described China's plans in these areas for the 21st century. He also issued letters of appointment to chief scientists and foreign experts for the Three National Comprehensive Programs. Two SFPC Vice-Ministers, Zhang Yuqin and Zhao Bingli, also attended the Conference. Xhang Yuqin presided over the opening ceremony. More than 70 representatives participated in the Conference. They were from the State Council's Office of Research, Office of Legislative Affairs, and Office of the Aid-to-the-Poor Program; from the State Developmental Planning Commission, the Ministries of Finance and of Science and Technology, the State Drug Administration, the All-China Women's Federation, the China Disabled Person's Federations; and from the World Health Organization, the United Nations Population Fund, the Ford Foundation, the International Federation of Gynecology and Obstetrics, and other domestic and international institutions and organizations. China has shown remarkable achievements since it began implementing its Family Planning Policy in the 1970s. China's achievements not only in controlling its population increase and improving the quality of services to its population, but also in its overall social and economic development, have contributed to stabilizing the growth of the world population. Following the 1994 Cairo Population and Development Conference, the integrated concept of ‘reproductive health’ was introduced into China's programs. Thanks to its accumulated, country-specific experience and its technological progress, China has substantially improved the quality of its Family Planning services. This new approach was well accepted by the Chinese people and won the support of the international community. Despite this success, however, the population issue remains an obstacle in the way of China's economic and social development. To address this problem, the Chinese government recently issued two important documents. One is called Decision on Strengthening the Work on Population and Family Planning, and the other China's Population and Development in the 21st Century. The two documents clarify the direction, aim and strategies of China's efforts regarding population and family planning in the 21st century and require that, while pursuing economic development, China also controls population growth, improves the quality of life, and protects natural resources and the environment. Only by following this path will China achieve sustainable development. During the conference, the State Family Planning Commission introduced and detailed the three China National Programs (the 3NCPs). The 3NCPs emphasize the principle that respect for human individual is the key factor, and focus on the needs of citizens. The 3NCPs are the Program for Improving the Quality of Contraceptive Care, the Healthy Baby Promoting Program (HBPP), and the Reproductive Tract Infections Intervention Program (RTIP). Implementing the 3NCPs will greatly contribute to putting into effect the spirit of the two documents issued by the central government, and to pushing forward the World Health Organization's reproductive health campaign in China. The 3NCPs are considered so important that they were incorporated into China's Tenth Five-Year Plan. The 3NCPs typify the new, human-centered agenda, which safeguards the rights of the people while conforming to the special characteristics of China's family planning. Introducing quality of care and technologically-advanced services will definitely improve the overall performance of the programs. An outstanding characteristic of the 3NCPs is their departure from the old paradigms that governed family planning until recently. By using the existing family planning and network resources, the 3NCPs promote cooperation among various governmental and non-governmental agencies, and especially between the family planning and medical care systems, thus setting up a mechanism that will combine the advantages and resources of both kinds of agencies. For example, the Healthy Baby Promoting Program (HBPP) was initiated by the Population Research Institute of Beijing University, whereas the Reproductive Tract Infections Intervention Program was initiated by the Chinese Academy of Preventative Medicine under the supervision of the Ministry of Public Health. In addition, to palliate a shortage of staff, SFPC also appointed two committees, one to administer the 3NPCs, and the other to ensure their technological excellence. During the Conference, chief scientists and research-group members analyzed the background, aim, strategy, plans, and challenges of the program, and made suggestions. Experts and family planning workers from various parts of China reported on the progress made in pilot studies on various topics. National and international participants discussed the project extensively. They stressed the fact that, with the improvement of the people's standard of living, the consolidation of the rule of law, and the breaking away from old child-bearing concepts, there was a great need for new methods better suited for the welfare of the individual. These methods would aim at minimizing the side effects and increasing the dependability and safety of contraceptive measures. informed choice and follow-up services are necessary; different contraceptive methods should be used at different ages; attention should always be paid to medical condition, life style, and culture; in addition to informed choice, all the other aspects of reproductive health care must be addressed. A specific example is the provision on the migrant population's education about the prevention of sexually-transmitted diseases. In the early stages of the PQOC project's implementation, some problems, such as a temporary population increase in some areas, are likely to occur. But in the long run, informed choice and other quality-based project components will contribute to the stabilizing of a low birth rate and improvement of the population's quality of life. Moreover, an evaluation system for the quality of care has been planned. It will allow proper technological assessment, including the evaluation of the efficacy and safety of contraceptive drugs. Foreign experts pointed out that the social, cultural and technological aspects of a quality-care system should be emphasized and well-balanced. Chinese experts and SFPC officials stressed the concept that individuals are the starting point of the health care system and the operating mechanisms and technology are its supporting pillars; and that by using these guiding principles, an efficient, comprehensive combination of social, cultural and technological services can be achieved. This approach is in accordance with the so-called ‘Triangular Framework’ concept endorsed by the World Health Organization. One point debated during the Conference was the use of the word ‘masses,’ instead of ‘clients,’ to define the users. In the mind of some foreign experts, the world ‘client’ emphasizes individuals and, therefore, the need to adapt to individual needs. Chinese officials explained that the word ‘masses’ was employed to indicate that quality of care should benefit everyone. In recent years, promoting healthy-baby care has made dramatic progress both in China and abroad. In spite of this, in China, the services provided are still inadequate to the needs. With the decrease of neonatal and infant mortality, hereditary diseases and birth defects have become the leading threats to newborns. A number of disabling, easily-preventable congenital diseases are still threatening the health of Chinese babies. Even worse, in some poor areas, people still desire to have many children because of a high perinatal mortality rate, and this situation will probably lead to the vicious circle of more children and more diseases. It was obvious that these issues would be discussed in detail during the Conference. With regard to possible solutions to these problems, foreign experts stressed that in Western, developed countries, prevention is expensive. Their Chinese counterparts, however, believe that by taking advantage of both its widespread family planning service network and accumulated experience, China can achieve the same results with less money. The Healthy Baby Promoting Program's design was based on these notions. The aim of the HBPP is to have birth-defect interventions performed at the community level as a way to improve the quality of life of the people. Moreover, with the development of genetic engineering, the implementation of the HBPP is likely to motivate scientists to develop more innovative interventions. The HBPP involves not only to treating hereditary diseases, but also to protecting the environment. It has control over the use of pesticides and educates the people on how to lead better, healthier lives. Full implementation of the program, which is needed to better satisfy the need of the masses, will depend on the increased efficiency of its supporting systems and on the improvement of its technology. This is another broad project related to reproductive health. China's family planning system is a complete network. It employs over 400 000 well-organized workers who serve all the women of child-bearing age and their spouses in mainland China. The knowledge and experience accumulated through the work already carried out to prevent and treat reproductive-tract infections (RTI), combined with already-existing contraception and sterilization services, greatly facilitate the setting up of programs for HIV/AIDS and RTI prevention and treatment in China. The general aim of the Reproductive Tract Infection Intervention Program is to establish a mechanism combining RTI prevention and family planning to increase the family planning system's ability to fight reproductive-tract infections. The RTIP has already been launched in several provinces of China. The implementation of the 3NCPs will provide many advantages to China. At present, China has a good environmental protection policy; a large network of workers extending to the level of the village and the community; and many academic institutions conducting research and training and providing numerous services. At the same time, extensive international cooperation, as well as exchange of information and resources, can bring the 3NCPs much-needed support. In this respect, the early-stage pilot projects have laid a solid foundation for further progress. It is clear that the 3NCPs will have many difficulties to overcome, such as changing the minds of those involved in the family planning system, winning over more support from the central government, and raising more funds. In summary, by improving and launching the 3NCPs, the Conference has been a success. The many recommendations received from national and international experts will continue to help improve the projects and bring them to completion. Everyone is now looking forward to seeing the benefits that the 3NCPs should soon bring to China.