Changes improve efficiency of family planning services

Departmental mergers help officials to redefine their roles

For most of her 13 years as a grassroots family planning officer, Wang Wanhui's main task has been to discourage her fellow villagers from having more children than the law allowed.

Now, her role is changing.

"Before the universal second-child policy was adopted in 2016, my job was to emphasize pregnancy management and population control," said Wang, who works in Longjing, a village in the township of Dongfeng in Guiyang, capital of Guizhou province.

"Women who had already given birth had to use contraceptive measures, such as intrauterine devices, and we asked them to have checkups every three months to make sure the devices were intact."

Wang's work priorities began to change several years ago in response to the gradual relaxation of the family planning policy. However, the biggest change came in early 2016.

"The adoption of the second-child policy saw the number of births rise markedly, so the major task of family planning workers in our town became the provision of healthcare services for pregnant women, especially in high-risk cases, to ensure their safety," she said.

Sixteen women in Longjing got pregnant in 2016, but last year the number was 26, including two high-risk cases: a 35-year-old, and a woman who had previously given birth via a cesarean section, making her vulnerable to complications such as a ruptured womb or premature birth.

"I spend most of my time keeping track of pregnant women who are close to giving birth, reminding them to visit the health center in Dongfeng for checkups and asking them to come to my office to pick up free doses of folic acid," Wang said. Folic acid can help prevent neural tube defects.

"I also help them to register online so they can get benefits such as free checkups and higher reimbursement for certain services during and after pregnancy. My workload is heavy because the village doctor and I are the only people available for the whole village, and we would face disciplinary proceedings if someone died during pregnancy or childbirth."

Wang is one of about 200 family planning officials in Guiyang's Wudang district whose roles have been transformed. They have started to focus more heavily on working with colleagues to provide maternal healthcare services to suit the universal second-child policy.

For more than three decades, the primary task of family planning officers was to prevent unauthorized births via the promotion and use of contraception, according to Qin Desheng, deputy director of Wudang's bureau of health and family planning.

However, that began to change a few years ago as the national family planning policy was gradually relaxed.

The merger of the district's family planning and health departments resulted in family planning officers being integrated with other health workers, especially those at the grassroots.

"The effect of the second-child policy in Wudang can be seen clearly, with nearly 4,000 births expected by the end of the year," Qin said, speaking in December.

"By comparison, in 2016, the total number of births in the district was about 2,000. Many couples who already had one child delayed having a second until the universal second-child policy was implemented," he added.

Qin noted that some rural couples, such as those whose only child was a girl, were allowed to have two children in the hope the second would be a boy, which would help to maintain the workforce.

As in many other parts of China, a large number of the women in Wudang who plan to have a second child are considered to be at high risk - for example, those ages 40 and older - so improving health management has become a key task for the district's health and family planning officials.

"While village doctors provide purely medical care, family planning officials have other functions," Qin said.

"They have close contact with villagers over many years, and as a result they establish a vast information network at the grassroots. For example, they can provide useful information about pregnant women, and also help those who plan to have a second child to have a pre-pregnancy checkup. When the universal second-child policy was implemented, many of our family planning workers were puzzled and did not know what their new jobs would entail. We believe they still have a role to play, and we have arranged training programs so they can provide a better service."

Promoting contraception

Qin said some couples want to have more than two babies in violation of the law, so the district's family planning officers have maintained some of their traditional duties, such as promoting awareness of contraception, distributing free contraceptive pills and devices, and fining people who break the law.

Lu Shiyuan has been engaged in family planning in two villages in Dongfeng, the township under the jurisdiction of Wudang, since 2003. He has seen a lot of changes during the past 14 years.

"Unlike our current role as service providers, back in 2003, we were like the residents' managers and our priority was to prevent illegal births," he said. "At the time, villagers who planned to have a child had to go through a number of registration procedures with the local government."

For Lu, the changes really gained momentum in 2014, when the national family planning policy was relaxed. The new regulations allowed couples to have a second child if one partner was the only child in their family. In response, local governments simplified the registration procedures to adapt to the change, including making it easier for people to register via computers or smartphones, he said.

Lu and his colleagues have relocated from their old office to the health center in Dongfeng so they can better assist the doctors and nurses and provide health management for women who are pregnant, have recently given birth, or are planning to have a baby, he added.

Complicated procedures

In 2012, when his wife gave birth to their first child, Zhao Ping, a Dongfeng native who owns a grocery store in Guiyang, had to return to the township to complete the birth registration forms.

"The procedures were very complicated back then, and we had to collect or fill in a lot of forms, including our marriage certificate, a letter from the local hospital confirming that my wife was pregnant and a letter from the local authorities certifying that my wife and I did not already have a child," he said.

He was pleased that the procedures were simplified in 2016 because he will not have to travel to Dongfeng to register if he and his wife have another child.

Instead, he will only need to enter their personal information, such as names, ID numbers and place of household registration, on the local government's website.

The change implemented by the family planning services in Guizhou is a microcosm of the transformation that has happened nationally, which is estimated to have affected nearly 1 million family planning officials, according to a national survey in 2015.

The number of family planning officers has remained unchanged since then, despite the relaxation of the family planning policy, according to the commission, which said the officials have been integrated with health workers at the grassroots across the country.

For example, family planning officials in Gansu province are also actively engaged in the provision of services such as health education, disease control and prevention, and poverty alleviation.

Meanwhile, many provinces have streamlined their administrative procedures so people can receive a wide range of services, including birth registration, maternal and child healthcare and child vaccinations, by producing a single certificate instead of the large number of documents required before.

Yuan Xin, a professor of population studies in Nankai University in Tianjin, said family planning officers will now be expected to focus more on providing healthcare services, but the authorities will need to provide training during the transition period.

"The family planning workers are familiar with reproductive health, but most lack sufficient knowledge of overall healthcare, including amended or new policies and technologies," he said.

"A number of training programs must be arranged to allow the workers to provide a more diverse range of healthcare."

Contact the writer at wangxiaodong@chinadaily.com.cn

(China Daily 01/08/2018 page1)