Frequency of Use of Basic Public Health Services by Married Migrant Women in China: Associations of Social Support, Discrimination, and Sociodemographic Factors | BMC Women’s Health

Despite the growing number of migrants in China, local governments in urban cities have mainly addressed only three health issues for rural-urban migrants: infectious diseases, reproductive health and occupational diseases due to the effects of these problems. on local residents. [1]. As a result, prevention and control of noncommunicable diseases among rural-urban migrants continues to receive insufficient attention.

The national BPHS is one of the very few programs that cover the prevention and control of noncommunicable diseases for rural-urban migrants. These services, mainly provided by community health centers (CHCs), are accessible free of charge to all residents. BPHS is the most basic preventive health services program provided by the Chinese government to current urban and rural residents and focuses on children, maternity wards, the elderly and chronic diseases. [2]. In order to promote the development of BPHS in China, the National Health Commission released its first detailed set of regulations and standards in October 2009. In 2019, after several revisions, the BPHS program consisted of 31 departments, with 6 out of 31 departments. specifically intended for women. : (1) establishing health records, (2) health education, (3) basic contraceptive services for married couples, (4) screening for breast and cervical cancer in rural populations, (5) prenatal diagnostic assessments, and (6) health record, at least five antenatal visits, timely care during the first 12 weeks of pregnancy, and postnatal care.

Historically, rural-urban migrant workers have been affected by the hukou system [3]. In China, hukou defines the rights of a person to health care services and social protection in a specified locality [4], services are provided to citizens according to their hukou location and classification (rural vs urban). For example, one study found that rural-urban migrants had lower use of basic public health services (BPHS) (30.37%) compared to local residents (43.23%) [5]. In addition, the old hukou system is the basis for the implementation of many public policies and social protection programs [1]. A change of hukou status is difficult when people migrate from rural to urban areas or from one place to another [3]. Thus, social and health care benefits in urban areas are not available to rural-urban migrants, but only to residents with urban status and registered locally. hukou. However, rural migrants can now apply for a residence permit, thus allowing them to have the same rights as a local resident in an urban city; for example, they can now have the same access to BPHS and health insurance. Although the basic rights of rural-urban migrants living in cities have gradually improved thanks to the actions of the Chinese government, residence permits still cannot guarantee that all rural-urban migrants will have the same rights as city dwellers. There are conditions for applying for a residence permit. For example, migrants must have lived in the city for more than six months and have a stable employment contract [6]. For a cosmopolitan city like Shenzhen, the application conditions are more restricted because migrants must have lived in the city for more than 12 months and have paid 12 months of social contributions. [6]. Therefore, there is still a gap between the access of migrant workers to the same rights as urban residents in China.

According to the annual Rural Migrant Worker Survey, 288.36 million rural workers worked in China in 2018 (an increase of 1.84 million from 2017), and 79.7% of rural migrants are married. [7]. Among all rural migrants, female migrant workers accounted for 34.8%, which is a slight increase from 2019 (34.4%). [7]. Due to the large and growing population of migrant women, understanding the factors associated with their use of health services will ultimately impact the health of the nation.

At present, China is actively developing the BPHS program and making significant progress. However, due to the imbalance of economic development in various parts of the country and the large geographic gaps between urban and rural areas, BPHS equalization in China is relatively slow. For example, although establishing a health record is crucial for disease prevention and treatment, only 25.2% of rural-urban migrant women had established health records in 2013. [5]. The establishment of health records is still well below the 2013 National Health Commission target of 65% [9]. In addition, only 52.7% of rural-urban migrant women had received health education in 2014 [10], and a survey in Fujian Province showed that the breast and cervical cancer screening rate was only 38.2%, which is much lower than the rate for local residents (79, 4%). [11].

Previous research has examined several factors associated with the use of health services, but with inconsistent results. Compared to education below the primary school level, higher education was significantly associated with more establishment of health records, use of health education, adequate knowledge of health, use of maternal health services, health examinations and reproductive health consultations. [12,13,14,15]. However, Liu et al. reported that education showed no significant association with reproductive health education and reproductive health screening for migrants [16]. This was corroborated by Wang et al. who reported that the educational level of migrants was not associated with the use of health education [17].

Social support refers to the perception and status of a person being cared for and receiving help from others [7]. High levels of social support are believed to encourage uptake of prevention services [10, 18]. Hou et al. reported that participation in organizations and social activities was associated with much higher health record creation and health education use by migrants than those who did not participate in these activities [10], indicating that social ties can have a positive influence on the use of BPHS. Migrants who followed migrant family members were significantly more likely to establish health records [19] than those who traveled alone in the city of migration, which also indicates the importance of social support. However, there are very few studies reporting the relationship between social support and BPHS use among rural-urban migrants and no study uses a social support scale to explore the relationship between specific types of social support. and the use of BPHS. Since rural-urban migrant women (even married women) are a unique group and are often separated from family and friends, having little connection to a new community can weaken their social support network. Therefore, it is necessary to explore how multidimensional social support affects the use of BPHS.

Finally, given that migrants often have little knowledge of their working and living environments, they can be marginalized and face internal and external discrimination. [20,21,22,23]. As a result, experiences of discrimination may have an additional impact on the use of BPHS [18]. To our knowledge, there is no study reporting the relationship between discrimination and the use of BPHS. However, Hausmann et al., In the United States, found that perceived discrimination was significantly associated with lower use of certain preventive measures, including mammograms, Pap tests, and colonoscopies. [24]. Without understanding the impact of these factors on BPHS use among rural-urban migrant married women, the needs of this group will remain unknown and therefore leave women vulnerable to health problems.

Although several studies have explored factors related to BPHS use among rural-urban migrants, most studies have only included demographic and migration factors, while social structural factors like social support and discrimination are rarely taken into account. [10]. According to Andersen’s behavioral model [25], social structure factors, which encompass personal, family and community factors, influence the use of health services. In our study, we include social support, discrimination, years of residence, duration of migration, and life circumstances as factors of social structure to examine its relationship to BPHS use. In addition, there are inconsistencies in the relationship between socioeconomic status (SES) and use of BPHS. Our BPHS use model fills this gap by using Anderson’s behavioral model as a framework to account for important predisposing characteristics and enabling factors of health behavior. Therefore, the aim of this study is to explore how demographic and social structure factors influence the use of BPHS among married migrant women from rural to urban areas. The specific objectives are to: (1) describe the frequency of use of BPHS services among married migrant women from rural to urban areas, and (2) examine how social support, age, education, income, years of residence, duration of migration, length of life, circumstances, family situation and discrimination influence this use.

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