Internal migration and health in China.

Summary Background After a massive syphilis epidemic in the first half of the 20th century, China was able to eliminate this infection for 20 years (1960–80). However, substantial changes in Chinese society have been followed by a resurgent epidemic of sexually transmitted diseases. Sporadic reports have provided clues to the magnitude of the spread of syphilis, but a national surveillance effort is needed to provide data for planning and intervention. Methods We collected and assessed case report data from China's national sexually transmitted disease surveillance system and sentinel site network. Findings In 1993, the reported total rate of cases of syphilis in China was 0·2 cases per 100 000, whereas primary and secondary syphilis alone represented 5·7 cases per 100 000 persons in 2005. The rate of congenital syphilis increased greatly with an average yearly rise of 71·9%, from 0·01 cases per 100 000 livebirths in 1991 to 19·68 cases per 100 000 livebirths in 2005. Interpretation The results suggest that a range of unique biological and social forces are driving the spread of syphilis in China. A national campaign for detection and treatment of syphilis, and a credible prevention strategy, are urgently needed.

Data from 2,153 sexually active rural-to-urban migrants in China were analyzed to examine the relationship between the movement of rural-to-urban migration and increased HIV/STD (sexually transmitted disease) risk and the applicability of constructs of a Western-based theory of behavioral change to the study population. Measurements included migrant mobility, sexual risk, and the seven constructs of the protection motivation theory (PMT). Data in the current study suggest that high mobility among rural-to-urban migrants was associated with increased sexual risk. The PMT constructs are applicable in identifying perceptions and attitudes associated with sexual risk behaviors in this culturally distinct population. Increased sexual risk was associated with increased perceptions of extrinsic rewards, intrinsic rewards, and response cost. Also consistent with PMT, increased sexual risk was associated with perceptions of decreased severity, vulnerability, response efficacy, and self-efficacy. After controlling for a number of key confounding factors, all seven PMT constructs were associated with sexual risk in the manner posited by the theory. The association between mobility and sexual risk underscores the importance of effective HIV/STD prevention efforts among this vulnerable population. The social cognitive theories including the PMT may form a logical base for prevention intervention programs targeting rural-to-urban migrants in China.

Economic migration and growth in informal employment in many of the major cities of developing countries, combined with health sector reforms that are increasingly relying on insurance and out-of-pocket payment, are raising concerns about equity and sustainability of economic and social development. In China, the number of internal migrants has dramatically grown since economic transition started in 1980, and maternal health care for these is a pressing issue to be addressed. To provide information for policy-makers and health administrators, a medical records review, a questionnaire survey and qualitative interviews were carried out in Minhang District, Shanghai. This paper describes important inequities in main maternal health outcomes and utilization indicators relating to economic and social transformation of the Chinese society. Analysis of the data collected clarifies that insufficient antenatal care is one of the main determinants for poor maternal health outcomes and that migrants are using antenatal care services significantly less than permanent residents. The data suggest that there is no single explanatory factor, but that migrants are faced with a package of obstacles to accessing health care services, and that health systems may need to rethink and redesign their delivery approaches to specifically target those groups that are faced with such multi-faceted packages of obstacles to service-access. Although the study addresses a specific Chinese phenomenon related to internal migration and registration of residency, parallels can be drawn to other settings where a combination of economic and social transitions of the society and a reform of health care financing are potentially creating the same conditions of significant inequalities.