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      Association between college health services and contraceptive use among female students at five colleges in Wuhan, China: a cross-sectional study

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          Abstract

          Background

          College students have a high incidence of unplanned pregnancies in China, which has highly raised public attention. As such, numerous reproductive health services are provided to college students. This study examined whether health services in college lead to contraceptive use among female college students in heterosexual relationships.

          Methods

          A self-administered questionnaire survey with cross-sectional design was administered among female students in four colleges in Wuhan, China to identify health service factors associated with contraceptive use in the past 6 months.

          Results

          The analysis revealed that younger female students had lower odds of contraception use, whereas students who reported availability of health-related web sites were more likely to use contraceptives. Female students who reported that contraceptives and birth control counselling were accessible from college health services had greater odds of contraceptive usage. Finally, provision of contraceptives and birth control counselling from school were associated with greater odds of contraceptive use.

          Conclusions

          Contraceptive-related health services play an important role in reducing unintended pregnancies by directly addressing the contraceptive needs of female students. Programs that provide targeted services may help to reduce high rates of unexpected pregnancies among female students in China.

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          Most cited references28

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          Women's autonomy in decision making for health care in South Asia.

          This article aims to discuss women's autonomy in decision making on health care, and its determinants in 3 South Asian countries, using nationally representative surveys. Women's participation either alone or jointly in household decisions on their own health care was considered as an indicator of women's autonomy in decision making. The results revealed that decisions of women's health care were made without their participation in the majority of Nepal (72.7%) and approximately half of Bangladesh (54.3%) and Indian (48.5%) households. In Sri Lanka, decision making for contraceptive use was a collective responsibility in the majority (79.7%). Women's participation in decision making significantly increased with age, education, and number of children. Women who were employed and earned cash had a stronger say in household decision making than women who did not work or worked not for cash. Rural and poor women were less likely to be involved in decision making than urban or rich women.
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            Changing sexual attitudes and behaviour in China: implications for the spread of HIV and other sexually transmitted diseases.

            In Imperial China sexual behaviour was regarded as an indispensable activity to reach harmony with the universe, through the unity of the interaction of two opposing forces: yin and yang. Sexual intercourse was accepted when linked to procreation within a family context, while an individual's sexuality was not considered important. Homosexuality was tolerated although not advocated, while masturbation was denounced. Since the One Child Family and Open Door policies in the 1970s and the economic reforms of the 1980s, attitudes towards sexuality in China have changed. Premarital sex has become widely accepted among young people and people in China are now more tolerant toward extramarital sex. Nowadays young people consider that love should dominate marriage and the quality of an individual's sex life is currently more valued than it used to be. Attitudes towards masturbation have become more tolerant and though homosexuality has been hidden by society for a long time, in recent years it has begun to be considered as a legitimate lifestyle choice. Attitudes towards sex and sexual behaviour have become recognized as an individuals' responsibility as long as no offence occurs against society or the interests of other individuals, resulting in the recognition of diversity of sexual behaviour. As part of the changing attitudes to sex and sexual behaviour, heterosexual transmission is becoming the most important route of HIV transmission in China. This is complicated by the internal migration of an estimated 120 million labourers moving from the countryside to the cities as the result of economic reforms, most of whom are sexually active young men. Unless addressed directly, these factors may add to the estimated 300,000 HIV-infected Chinese, further fuelling an already rapidly spreading epidemic. The ramifications of the Chinese HIV epidemic will not only be felt within China, but also within the surrounding Asian countries thereby fuelling the HIV pandemic.
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              Can the Internet be used effectively to provide sex education to young people in China?

              To assess the feasibility and effectiveness of sex education conducted through the Internet. Two high schools and four colleges of a university in Shanghai were selected as the research sites. Half of these were assigned to the intervention group and the other half to the control group. The interventions consisted of offering sexual and reproductive health knowledge, service information, counseling and discussion to all grade one students in the intervention group. The intervention phase lasted for 10 months and was implemented through a special website, with web pages, online videos, Bulletin Board System (BBS) and expert mailbox. In total, 624 students from the intervention, and 713 from the control schools and colleges participated in the baseline survey, and about 97% of them were followed up in postintervention survey to assess changes that can be attributed to the sex education interventions provided through the Internet. The median scores of the overall knowledge and of each specific aspect of reproductive health such as reproduction, contraception, condom, sexually transmitted infections (STIs) and human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) were significantly higher in the intervention group as compared with those in the control group at postintervention (p .05). Group by time interaction effects in ordinal logistic regression analysis were found on knowledge score (p < .0001) and in attitude of high school students toward sex-related issues (p < .05), suggesting that interventions increased subjects' knowledge significantly and changed high school students' attitudes to being less liberal toward sex. The intervention also had positive influence on students' attitudes toward providing contraceptive service for unmarried people. Providing sex education to students in Shanghai through the Internet was found feasible and effective. The Internet-based sex education program increased students' reproductive health knowledge effectively and changed their attitudes toward sex-related issues in terms of being less liberal toward sex and more favorable to providing services to unmarried young people. The Internet thus offers an important and hitherto untapped potential for providing sex education to students and young people in China.
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                Author and article information

                Contributors
                longlu13@hotmail.com
                19399756@qq.com
                437812977@qq.com
                kyhelp@tom.com
                shaofanie5@gmail.com
                86-28-855-01300 , hxliuyi@163.com
                Journal
                BMC Public Health
                BMC Public Health
                BMC Public Health
                BioMed Central (London )
                1471-2458
                5 September 2016
                5 September 2016
                2016
                : 16
                : 1
                : 929
                Affiliations
                [1 ]West China School of Public Health, Sichuan University, Chengdu, China
                [2 ]Chengdu Municipal Center for Disease Control and Prevention, Sichuan, China
                [3 ]Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
                Article
                3612
                10.1186/s12889-016-3612-x
                5011784
                27595794
                77cdb55c-1e66-4071-b643-d5cfaadde3be
                © The Author(s). 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 31 December 2015
                : 30 August 2016
                Funding
                Funded by: Chengdu Municipal Bureau of Science and Technology
                Award ID: 0040405301091
                Award Recipient :
                Funded by: The National Key Technology R&D Program
                Award ID: 2006BAI15B04
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/501100004912, Sichuan University;
                Award ID: 2016SCU11007
                Award Recipient :
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2016

                Public health
                health service,contraceptive use,females,college students
                Public health
                health service, contraceptive use, females, college students

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