Reproductive Health Policy in China: A Study of Preconception Care in Rural China

As countries strive for better maternal and child health outcomes, the concept of preconception health has demonstrated increasing global importance in policy agendas (1-3). Preconception health relates to women’s health, reproductive freedom, and pregnancy outcomes (3) and includes three major concepts of preconception care: reducing risk in preparation for pregnancy, managing preexisting medical conditions, and delivering preventive interventions (2). In 2006, the United States (U.S.) Centers for Disease Control and Prevention (CDC) issued 10 recommendations for preconception care. These recommendations focus on risk factors and risk reduction and reflect a biomedicine-oriented discourse that dominates the preconception care policy language in the U.S. (4-6). In the same year, preconception care was defined as “as a set of interventions that aim to identify and modify biomedical, behavioral, and social risks to a woman’s health or pregnancy outcome through prevention and management, emphasizing those factors which must be acted on before conception or early in pregnancy to have maximal impact” (5). This definition of preconception care was based on sufficient evidence (5); however, Russell et al. (7) argue that it is not enough to discuss healthcare policy-making in the dominant discourse of evidence-based medicine only because policy-making is the formal struggle over ideas and values. One also needs to address the language, arguments, and discourses in healthcare policy-making. Further, it is important to show the links among policy texts to reveal prevailing ideologies, stories, power relations, and tensions (8) as the public response to a policy may vary. For example, the public’s interpretation of the definition of preconception care issued by the U.S. CDC in 2006 was divided. Some groups perceived the definition as an erosion of reproductive choices for individual women because preconception care was defined at the population level. Other groups welcomed the definition because they viewed it as a policy-level effort to improve the health of reproductive-aged women (9). Thus, it is important to have an understanding of preconception health and care policy language and public-level discourses. Although it is known that preconception care policies still vary by region as related to each region’s healthcare sysAbstract Objectives: Policy plays an important role in shaping preconception health and care. The purpose of this study was to explore how preconception care was defined in Chinese government policies. The specific aims of the study were to: (a) define and critically analyze the language of preconception care in the context of Chinese government policies and (b) explore rural women’s and healthcare providers’ views on preconception care-related government policies. Materials and Methods: This was a cross-sectional study of Chinese preconception health and care-related policy at the national and provincial levels. The study included an analysis of publicly available preconception care policies issued before August 2009. In addition, individual interviews with rural women and healthcare providers were conducted from April 2009 to August 2009 in Tonglu County, Zhejiang Province, China. Results: Three major discourses in relation to defining preconception care were identified from the policy documents: (a) preconception care in relation to women’s physiology, (b) preconception in relation to marriage registration, and (c) preconception care in relation to being married. Although participants recognized the governmental policy effort in relation to preconception health promotion, they still see policy as a formality. Conclusion: This was the first study to examine language use in Chinese preconception care policies. The study found that the concept of preconception care was constructed mainly around marriage and that the public views these policies as a formality. Strategic plans are needed to increase societal awareness of the importance of preconception health policies in China.