title: Sexual and reproductive healthcare utilization among women aged 40 to 49 in rural China.
abstract: China's national family planning system is mainly directed toward women of early reproductive ages. Most studies of service provision focused on younger women, who almost all receive regular examinations. Little is known about service-seeking behavior among women of late reproductive ages.
  
  
  
  This cross-sectional household survey interviewed 1,811 rural women aged 40 to 49 in seven provinces. We examined sexual and reproductive health, utilization of sexual and reproductive health services, and predictors of receiving a free gynecological examination in the past 2 years.
  
  
  
  Educational levels were not high, and most women were rural farmers or housewives. More than one-fourth had migrated for work to big cities when they were younger. The mean frequency of sex in the last month was 3.6 times. Approximately 22.7% of women had not received a gynecological examination and 31.2% had not received any health education during the past 2 years. The first choice for where to seek services was township medical facilities (58.4%). On multivariate regression, age, education, migrant working experience, awareness of the need for intrauterine device removal after menopause, health education received, and attitude toward health examinations were significantly associated with receiving a gynecological examination in the past 2 years.
  
  
  
  Women of late reproductive age in rural China are not receiving as regular care as younger women. This study identifies sociodemographic and health service correlates for service-seeking behavior, many of which are modifiable. Health services should pay greater attention to this group, including community-based efforts to encourage routine examinations and appropriate use of health services.
authors.affiliation: 1School of Humanities and Social Sciences, Nanjing Youdian University, Nanjing, China 2Institute for Environment and Spatial Analysis, University of North Georgia, Oakwood, GA 3Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA.
authors.forename: Xiaoming
authors.initials: X
authors.lastname: Sun
authors.forename: Yu
authors.initials: Y
authors.lastname: Sun
authors.forename: Zhanhong
authors.initials: Z
authors.lastname: Zong
authors.forename: Xingyu
authors.initials: X
authors.lastname: Shu
authors.forename: Jingshu
authors.initials: J
authors.lastname: Mao
authors.forename: Norman
authors.initials: N
authors.lastname: Hearst
mesh_terms: D000328:Adult; D002681:China / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005193:Family Planning Services / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D012424:Rural Population; D012736:Sex Education; D012725:Sexual Behavior; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D016387:Women's Health