Unmet sexual and reproductive health needs of women aged 50 to 64 years in rural China

Objective: China's family planning program focuses on younger women. Women older than 50 years, especially those in rural areas, are ineligible for free services and often have few other care options. Few studies have examined the sexual and reproductive health demands and unmet needs of these women. Methods: This cross-sectional, interviewer-administered survey included 1,652 rural women aged 50 to 64 years from seven provinces in China. We examined women's sexual and reproductive health status, knowledge, and service demands, and whether they still had an intrauterine device (IUD). Results: Educational levels were low, and most were rural farmers or housewives. The mean age at menopause was 48.9 years, and 52.4% reported climacteric symptoms. The mean frequency of sex in the last month was 1.8 times. About 47.4% of women had undergone a gynecological examination during the past 2 years. The first choice for care was family planning clinics (31.2%) followed by township hospitals (28.4%). Identified service needs included women's health check-ups (56.5%), sexual health knowledge (54.4%), women's health knowledge (35.4%), menopause counseling (34.8%), and IUD removal after menopause (17.0%). Among 519 postmenopausal women who used an IUD, 19.1% had not had it removed. On multivariate regression, awareness of correct time for IUD removal, beliefs about sex after menopause, receiving formal health education, and undergoing gynecological examination were significantly associated with having had IUD removal. Conclusions: A large proportion of middle-aged women in rural China lack sexual and reproductive health services, including IUD removal after menopause. A comprehensive program of sexual and reproductive health services is needed for middle-aged women in rural China.