programs to address the economic and social consequences of rapid population growth \[[@B5-ijerph-16-02121]\]. In 1963, the State Council Family Planning Commission was formed to manage population control and coordinate city and province-level family planning commissions. While the work of the Family Planning Commission was disrupted by the Cultural Revolution, the State Council's 1971 "Report on Family Planning Work" marked the emergence of China's one-child policy, which legally determined how individual families planned their families and how family planning service organizations operated \[[@B6-ijerph-16-02121]\]. After the one-child policy was incorporated into China's Constitution in 1978, a new family planning organization, the Population and Family Planning Commission, was created to plan, implement and guide the one-child policy. Over the next two decades, the government made a series of legal modifications toresult was untimely information communication, resulting in the duplication and waste of resources \[[@B9-ijerph-16-02121]\]. China's family planning organizations were seen as organizationally unfit for the two-child family planning policies, enshrined in Chinese law in 2015.

To adapt to the forthcoming two-child institutional change, China reformed its family planning, population control and health organizations. In 2013, the former Ministry of Health and National Population and Family Planning Commission were merged into National Health and Family Planning Commission, with comparable organizations at each level of government. Shandong province established its commissions in 2014. The purpose of the organizational change was to facilitate the implementation of the new two-child policy, reallocate funding and expenditure to family planning work, reduce overlapping work practices between departments, eliminate wasteful funding and streamline information flows and