广东省农村育龄妇女产前保健服务研究

目的了解广东省农村育龄妇女产前保健服务利用现状,探讨妇女产前保健的影响因素。方法利用广东省第三次卫生服务调查数据,研究分析调查时15～49岁农村育龄妇女回顾在1998年1月1日-2003年10月20日最后一次活产时的产前保健服务利用情况。结果全省农村育龄妇女产前检查率85.65%,高于全国农村水平;平均产前检查次数5.14次;产前检查次数≥5次的占48.88%;平均初检孕周13.67周;早孕检查率49.50%,低于全国农村水平。多因素Logistic回归分析发现,影响产前保健利用及时性的主要因素有:文化程度、居住地区、职业和活产次;影响产前保健利用足够性的主要因素有:文化程度、居住地区、经济状况、职业、活产次和家庭离最近医疗点的距离。结论广东省农村育龄妇女产前保健覆盖率扩大,产前检查次数及产前检查次数符合率提高,但早孕检查率下降,早孕检查不受重视;全省不同地区间农村妇女的产前保健服务利用不均衡,非珠三角农村妇女产前保健利用明显不足。建议采取相应措施,提高农村育龄妇女文化程度,加强计划生育管理,提高广东省农村育龄妇女孕产期保健服务利用水平。     

中国已婚育龄妇女分娩保健服务的状况与变化研究

目的:分析我国已婚育龄妇女分娩保健服务状况及其变化。方法:对全国31个省(直辖市、自治区)抽取的调查前三年有生育史的1962名已婚育龄妇女进行问卷调查,结合1997年全国人口与生殖健康调查资料,对两次调查前三年有生育史妇女最近一次活产的分娩保健服务状况进行比较分析。结果:①与1997年调查前三年相比,2001年调查前三年育龄妇女的入院分娩率增加,家庭分娩的比例明显减少;②农村妇女家庭分娩比例明显降低,由1997年调查时的61·41%降为2001年调查时的40·78%,1998~2000年间,92·54%城镇妇女接受分娩保健服务,农村妇女家庭分娩比例高出城镇7·4倍,为40·78%;③分娩保健服务在各地区发展不平衡,东部和中部地区发展快,西部地区,尤其是西南地区发展相对较慢,1998~2000年间,西部地区妇女中,一半以上在家分娩,西部地区农村家庭分娩妇女一半以上由家人接生,约为东部和中部地区的6倍;④少数民族妇女家庭分娩和由家人接生的比例明显高于汉族妇女;⑤随着文化程度和经济收入的增加育龄妇女对分娩保健服务的利用增加,文盲、经济收入低的妇女家庭分娩比例和由家人接生的比例非常高。结论:我国分娩保健服务状况在改善,但发展极不平衡,西部地区农村的分娩保健服务急待提高。应加强对西部地区分娩保健服务的支持力度,研究制定应对策略,加强对西部农村接生人员的专业技术培训。     

农村已婚育龄妇女产前保健状况及影响因素分析

目的:了解农村已婚育龄妇女产前保健状况,探讨农村育龄妇女产前保健的影响因素,为孕产期保健提供依据。方法:应用多阶段整群抽样方法选择河北省农村已婚育龄妇女采用面对面的问卷调查方法,对农村已婚育龄妇女进行产前保健状况调查,以产前检查地点为应变量使用累加Logistic模型分析产前检查地点的影响因素。结果:76.5%的已婚育龄妇女进行过产前检查,检查的地点主要是妇幼保健院(42.4%)、其他综合医院(19.4%)。选择检查地点主要原因90.9%觉得交通便利,而未产检的原因61.4%已婚育龄妇女认为不需要或不知道要检查,文化程度、家庭年收入对选择产前检查地点有影响(P<0.05)。结论:增加农民收入,提高农村妇女文化水平,进而改善农村育龄妇女产前保健水平。     

山东省部分地区农村妇女产前保健利用现况及影响因素分析

目的:了解山东省部分地区农村育龄妇女产前保健利用现况及其影响因素。方法:于2009年9月至2010年1月对山东大学卫生研究基地17个村已婚育龄妇女自2004年9月1日以来最后一次分娩的情况进行面对面问卷调查,采用χ2检验和非条件logistic回归模型对产前保健服务利用的影响因素进行单因素和多因素分析。结果:孕产妇产前检查率为94.11%,孕早期检查率为72.54%,产前检查≥5次的比例为38.37%。孕期产前保健利用不足的比例为69.48%,产前保健利用过度的比例为9.00%。研究对象年龄、家庭人均年收入、离医疗机构距离以及是否第一次分娩是影响产前保健服务利用的相关因素。结论:山东省部分地区农村妇女产前保健服务利用不足的比例较高,建议进一步采取措施提高农村妇女产前保健服务利用程度,以提高孕产妇的健康水平和婴儿的出生质量。     

农村育龄妇女生殖保健状况调查

目的 了解山西省农村地区育龄妇女生殖保健现状。方法 采用分层整群抽样方法选取4个地区22个自然村共3256名育龄妇女进行有关生育、保健等生殖健康状况及其需求的现况调查。结果 农村育龄妇女初婚年龄平均为19.2岁、平均孕次1.95次，平均活产子女数0.86。夫妇双方婚检的参与率为34.09％，年龄越小、文化程度越高，参与婚前检查和产前检查的比例越高。接受生殖健康优质服务的主要地点集中在乡级计划生育所(70.19％).相关信息的获取途径主要为电视(83.74％)。育龄妇女对生殖健康服务的需求中.以提供产前检查服务的需求最高(94.17％)。结论 农村育龄妇女生殖健康服务基础薄弱，文化程度与个人生殖保健的水平呈正相关，农村育龄妇女生殖保健存在问题较多，对生殖健康服务的需求迫切。     

湖北省孕产妇产前检查状况及相关因素分析

目的:了解湖北省孕产妇产前保健现状,探讨其相关因素,为更好地进行孕产妇产前保健管理提供建议和参考。方法:利用第五次全国卫生服务调查中湖北省2008年8月15日—2013年8月15日分娩妇女的资料进行分析,行单因素分析,再采用二项logistic回归,分析与产前检查次数相关的因素。结果:农村地区孕产妇产前检查率为97.8%,城市地区为98.3%,最近1次分娩的孕产妇产前检查次数为5.8±3.2次。回归分析结果显示,文化程度高、家庭人均年收入高、产次少的孕产妇倾向于做更多次产前检查。结论:应针对文化程度低、家庭经济状况差及分娩次数多的孕产妇加强产前保健知识宣教,促进母婴健康。     

湖南省三县农村孕产妇产前保健现状及其影响因素分析

为了解湖南省农村妇女产前保健的现状,探讨影响农村妇女产前保健的因素,采取多阶段分层整群随机抽样的方法抽取1800户居民,对其中1998-2003年已产妇女共218名进行入户面对面问卷调查,发现产前检查的机构以乡镇卫生院为主。初产妇的产前检查率和产前保健率均高于经产妇。影响孕产妇是否进行产前检查的因素包括生育年龄、文化程度、家庭人均年收入和妊娠次数。     

陕西省农村育龄妇女产前检查影响因素结构方程模型分析

目的了解陕西省农村育龄妇女的产前保健现状,探讨其影响因素的直接与间接作用,为进一步制定西部农村妇女围产期保健干预措施提供基线资料和依据。方法采用多阶段分层随机整群抽样方法对在陕西省5个贫困县抽取的4 779名2007—2009年曾分娩过的农村育龄妇女进行围产期保健状况问卷调查,采用确证性因子分析构建测量模型,一般加权最小二乘法(WLS)估计参数,通过评价修正来确定最佳模型。结果陕西省调查分析的4 779名2007—2009年曾分娩过的农村育龄妇女中,有63.5%的育龄妇女在孕12周内完成首次产检,有43.8%的育龄妇女接受过至少5次产检,有30.2%的育龄妇女按要求完成所有产检内容,有89.3%的育龄妇女产检地点在乡级及以上医院,4项均符合要求的育龄妇女占14.2%;结构方程模型分析结果显示,家庭特征、保健知识和育龄妇女社会人口特征等均影响到产前保健服务的利用,其中家庭特征影响最大,占62.1%,个体特征的影响次之,占25.4%,而保健知识占12.5%。结论陕西省农村妇女的产前检查质量有待提高,应重点针对家庭经济差、文化程度低及年龄较大的育龄妇女进行产前保健知识宣教。     

秦巴卫生项目干预效果评价:对产前保健利用的影响

目的:分析秦巴卫生项目(卫生Ⅷ项目B部分)对项目地区产前保健服务利用的影响,为促进中国农村贫困地区孕产期保健提供具有实效的思路和建议。方法:利用卫生Ⅷ项目终末家庭调查数据库,选取2002-2006年期间有过活产的妇女的相关信息,从产前检查时间和产前检查次数两方面分析干预措施对项目覆盖的四川、陕西和宁夏3省产前保健的作用效果。结果:产前检查不少于5次的比例受项目干预措施、民族、受教育程度、收入、生育史、年份、到达医疗机构所需时间的影响,干预乡孕妇相对于对照乡妇女接受不少于5次产前检查的OR值为1.85(P0.0001);孕早期检查率主要受产妇民族、受教育程度、收入和年份影响,是否项目乡并非孕早期检查率的显著影响因素。结论:秦巴卫生项目的实施促进了产前保健服务利用,但主要表现为产前检查次数的增加,干预措施对提高孕早期检查率,即提前产前检查时间无明显作用。秦巴地区妇女产前保健服务利用水平仍比较低,有待项目和配套政策的进一步支持。     

永靖县农村育龄妇女妊娠结局调查分析

目的:通过对永靖县育龄妇女妊娠结局的调查,了解农村妇女的生殖健康现状及其影响因素,为进一步搞好计划生育工作和妇女保健工作提供科学依据。方法:整群抽取甘肃省永靖县6个乡(镇)、6个村的育龄妇女作为调查对象,于2004年7月采用统一制定的调查问卷对其进行入户调查,同时组织育龄妇女到县(乡)计划生育服务站(所)进行妇科检查。结果:1 268名育龄妇女,总妊娠次数3 034次,人均妊娠2.39次。妊娠结局中死胎死产91次,占3.00%;自然流产198次,占6.53%;人工流产241次,占7.94%;活产2 504次,占82.53%。死胎死产率3.51%,自然流产率7.09%。死胎死产发生率和自然流产发生率随妊娠次数增加而增加;文化程度较低或者收入较低者发生率较高。结论:甘肃省农村地区育龄妇女妊娠结局中死胎死产率、自然流产率与全国或者国内其他地区调查结果相比,发生率比较高,其相关影响因素有不同之处。应进一步加强对农村育龄妇女生殖健康知识的普及教育,提高育龄妇女产前保健水平和入院分娩率,降低不良妊娠结局发生率。     

Does the Quality of Prenatal Care Matter in Promoting Skilled Institutional Delivery? A Study in Rural Mexico

Objectives: To determine if the quality of prenatal care predicts skilled institutional delivery, a primary means of reducing maternal mortality. Methods: The probability of skilled institutional delivery is predicted among 4173 rural low-income women of reproductive age in seven Mexican states, as a function of maternal retrospective reports about prenatal care services received in 1997–2003. Results: Women who received most prenatal care procedures were more likely to have a skilled institutional delivery (OR 2.29, 95% CI 1.18, 4.44). Women who received less than the 75th percentile of prenatal care procedures were not significantly different from those who received no prenatal care. Conclusions: Policies promoting increased access to prenatal services should be linked to the promotion of practice standards to impact health and behavioral outcomes.National Institute of Public Health, Avenue Universidad No. 655     

The Influence of Site of Care on the Content of Prenatal Care for Low-Income Women

Objective: To assess whether site of prenatal care influences the content of prenatal care for low-income women. Design: Bivariate and logistic analyses of prenatal care content for low-income women provided at five different types of care sites (private offices, HMOs, publicly funded clinics, hospital clinics, and other sites of care), controlling for sociodemographic, behavioral, and maternal health characteristics. Participants: A sample of 3405 low-income women selected from a nationally representative sample of 9953 women surveyed by the National Maternal and Infant Health Survey, who had singleton live births in 1988, had some prenatal care (PNC), Medicaid participation, or a family income less than $12,000/year. Outcome Measures: Maternal report of seven initial PNC procedures (individually and combined), six areas of PNC advice (individually and combined), and participation in the Women Infant Children (WIC) nutrition program. Results: The content of PNC provided for low-income women does not meet the recommendations of the U.S. Public Health Service, and varies by site of delivery. Low-income women in publicly funded clinics (health departments and community health centers) report receiving more total initial PNC procedures and total PNC advice and have greater participation in the WIC program than similar women receiving PNC in private offices. Conclusions: Publicly funded sites of care appear to provide more comprehensive prenatal care services than private office settings. Health care systems reforms which assume equality of care across all sites, or which limit services to restricted sites, may foster unequal access to comprehensive PNC.     

Prenatal care utilization in rural areas and urban areas of Haiti.

OBJECTIVES: This study is based on the 2000 Demographic and Health Survey (DHS) conducted in Haiti. Using the DHS information on women aged 15 to 49 who had given birth during the three years preceding the survey interview, this study was intended to: (1) examine the determinants of the likelihood of the women using prenatal care in the rural areas and in the urban areas of the country and (2) for the women who made at least one prenatal care visit, examine the determinants of the number of prenatal visits in the rural areas and the urban areas. METHODS: The multivariate analysis used logistic models to identify which factors explained the decision to seek prenatal care, and negative binomial models were used to determine how many prenatal visits were conducted by the subgroup of women who did make prenatal care visits. RESULTS: Estimated at the mean values of the control variables, the expected probability of using prenatal care services in rural Haiti was 77.16%, compared to 85.83% in urban Haiti. Among users of prenatal care services, mothers in rural areas made an expected number of 3.78 prenatal care visits, compared to 5.06 visits for the women in urban areas. CONCLUSIONS: A substantial percentage of pregnant women have access to prenatal care services in Haiti, but mothers in rural areas who decided to seek care still fell slightly below the four visits recommended by the World Health Organization. The education levels of both mothers and their partners is a dominant predictor of prenatal care use. Longer travel times and greater distances to health centers in rural areas constituted barriers to repeated visits. Policymakers and health care providers need to take these findings into consideration as they decide on the delivery and management of health care services in Haiti.     

Pregnancy Intentions,Pregnancy Attitudes,and the Use of Prenatal Care in Missouri

Objectives: This study uses data from 2378 mothers of live-born infants from the NICHD/Missouri Maternal and Infant Health Survey to examine the relationship between pregnancy intention and adequacy of prenatal care. Methods: Pregnancy intention was measured using traditional classifications of mistimed and unwanted pregnancies as well as additional measures of women's attitudes about their pregnancies. Odds ratios for inadequate prenatal care and its component parts (initiation of care and receipt of services) were calculated using multiple logistic regression in separate models and in a combined model for the measures of intention and attitude. Results: Women's attitudes about their pregnancies were associated with inadequate prenatal care, including both inadequate initiation of care and inadequate receipt of services. Traditional measures of intendedness were significantly related only to inadequate initiation of care. Women who were unhappy about the pregnancy (OR = 1.44), unsure that they wanted to be pregnant (OR = 2.81), or denied their pregnancies (OR = 4.82) were more likely to have inadequate prenatal care than women who did not have these attitudes. Women who were unhappy about being pregnant (OR = 1.86), unsure that they wanted to be pregnant (OR = 3.44), or who denied the pregnancy (OR = 6.69) were more likely to have inadequate initiation of care. Women who were unsure that they wanted to be pregnant (OR = 1.95) or who denied their pregnancies (OR = 2.47) were more likely to have received inadequate care once they had entered care. Conclusions: This study suggests that attitudes about pregnancy may be a psychosocial barrier to women obtaining early and continuous prenatal care. Pregnancy attitudes should be assessed and appropriate services provided to improve women's utilization of prenatal care. New measures of pregnancy attitude, beyond the traditional intention measures, can be useful in assessing pregnancy wantedness and identifying women to target for these services.     

流动人口特约分娩点孕产妇保健状况调查

目的:了解流动人口特约分娩点孕产妇保健状况,为进一步完善流动人口孕产妇保健管理提供依据。方法:以2005年1~12月在上海市南汇区新场社区卫生服务中心分娩的所有流动人口孕产妇为研究对象,收集病史资料和流动人口分娩登记表信息,对1152例流动孕产妇构成、产前检查次数、分娩方式及分娩费用等进行分析。结果:没有做过产前检查或只有1次产前检查的流动孕产妇占60%,产前检查次数与产次有关(P<0.0001),流动孕产妇剖宫产组平均住院费用为3 387元,阴道分娩组平均住院费用为1105元,结论:流动人口妇女孕产期保健服务利用率低,住院分娩费用相对其收入仍偏高,需要加强对流动人口孕产期保健知识的宣传,降低经济负担,为更多的孕产妇提供限价服务。     

中国南北方部分地区1994-2000年孕产妇系统保健状况及其变化

目的 了解中国南北方部分地区1994—2000年的孕产妇系统保健状况及其变化。方法 数据来自“中美预防出生缺陷和残疾合作项目”中13个县（市）的围产保健监测数据库。研究对象为19942000年在上述项目县（市）分娩了孕满20周单胎活产儿的368589名妇女。结果 从19942000年，南北方地区产前检查率一直高于99．0％，第一次产前检查时的平均孕周从1994年13．1周提前至2000年的10．7N，早孕检查率从65．5％升至79．4％，产前检查次数≥5次的比例从34．1％升至71．8％，住院分娩率从913％升至98．8％，家庭分娩率从5．6％降至0．6％，产后访视次数≥3次的比例从80．5％升至951％。除早孕检查率外，同期比较，北方地区的其他各率均低于南方地区，且北方地区的城乡差别大于南方地区。结论 中国南北方地区的孕产妇系统保健状况得到了极大的改善，但南北地区之间、北方城乡之间存在明显的差别。     

新疆生产建设兵团已婚育龄妇女孕产期保健状况调查

目的：了解新疆生产建设兵团1971-2006年间孕产期保健状况。方法：采取分层整群、四阶段、概率比例随机抽样方法,调查员入户面对面问卷调查。结果：共调查有活产已婚育龄妇女6624人,2001年以来,产前检查率、孕早期（妊娠≤12周）检查率、师直≥8次产前检查率、团场≥5次产前检查率、住院分娩率分别达到了86.60％、66.64％、58.70％、65.19％、82.01％,在家分娩率降到14.10％,而产后访视率仅为32.01％。育龄妇女的分娩时期、民族、受教育程度、生育史、家庭年收入、职业与是否参加产前检查有关。结论：近几年孕产期保健状况有明显改善,但产前检查率、孕早期检查率和产后访视率偏低,应特别加强对文化程度低、从事农业、少数民族孕妇的健康教育,普及孕产期卫生保健知识,规范产后访视,提高孕产期保健服务质量和服务利用率。     

Health care utilization among women on O'ahu: implications for Native Hawaiian women

Women generally seek and use more health care services than do men. Women are also more likely to encounter financial and non-financial barriers to care than do their male counterparts. These differences are accentuated among low income and minority women. We examined health care utilization patterns among women on O'ahu using survey data, and compared those patterns among Native Hawaiian and other ethnic groups. We also provide prevalence rates for several critical women's health issues by ethnic group and explore demographic predictors for health care utilization. Although the vast majority of women have seen health care providers in the last year, ethnic and socioeconomic disparities were identified, especially with respect to our Native Hawaiian female population. A pattern for Native Hawaiian women reveals among the highest rates of depression, as well as sexual/physical/emotional abuse. Alarmingly, Native Hawaiian women are also less likely to have seen a provider in the last year, less likely to have insurance coverage, and more likely to visit emergency departments. Differences by provider type served to reinforce these disparities. In order to reduce barriers to health care utilization for Native Hawaiian women--and for all women in Hawai'i--we recommend universal insurance coverage that includes screening and counseling services. Additionally, training for health care providers is essential in order to improve culturally competent, psychological assessments of health issues for women, particularly Native Hawaiian women.