郑州市医院流产后计划生育服务现况的定性研究

目的:了解郑州市医院流产妇女流产原因及影响因素,医院开展流产后计划生育服务的需求以及服务现况。方法:采用个人访谈、关键信息人访谈和小组集中讨论的研究方法。结果:主要流产原因未婚妇女是不了解避孕方法而未采用避孕措施,已婚妇女多为避孕失败,少数是对优生考虑而流产。大多数流产妇女认为,医生的服务态度不好,只是简单介绍流产后注意事项,没有主动提供避孕知识的宣教和咨询,更没有提供免费的避孕药具。绝大多数流产妇女建议医院的流产后服务应该改善,医生应该主动向妇女介绍一些避孕方法,提供一些免费避孕药具等。大多数服务提供者认为流产前后对流产妇女进行避孕知识的宣传教育有必要,但存在一定的困难,主要是需要增加人员、加大经费投入等;一部分人认为若在流产后对妇女进行避孕知识的宣传和教育,可以增加避孕方法的使用,减少非意愿妊娠和重复流产。结论:流产原因多为未避孕和避孕失败,医院尚未开展流产后计划生育服务,应提供规范的流产后计划生育服务,以提高流产妇女的避孕知识和避孕方法的正确使用。     

干预措施对重复人工流产妇女紧急避孕的影响

目的 评价避孕节育咨询指导宣教对提高早孕重复人工流产妇女紧急避孕知识水平的效果.方法 对2005年9月至2006年8月间,参与北京海淀区"早孕终止妊娠后避孕干预效果分析"项目的921例早孕重复人工流产妇女随访1年,统计分析其紧急避孕知识状况.结果 被调查妇女干预前知晓率为67.10%,使用率为10.84%,术后随访1年知晓率为89.14%,使用率为18.13%,差别均有统计学意义(P＜0.01),且掌握紧急避孕知识得分差别也有统计学意义(P＜0.01).结论 医疗保健机构是宣传、指导紧急避孕应用的主要载体和关键环节,进一步加大宣教力度是提高紧急避孕方法知晓与应用最直接和有效的方法.     

紧急避孕知识的普及及服务网络的建立

紧急避孕是除了常规避孕方法外,降低意外妊娠的主要方法之一,但还未受到人们包括医生的足够重视,医生不作紧急避孕宣传,甚至存在偏见,普通人群对紧急避孕的认识更是有限。目前已有一些安全有效的紧急避孕药物和方法,为了提高人们对紧急避孕的认识,进一步降低意外妊娠,需要加强大众传媒对紧急避孕的宣传,建立健全紧急避孕服务网络,包括对专业人员的培训,使更多的地方提供紧急避孕服务。     

流产后提供避孕服务者对提供避孕服务态度的调查

目的:了解提供避孕服务者包括计划生育专业技术人员和干部对提供流产后服务的态度、意愿及知识知晓情况,提出落实流产后计划生育咨询和技术服务的建议。方法:选择河北省丰宁满族自治县、黄骅市、阜城县和邯郸市丛台区4个县(区)市,采用问卷调查方式按照统一标准对计划生育专业技术人员和干部进行面对面问卷调查。结果:共调查提供流产后避孕服务者435人,包括计划生育专业技术人员257人,计划生育干部178人,发放调查问卷435份,收回435份。调查显示:提供流产后避孕服务的人员没有经过避孕知识系统培训的213人,认为流产后避孕重要的192人,非常重要的243人;认为提供流产后避孕服务的途径位居前三位的是由妇科和计划生育医生提供的服务、进行面对面咨询和发放宣传资料;愿意为流产后妇女提供的避孕方法位居前三位的是避孕套、宫内节育器及避孕药;认为提供流产后避孕服务目前存在的最大困难是流产后妇女不愿接受和提供避孕服务的人员不足。结论:加强提供流产后避孕服务人员的专题培训,提高提供避孕服务人员对流产后避孕重要性的认识,让提供者具备流产后避孕服务意识,更好地为广大流产后妇女提供流产后服务。     

青海省育龄妇女紧急避孕情况调查分析

目的:了解青海省育龄妇女紧急避孕知情和使用情况,以减少非意愿妊娠和人工流产。方法:对青海省425例育龄妇女进行问卷调查。结果:文化程度低的妇女知晓率低,妇女有关紧急避孕的知识主要来源于书报杂志和亲友。70.1%的对象知道紧急避孕法,多数知道的是激素类紧急避孕药,但其中只有11.1%知道其使用有效时间为性生活后72h以内。用药者中58.9%1年内服用紧急避孕药2次及以上。72.3%用药后有再次未防护的同房。药物来源以药店为主。24.1%急避孕失败。425例中只有15例知道放置宫内节育器紧急避孕。高文化程度,高收入,工作环境好的人群知晓率高。结论:高原地区育龄妇女紧急避孕知识缺乏,文化水平制约着妇女对知识的接受能力。为减少非意愿妊娠和人工流产,迫切需要加强紧急避孕的知识宣传。     

紧急避孕知识的普及及服务网络的建立

紧急避孕是除了常规避孕方法外,降低意外妊娠的主要方法,但还未受到人们包括医生的足够重视。医生不作紧急避孕宣传,甚至存在偏见,普通人群对紧急避孕的认识更是有限目前已有一些安全有效的紧急的药物和方法,为了提高人们对紧急避孕的认识,进一步降低意外妊娠,需要加强大众传媒对紧急避孕的宣传,建立健全紧急避孕服务网络,包括对专业人员的培训,使更多的地方提倡紧急避孕服务。     

成熟避孕方法综合推广与川渝农村避孕节育技术服务提供的改善

目的:评价成熟避孕方法推广的综合措施对项目地区避孕方法选择及计划生育技术服务质量的干预效果。方法:在运用WHO提出的方案进行战略评估的基础上,根据评估结果2003年5月对重庆市和四川省眉山市项目现场开展行动研究,制定并逐步落实以优化避孕药具种类;加强技术人员业务培训,规范服务过程,提高服务质量;完善服务记录;更新群众宣教内容和改善管理制度等为主要内容的综合干预方案。2005年7月,运用一系列定性、定量研究方法对干预效果进行评价。结果:经过综合推广,TCu380A、MLCu375等安全高效的宫内节育器已成为项目试点地区主要使用的宫内节育器类型;药铜165以及长效口服避孕药等有效性、安全性欠佳的避孕药具使用人数逐年减少。计划生育手术前的血常规、白带常规等基本检查比例由基线评估时的基本空白提高到近100%。技术人员咨询知识与技巧大幅增加,手术质量明显改善,术后随访及对口服避孕药使用者的健康监测工作逐步受到重视,定期的环情孕情检查中增加了健康检查的内容,各种技术服务记录趋于完善,服务质量获得服务对象的认可,避孕失败意外妊娠率较往年低。结论:成熟避孕方法综合推广干预措施可以有效提高高效避孕方法的使用比例,并提高计划生育技术服务整体质量。     

医院内提供流产后计划生育服务的可行性研究

目的:分析在医院内提供流产后计划生育服务的可行性。方法:2011年5~8月采用随机整群抽样方法选取上海市60家医院的596名医生进行调查。结果:医生年龄39.0±7.52岁(24~60岁),日均门诊量中位数40(10~120)人次,每个流产者诊疗时间中位数15(5~90)min,流产后计划生育咨询时间中位数5(1~30)min。医生对选择流产后避孕方法的知识掌握程度以宫内节育器和紧急避孕最好,口服避孕药、单纯孕激素避孕方法及杀精子剂相对薄弱。虽然61.9%的医生认为为流产妇女提供计划生育咨询是门诊医生的责任,但认为最佳与可行的宣教和咨询方式存在明显差异(P0.01)。以下障碍影响了在医院提供流产后计划生育服务,包括门诊工作量太大医生无法保证咨询质量(89.6%),无专人负责避孕咨询(66%),无合适场地提供隐私服务(38.8%),避孕药具种类有限(29.1%),流产妇女无迫切需求(17.4%)。结论:需加强对医务人员流产后避孕标准操作规程的培训,同时必须从医院支持、管理激励、改善硬件、保障药具供给和人群健康教育多个方面共同努力才能有效提高医院实施流产后计划生育服务的可行性。     

流动人口紧急避孕知识状况分析

对1998年1～12月在上海市闵行区开展的“以现居住地为主”计划生育综合干预项目中4679名外来育龄妇女的紧急避孕知识状况进行分析,以了解她们的紧急避孕知识状况及影响因素,评价计划生育宣传教育干预对提高本市外来育龄妇女紧急避孕知识水平的效果。结果显示:外来育龄妇女紧急避孕知识贫乏,干预前仅3.9％的妇女听说过紧急避孕,其中仅有28.8％能正确回答在何种情况下及如何使用紧急避孕措施。干预后实验组紧急避孕知晓率由干预前的4.4％。增至干预后的39.4％,而对照组紧急避孕知晓率从3.4％仅提高到7.0％。干预后有68.5％的对象认为应该推广紧急避孕。此外,采用过紧急避孕措施的29人中16人均为干预后的实验组研究对象。多因素分析显示,户籍地、受教育年限、避孕知识来源及常用避孕方法知识得分,计划生育宣传教育为紧急避孕知晓率的影响因素。因此,必须大力开展计划生育宣传教育,提供与计划生育、生殖健康相关的信息与服务。通过电视、广播、宣传材料、专题讲座等各种途径向流动人口宣传紧急避孕的相关知识,以使她们在发生无保护性行为或避孕失败时采取补救措施,降低人工流产率,提高其生殖健康水平。     

川渝农村地区避孕措施的使用及服务状况调查

目的:了解川渝农村地区避孕节育的使用和服务状况,探讨影响计划生育服务质量的因素并提出改进意见。方法:采用定性与定量研究方法,调查育龄妇女避孕措施使用情况,并对计划生育服务站的设施和服务进行调查。结果:育龄妇女普遍缺乏避孕知识,70％以上的育龄妇女选用宫内节育器避孕。技术人员很少提供避孕节育的咨询、随访服务;服务过程中存在忽视生殖道感染等问题。一些技术人员对避孕节育知识掌握片面或不正确,村计生专干难以对避孕药具使用者提供有效的咨询及随访工作。结论:为提高农村避孕节育优质服务水平,应在宣教中增加避孕节育知识新内容;加强对技术服务人员知识、咨询、随访方面的教育和培训;结合计划生育开展生殖健康服务。     

Release of progestin-only emergency contraception

Progestin-only emergency contraception has been available in a prepackaged product since 1999. In a multicenter randomized trial, the levonorgestrel-only regimen was better tolerated and significantly more effective than the previous standard of care, the Yuzpe regimen. The levonorgestrel-only regimen prevented 85% of unintended pregnancies compared with 57% in the Yuzpe regimen. Emergency contraception is more effective the earlier the treatment begins. With the emergence of specifically prepackaged kits, emergency contraception appears to be more accessible and convenient to providers and to women. However, substantial barriers still exist to women who wish to obtain emergency contraceptive within the recommended initiation of 72 hours after unprotected intercourse. More recent information that emergency contraception is more effective the sooner it is initiated underscores the need for effective educational and distribution strategies.     

低剂量米非司酮用于紧急避孕临床观察

目的:进一步确认米非司酮25mg用于紧急避孕的有效性。在全国11个省市的计划生育技术指导站及综合医院妇产科观察了622例紧急避孕的临床效果,均为避孕失败或无保护性生活后72小时内就诊并符合条件的健康妇女,单次口服米非司酮25mg。结果:失败5例,按Dixon法计算,避孕有效率为91.25％。受试者的月经周期无明显改变且未出现明显副作用。此研究进一步证实米非司酮25mg单次口服可作为理想的紧急避孕药物。     

Emergency contraception in Mexico City: what do health care providers and potential users know and think about it?

Emergency contraception promises to reduce Mexico's high unwanted pregnancy and unsafe abortion rates. Because oral contraceptives are sold over-the-counter, several emergency contraceptive regimens are already potentially available to those women who know about the method. Soon, specially packaged emergency contraceptives may also arrive in Mexico. To initiate campaigns promoting emergency contraception, we interviewed health care providers and clients at health clinics in Mexico City, ascertaining knowledge, attitudes, and practices concerning the method. We found limited knowledge, but nevertheless cautious support for emergency contraception in Mexico. Health care providers and clients greatly overestimated the negative health effects of emergency contraception, although clients overwhelmingly reported that they would use or recommend it if needed. Although providers typically advocated medically controlled distribution, clients believed emergency contraception should be more widely available, including in schools and vending machines with information prevalent in the mass media and elsewhere.     

Preventing unintended pregnancy: the cost-effectiveness of three methods of emergency contraception.

OBJECTIVES: This study examined the cost-effectiveness of emergency contraceptive pills, minipills, and the copper-T intrauterine device (IUD) as emergency contraception. METHODS: Cost savings were modeled for both (1) a single contraceptive treatment following unprotected intercourse and (2) emergency contraceptive pills provided in advance. RESULTS: In a managed care (public payer) setting, a single treatment of emergency contraception after unprotected intercourse saves $142 ($54) with emergency contraceptive pills and $119 ($29) with minipills. The copper-T IUD is not cost-effective as an emergency contraceptive alone, but savings quickly accrue as use continues. Advance provision of emergency contraceptive pills to women using barrier contraceptives, spermicides, withdrawal, or periodic abstinence saves from $263 to $498 ($99 to $205) annually. CONCLUSIONS: Emergency contraception is cost-effective whether provided when the emergency arises or in advance to be used as needed. Greater use of emergency contraception could reduce the considerable medical and social costs of unintended pregnancies.     

Emergency contraception

Emergency contraception is used after unprotected intercourse or a contraceptive accident to prevent unwanted pregnancy. It is thought to work by stopping or delaying ovulation or preventing implantation if fertilization has already taken place. Hormonal methods, mifepristone, and intrauterine device insertion are among the methods used worldwide. Combination estrogen-progestin birth control pills are the most commonly used form of emergency contraception in the United States. According to the Yuzpe method, combination pills are taken within 72 hours after intercourse, followed by a second identical dose 12 hours later. With this method, the number of unintended pregnancies is reduced by about 75%. Nausea and vomiting are the most troublesome adverse effects, but these can be controlled with antiemetic medication taken prior to the first dose. The Food and Drug Administration, Washington, DC, has approved an emergency contraception kit consisting of 4 combination pills, a urine pregnancy test, and a patient information book. Most recently, the Food and Drug Administration has approved a progestin-only formulation, which has fewer adverse effects and equal or improved efficacy compared with the combination formula. An intrauterine device can be inserted up to 5 days after unprotected intercourse and is a cost-effective option if it is used as ongoing contraceptive protection. The most readily available form of emergency contraception consists of 2 doses of estrogen-progestin combination birth control pills or 2 levonorgestrel pills taken 12 hours apart. Emergency contraception should not be considered as an alternative to ongoing contraceptive methods, but can prevent unwanted pregnancy.     

New options in contraception for adolescents

There have been several recent advances in the contraceptive methods available to adolescents in the United States. A new monthly injectable method combines efficacy and ease of compliance with excellent menstrual cycle control. Very low-dose oral contraceptive pills containing gonane progestins decrease the incidence of estrogen-related side effects, and are associated with low rates of breakthrough bleeding. Oral contraceptive pills prescribed in continuous cycles can provide relief from menstrual-related symptoms, and may improve contraceptive effectiveness. Noncontraceptive benefits of oral contraceptive pills, such as improvement in dysmenorrhea and acne, may motivate more consistent pill-taking, and should be identified as additional reasons for pill continuation. Maximizing the prescribing time limit of emergency contraception to 120 hours after unprotected intercourse may improve access. Emergency contraception is more effective the sooner it is used, and should be provided in advance to adolescents for immediate use in the event a postcoital method becomes necessary.     

紧急避孕的研究进展

目前最为常用的紧急避孕方式为雌激素加孕激素组合或只含孕激素的药物 ,避孕效果可靠 ,副作用小。其它作为紧急避孕的措施还包括米非司酮和内置含铜的宫内节育器。但其避孕效果比不上正规的避孕药 ,通常只作为一种事后补救措施     

Knowledge, attitude and practice of emergency contraception among graduating female students of jimma university, southwest ethiopia

Background

Emergency contraception refers to methods that women can use to prevent pregnancy after unprotected sexual intercourse, method failure or incorrect use. Unwanted pregnancy followed by unsafe abortion can be avoided by using different contraceptive methods including emergency contraceptives. The objective of this study was to assess the knowledge, attitude and practice of emergency contraception among graduating female students of Jimma University main campus.

Methods

A cross-sectional study was conducted in Jimma University main campus in 2009. The calculated sample size was allocated to each faculty proportions to size of female students. Then within the faculty the sample unit was selected by using simple random sampling technique. Data was collected using self administered questionnaire and analyzed using SPSS for widow version 16.0.

Results

A total of 389 (96.5%) volunteered graduating female students participated in the study. One hundred sixty three (41.9%) were ever heard of Emergency Contraceptive, only 11(6.8%) used the method. The common sources of information were friends 60 (36.5%), radio 37 (22.8%) and television 20 (12.3%). One hundred sixteen (71.2%) agreed to use Emergency Contraceptive when they practice unintended sexual intercourse.

Conclusion

Awareness and use of emergency contraception among graduating female students of Jimma University was low. There is a need to educate adolescents about emergency contraceptives, with emphasis on available methods and correct timing of use.     

Patterns of emergency contraception use by age and ethnicity from a randomized trial comparing advance provision and information only

PURPOSE: This study measures the impact of the advance provision of emergency contraception (EC) among family planning clients at 31 clinics in California. METHODS: We randomized over 9000 clients to receive a packet containing either two 0.75-mg levonorgestrel pills (Plan B) or an identical packet containing EC information only. We conducted follow-up interviews on a subset of 1130 clients selected to optimize the age and ethnicity distribution. The interviews collected information on EC use, contraception, risk-taking behaviors and EC attitudes. RESULTS: Clients who received EC in advance were significantly more likely to have used EC (19%) than women who received information only (12%) (p=.0009). There were no significant differences between the contraceptive and risk-taking behavior of the two treatment groups. Study respondents of all ages and ethnicities expressed positive attitudes about EC. Nevertheless, even with EC on-hand, many respondents who reported unprotected intercourse decided not to take EC. CONCLUSION: More research should be done on the reasons women decide not to use EC even when readily available.     

Emergency Contraception: The User Profile

Emergency contraception (EC) has recently become available, accepted and widely used in Sweden but little is known about the characteristics and background factors of women requesting EC.Methods: During a four-month period, consecutive women (n=762) visiting family planning clinics to request emergency contraception filled out a questionnaire about their current need for EC.Results: The user of emergency contraception was typically a nulligravid young woman (83%) but 13% had a previous history of at least one induced abortion and 4% had given birth in the past. One out of four had used EC before, and of these 20% more than once. Condom breakage was the major reason for the current need for EC but as many as 37% had not discussed the need for contraception prior to intercourse. Friends were the most important source of knowledge about EC.Conclusion: Women requesting emergency contraception could be anyone and emergency contraception is used to compensate for contraceptive failure in order to prevent unwanted pregnancies.