避孕节育咨询与知情选择对农村地区已婚育龄妇女的影响

目的:了解农村地区已婚育龄妇女避孕知识状况并探讨其影响因素。方法:对国家人口和计划生育委员会知情选择项目四个试点县的3 901名 20~49岁已婚育龄妇女的避孕知识状况及其影响因素进行问卷调查,并采用SAS8.2对调查数据进行统计分析。结果:①调查对象的避孕知识综合得分平均为25.44分,50分以上的仅有4.36%。得分最高的避孕方法为宫内节育器(72.17分),最低的为宫颈帽(2.57分)。不同知识类别得分中名称知晓得分和用法得分两者较高,避孕方法原理、优点及缺点得分均较低。②调查对象的避孕知识主要通过培训班、讨论会、咨询(56.17%)的形式从乡镇或村(社区)计生人员处获得(68.21%)。③影响避孕知识得分的因素包括年龄、家庭人均收入、文化程度、对象的咨询状况以及与避孕知情选择有关的知识和态度等。④88.57%的对象认为面对面交流、培训班为获得避孕知识的最佳方式,88.40%的对象认为是乡镇或村(居委会)的计划生育技术人员,是提供避孕知识咨询的最佳人选。结论:农村已婚育龄妇女避孕知识水平较低,亟需通过宣传教育来提高,以期能使知情选择在广大农村育龄妇女中更好地推广。     

开展避孕节育优质服务对农村育龄妇女人工流状况的影响

目的了解开展避孕节育优质服务后,甘肃省农村已婚育龄妇女人工流产状况的变化.方法从甘肃省永靖县、临泽县随机选择6个乡镇育龄妇女分为干预组和对照组进行基线调查,于2002年1月起对干预组育龄妇女进行"避孕节育知情选择和计划生育优质服务"系列宣传、教育、培训.终期调查于2004年3月干预措施结束时进行.结果甘肃省农村已婚育龄妇女在基线和终期调查中,干预组人工流产率分别为4.27%和2.91%,对照组分别为4.04%和3.49%.终期调查干预组不同社会特征育龄妇女人工流产率与对照组比较均无统计学意义,且均低于基线调查时结果.干预组中接受避孕知识宣传材料或培训活动超过3次的育龄妇女,其人工流产率低于对照组.Logistic多元回归结果显示,对紧急避孕知识缺乏了解,文化程度高且理想子女数多者易发生人工流产.结论开展及加强"避孕节育知情选择",有利于降低农村已婚育龄妇女的人工流产率,提高生殖健康的水平,维护其身心健康;应进一步加大计划生育优质服务的力度,正确引导农村育龄妇女的避孕行为,降低人工流产率.     

开展避孕节育优质服务对农村育龄妇女人工流产状况的影响

目的:了解开展避孕节育优质服务后,甘肃省农村已婚育龄妇女人工流产状况的变化。方法:从甘肃省永靖县、临泽县随机选择6个乡镇育龄妇女分为干预组和对照组进行基线调查,于2002年1月起对干预组育龄妇女进行“避孕节育知情选择和计划生育优质服务”系列宣传、教育、培训。终期调查于2004年3月干预措施结束时进行。结果:甘肃省农村已婚育龄妇女在基线和终期调查中,干预组人工流产率分别为4.27%和2.91%,对照组分别为4.04%和3.49%。终期调查干预组不同社会特征育龄妇女人工流产率与对照组比较均无统计学意义,且均低于基线调查时结果。干预组中接受避孕知识宣传材料或培训活动超过3次的育龄妇女,其人工流产率低于对照组。Logistic多元回归结果显示,对紧急避孕知识缺乏了解,文化程度高且理想子女数多者易发生人工流产。结论:开展及加强“避孕节育知情选择”,有利于降低农村已婚育龄妇女的人工流产率,提高生殖健康的水平,维护其身心健康;应进一步加大计划生育优质服务的力度,正确引导农村育龄妇女的避孕行为,降低人工流产率。     

知情选择在避孕节育措施的影响

目的:探讨避孕方法知情选择在已婚育龄妇女避孕节育知识、自愿知情选择避孕方法的影响。方法:对839位育龄妇女采用问卷调查的方法了解其避孕的相关知识,对健康教育后的799人节育措施实施情况进行追踪,并进行相关的统计分析。结果:目标人群有关避孕节育知识的知晓率有不同程度提高;育龄群众能在一定程度上主动选择避孕方法,其避孕方式正朝着多样化方向发展。结论:避孕方法知情选择的健康教育活动,不仅使育龄群众掌握了多种避孕节育知识,同时获取了生殖健康的基本知识,真正实现知情选择,科学避孕。     

避孕方法知情选择干预措施对已婚育龄妇女避孕知识水平的影响

目的:评价避孕方法知情选择干预措施对已婚育龄妇女避孕知识、知情选择相关知识和态度的影响,探索影响干预效果的潜在因素。对象和方法:本研究以计划生育门诊为基础的干预研究,进行基线调查后对到干预门诊就诊的妇女进行避孕节育知情选择宣教,培训干预门诊的服务人员并提供咨询服务,干预后进行效果评估调查。结果:干预措施显著提高了干预组服务对象避孕知识、知情选择知晓率和正确理解程度,提高了服务提供者的咨询技巧。计划生育干部和技术人员认为基层技术人员数量少、素质低,给知情选择的开展带来一定的困难。结论:应通过多种渠道给予育龄群众更广泛全面的信息,加强基层服务提供者的培训。     

宣州市已婚育龄妇女避孕知识状况及其影响因素分析

目的 :了解已婚育龄妇女对避孕知识的掌握程度。方法 :对 70 7例 2 0～ 40岁已婚育龄妇女的避孕知识状况及其影响因素进行了分析。结果 :(1 )大部分对象的避孕知识得分在2 0～ 6 0分之间 ,约占 70 %。得分在 80分以上的对象仅占 1 .6 %。在听说过的各种避孕方法中 ,宫内节育器位居首位 (99.7% ) ,其次是避孕套 (97.2 % )和口服避孕药 (96 .6 % )。(2 )研究对象获得避孕知识的首要途径是书籍和手册 (50 .1 % ) ,其次是咨询医务人员(39.9% )。 (3)影响避孕知识得分的因素包括职业、文化程度、家庭收入、避孕知情选择的知识和态度等     

云南白族、贵州苗族已婚育龄妇女节育模式的研究

为了探索少数民族计划生育工作现状和节育模式,调查了云南白族、贵州苗族地区2026例已婚妇女,结果显示白族、苗族计划生育工作成绩显著,育龄妇女节育比例均高于80％,云南白族以宫内节育器为主要避孕方法（62．03％）,贵州苗族以男女绝育为主（76．62％）。Logistic多元回归分析显示夫妇的生育意愿、性别偏好、计生干部作用均影响是否采用绝育措施本道避孕方法较少、曾用避孕方法较多者倾向于绝育。两地相比,云南白族地区的计划生育工作较好,妇女避孕知识较多,自觉节育比例更大。鉴于今后计划生育全程服务和“知情选择”的推广,建议少数民族地区在继续推行现行的长效避孕方法（绝育和宫内节育器）的同时,积极宣传避孕知识,加强对群众生育观念的正确引导,增强基层计生技术力量,逐步向知情选择过渡。     

避孕方法知情选择对人工流产发生的影响

目的:从个体角度解析知情选择避孕方法对人工流产发生的影响,并进一步探究两者间的相互关系。方法:采取病例对照研究方法(case-control),根据已婚育龄妇女管理信息系统登记名单,从浙江省德清县、山东省即墨市、安徽省居巢区、宁夏回族自治区中卫市四县(市、区)中,每县(市、区)随机抽取在2002￣2004年间有过人工流产经历的已婚妇女200名,以及截止2004年底从未有过人工流产经历的已婚妇女200名进行1∶1配对。结果:IUD使用者对IUD禁忌证、副作用知情,以及避孕套使用者对正确使用知识知情,可降低人工流产的发生;此外,促进群众能够主动地选择避孕节育方法,而不是由计划生育干部代替选择,则人工流产的发生会降低。从提供个性化咨询服务、规范化筛查服务以及常规化随访服务等方面提高服务能力和质量,促进知情和自主选择避孕方法,可以降低人工流产的发生。结论:对使用IUD和避孕套者,知情可降低人工流产的发生;自主选择对减少避孕失败的发生有重要的影响;技术服务贯穿整个知情选择的全过程,服务到位是降低人工流产的重要手段。     

江苏农村育龄妇女避孕方法可接受性的研究

对1986年9月在中国江苏农村进行的“中国农村已婚育龄妇女使用避孕方法的变化”调查资料,应用单因素交叉表及多因素logistic回归分析江苏农村妇女的节育方法使用状况、副作用评价、满意程度及其原因。研究结果表明;江苏农村已婚妇女中,现用的节育方法主要是宫内节育器和女性绝育(分别占46.67%和36.39%)。妇女对各种节育方法的满意程度均较高,尤其对口服避孕药和宫内节育器更为满意。妇女对各种节育方法的评价不尽相同,宫内节育器、针剂、绝育和口服避孕药的优点较为突出,但副作用也较明显。避孕套虽然“使用简便”一项较差,但副作用小。不同特征妇女对各种节育方法的评价有所不同。     

农村妇女避孕方法使用及其影响因素分析

本文使用的数据来源于1986年在江苏省进行的“农村已婚育龄妇女使用避孕方法的变异”的调查。本次调查的目的是对已婚育龄妇女避孕方法使用的类型及动力学进行综合研究。调查的数据表明,江苏农村已婚育龄妇女的避孕率为85%,其中,宫内节育器和女性绝育术为最普遍使用的方法。在使用避孕方法的妇女中,宫内节育器和女性绝育术的使用比例分别为46.6%和36.4%。妇女对正在使用的避孕方法的评价和希望使用新方法的意愿都存在着差别。从这些差别的分析中不难看出,面对广大育龄妇女的避孕要求,我们应提供较为先进的避孕方法的信息及咨询服务,从而扩大避孕方法的可选择范围,避免一些方法的错误使用,提高使用者的满意程度。     

中国八省市计划生育工作者对向未婚年轻人提供避孕服务的态度

目的 :了解我国不同地区计划生育工作者对向 1 8～ 2 4岁未婚年轻成人提供避孕服务的态度及其可接受的服务方法。方法 :1 998年 7月～ 1 998年 1 2月 ,对八个省市 96 5名街道或乡镇以上的计划生育干部和 96 2名基层负责避孕药具发放的计生服务人员进行了问卷调查。结果 :约 6 0 %的研究对象对政府部门是否应该向未婚年轻成人提供避孕服务持肯定态度 ,约 3 6 %的研究对象对此持否定态度 ,有的省市持否定态度的比例超过了 5 0 %。研究对象可接受的向未婚年轻成人提供避孕服务的方法因地区不同而有差异。结论 :转变计划生育工作者对向未婚年轻成人提供避孕服务的态度仍任重道远。建议政府部门制定明确的政策 ,转变计生工作者的观念 ,更好地服务于未婚青年 ,改善他们的生殖健康状况。     

A case/comparison study in the Eastern Region of Ghana on the effects of incorporating selected reproductive health services on family planning services

OBJECTIVE: to assess the impact on the provision of family planning (FP) services when FP providers were also trained to provide additional, selected, reproductive health services.DESIGN:case/comparison study. PARTICIPANTS AND SETTINGS: twenty-four FP service delivery points in which training in sexually transmitted infection prevention and control services or post-abortion care services had been initiated (case facilities), were compared to 19 control facilities in which similar provider training had not yet been targeted. All settings were located in the Eastern Region of Ghana. MEASUREMENTS: service statistics for three study years (1996-1998) were reviewed. Structured interviews with providers, managers and clients provided qualitative data concerning impact and satisfaction. FINDINGS: case facilities which had integrated these additional reproductive health (RH) services experienced consistently higher numbers of clients and the total number of clients receiving FP services increased over time. There was also a statistically significant increase in continuing FP clients within case facilities. In contrast, the number of FP clients serviced in the comparison area remained basically unchanged over time. KEY CONCLUSIONS: interviews conducted with providers and managers in both types of settings indicated strong support for receipt of training to provide these integrated services and a request for additional training in an even broader array of RH and adult/child services. Clients also perceived the benefit of additional RH services and perceived these services to be of high quality. IMPLICATIONS FOR PRACTICE: expanding the repertoire of clinical skills of FP providers, enabling these practitioners to render RH services that augment basic FP services, has the potential to increase the number of new and continuing FP clients, and increases the satisfaction of both providers and consumers with respect to these services.     

COMPARISON OF RURAL AND URBAN CERTIFIED NURSE-MIDWIVES IN ARIZONA

A survey of certified nurse-midwives (CNMs) in Arizona was carried out in 1990 to provide data for maternity service planning in the state. Information was gathered on location and scope of CNM practice, barriers to practice, and the contribution of CNMs to maternity care. Demographic and clinical practice characteristics of urban and rural CNMs were also compared. Urban and rural CNMs are significantly different in terms of education (urban CNMs are much more likely to have master's degrees) and number of years since first certification (urban CNMs have been certified significantly longer). Rural midwives are more likely to be under the age of 40. Health services provided by urban and rural CNMs were compared with each other and with national data. Midwives in rural areas of Arizona are more likely to provide comprehensive nurse-midwifery services than are either urban Arizona midwives or U.S. midwives as a whole. Urban and rural CNMs described lack of physician backup as a major barrier to nurse-midwifery practice in rural areas. Lack of hospital privileges was another major obstacle noted by rural nurse-midwives. Arizona CNMs felt they could provide comprehensive, cost-effective maternity services in rural areas that would improve access to care, patient satisfaction, and maternal and child health outcomes.     

Integration of cervical screening in family planning clinics.

OBJECTIVES: To assess the suitability of cervical cancer screening in family planning (FP) clinics and the relevance for women's health. METHODS: A survey was done on clients visiting the clinics of the Family Planning Association of Kenya (FPAK). Client characteristics, age, screening status and PAP smear results were registered. In-depth interviews were held with a limited number of staff and clients. RESULTS: In 1999, 38052 clients visited FPAK clinics, 43.5% were younger than 30 years old. More than 10000 cervical smears were taken. A total of 4.5% of the smears were abnormal, including 1.5% high-grade squamous intraepithelial lesions (HSIL) and 0.2% invasive cancers. The clinics were well prepared to provide high quality screening services. Patients and staff had a positive view on screening. CONCLUSIONS: Providing cervical cancer screening in FP clinics is beneficial for the clients but is unlikely to have an impact on the epidemiology of cervical cancer morbidity as FP services reach only a small percentage of the women who are most at risk. Measures to reach more and older women could assure a larger impact.     

Privatisation of health services and the reproductive health of rural Chinese women

China’s rural health care system has undergone major changes since the early 1980s, when the country began privatising rural health services. Following fiscal devolution, the rural primary health service was transformed into a fee-for-service system, dependent on the availability of local resources. This article reports some of the results of a study undertaken in 1994–96 to examine the impact of privatization on financing, provision and use of reproductive health services by women in two rural counties in Yunnan Province, China. The most common self-reported symptoms of reproductive morbidity were abnormal vaginal discharge and vaginal tears during home delivery, which went mostly untreated. Hospital-based delivery and use of antenatal care was very low, adversely affected by costs and perceived low quality. Service quality was affected by low investment in training, maintenance and supervision of workers. Most of the burden for maternal and child health care fell on local health workers, yet resources for these services had declined from 1985 to 1995. Only support for family planning services, which were funded and provided separately, had increased. Rural women’s reproductive health needs were inadequately attended to by rural health services following reforms. Our data has helped to increase attention to those needs within planned reform efforts.     

Development of neonatal respiratory and intensive care: Chinese perspectives

Recent economic improvements in China have allowed the development of perinatal-neonatal care in sub-provincial regions. However, variations in neonatal respiratory and intensive care exist, especially in regions with limited resources. We conducted a series of collaborative clinical investigations into neonatal hypoxemic respiratory failure (NRF). In the study period from 2004 to 2005, this nationwide study found an incidence of NRF of 13.4% of total admissions to neonatal intensive care units (NICUs), with a mortality of 32%. Fewer than 30% of infants with respiratory distress syndrome (RDS) received surfactant treatment. Most cases of NRF had birth weights (BWs) of 1,000-1,500 g. Approximately 60% of deaths were due to withdrawal of respiratory support because of economic restraints despite initial response to therapy. Extremely low BW or gestational age accounted for less than 2% of all NRF cases, and their survival rate was less than 50%. A prospective clinical epidemiologic study of NRF in 14 NICUs, mainly sub-provincial centers, in Hebei province was undertaken in the study period from 2007 to 2008. NRF made up 16.9% of total NICU admissions, with increased use of surfactant (>50%) and continuous positive airway pressure (>80%) in this study. However, mortality due to RDS, meconium aspiration syndrome and pulmonary infection/sepsis remained higher than 30%, in part affected by socioeconomic factors. With measures to assist hospitalized neonates from low income families in urban areas, as well as the 'new rural cooperative health care program' to subsidize families from rural areas, the quality and affordability of NICU services may be improved in the forthcoming years.     

Health-related quality of life among urban, rural, and island community elderly in Taiwan.

BACKGROUND AND PURPOSE: There are published norms of the 36-item short form of the Medical Outcomes Study Questionnaire (SF-36) for many countries, but few such studies have been conducted in Taiwan. The purpose of this study was to provide the norms for the SF-36 health status measure in urban, rural, and remote island community elderly populations, and to explore the relation between demographic or characteristic factors and the SF-36. METHODS: A structured questionnaire was used for door-to-door data collection in this survey of an urban, a rural, and a remote population (Shihpai, Yuli, and Kinmen, respectively, in Taiwan). Interviewers also collected information on subjects' demographics, medical history, use of health services, and health-related quality of life using the SF-36. A total of 6503 subjects who were at least 65 years of age were invited, and 4424 (73.1%) participated in the survey. RESULTS: The urban norms were significantly higher than the rural norms in seven scales of the SF-36 and significantly higher than the remote island norms in 4 scales, including physical functioning (84.6 vs 77.1), role limitations due to physical problems (77.8 vs 70.2), general health perceptions (70.5 vs 65.5), and role limitations due to emotional problems (90.6 vs 85.2). Remote island norms were significantly higher than urban and rural norms in vitality and mental health scales. In the multivariate analyses, women had significantly poorer scores in all scales of the SF-36 than men (p < 0.05), except for social functioning. Higher education was significantly associated with increased scores in all scales, except for vitality/energy and mental health scales. Scores of all scales were significantly reduced according to the number of chronic diseases a subject had. The need for domestic services and utilization of inpatient and outpatient health services were associated with lower scales (p < 0.05). CONCLUSIONS: There were significant differences between urban, rural, and remote island elderly populations in most scales of the SF-36. The urban elderly population had the greatest health-related quality of life on most scales, particularly on the physical health scales. The remote island elderly population had the highest scores on the vitality and mental health scales, whereas the rural elderly population had the poorest health-related quality of life, particularly rural women.     

Self-reported cervical screening practices and beliefs of women from urban, rural and remote regions.

This survey aimed to explore women's perceptions of a number of issues relating to the availability and utilisation of cervical cancer screening services in the rural, remote and urban regions of New South Wales (NSW) Australia. The survey involved urban, rural and remote regions of NSW determined by the definition of the Department of Community Services and Health. This was a cross-sectional telephone survey. Of the 339 eligible urban households, 265 (78%) completed interviews; of the 286 eligible rural households, 238 (83%) completed interviews; of the 285 eligible remote households, 230 (81%) completed interviews. Telephone contact was made with randomly selected households in each region. Women in the households were asked to complete a computer-assisted telephone interview. The survey addressed a number of issues relating to cervical screening: cervical cancer risk status; provider of Pap smear service; distance travelled to have a Pap smear; perceived barriers and facilitators to cervical screening. There was no statistically significant difference in the proportions of women from urban (74%), rural (76%), and remote (71%) regions who reported having a Pap smear in the 2 years preceding the survey. General practitioners provided the majority (more than 70%) of tests irrespective of region. Compared with women from urban areas, women from rural and remote areas were almost twice as likely to have had their last Pap smear from a male general practitioner. A greater proportion of women from remote regions had to travel for 60 minutes or more to access providers of Pap smear services. Few differences in the top three reported barriers to, and facilitators for screening were evident between regions and between those women who had and had not been adequately screened. Issues of distance, isolation and access to alternative service providers are a concern to women in rural and remote regions and should be considered by those involved in the implementation of cervical cancer screening services.     

Prioritizing the sexual and reproductive health and rights of adolescent girls and young women within HIV treatment and care services in emergency settings: a girl-centered agenda

Background

The integration of family planning (FP) and HIV-related services is common in sub-Saharan Africa. Little research has examined how FP quality of care differs between integrated and non-integrated facilities. Using nationally representative data from Malawi and Tanzania, we examined how HIV integration was associated with FP quality of care.

Methods

Data were drawn from Service Provision Assessments (SPAs) from Malawi (2013–2014) and Tanzania (2014–2015). The analytic sample was restricted to lower-level facilities in Malawi (n = 305) and Tanzania (n = 750) that offered FP services. We matched SPA measures to FP quality of care indicators in the Quick Investigation of Quality (QIQ). We conducted bivariate and multivariate analyses of 22 QIQ indicators to examine how integration status was related to individual QIQ indicators and overall FP quality of care at the facility- and client-level.

Results

The prevalence of HIV integration in Malawi (39%) and Tanzania (38%) was similar. Integration of HIV services was significantly associated (p < 0.05) with QIQ indicators in Malawi (n = 3) and Tanzania (n = 4). Except for one negative association in Tanzania, all other associations were positive. At the facility-level, HIV integration was associated with increased odds of being at or above the median in FP quality of care in Malawi (adjusted odd ratio (OR) = 2.24; 95% confidence interval (CI) = 1.32, 3.79) and Tanzania (adjusted OR = 2.10; 95% CI = 1.37, 3.22). At the client-level, HIV integration was not associated with FP quality of care in either country.

Conclusion

Based on samples in Malawi and Tanzania, HIV integration appears to be beneficially associated with FP quality of care. Using a spectrum of FP quality of care indicators, we found little evidence to support concerns that HIV integration may strain facilities and providers, and adversely impact quality outcomes. Rather, it appears to strengthen FP service delivery by increasing the likelihood of stocked FP commodities and achievement of other facility-level quality indicators, potentially through HIV-related supply chains. Further research is needed to assess FP quality of care outcomes across the various platforms of FP integration found in sub-Saharan Africa.

     

Measuring Preferences for Delivery Services in Rural Vietnam

ABSTRACT: Background: The relatively low use of maternity services at the primary health care level in Vietnam has highlighted the need for economic evaluations of the current maternal health delivery network. This study measured willingness‐to‐pay for obstetric delivery preferences in rural Vietnam. Methods: An interviewer‐administered survey was conducted among 200 postpartum and 196 pregnant women, and 196 men in Quang Xuong district, Thanh Hoa province of Vietnam, using the payment card technique. Results: A kappa score of 0.98 showed very good agreement between the two interviewers administering the survey. An association was found between willingness‐to‐pay and satisfaction with the quality of maternity services. No significant differences were found in willingness‐to‐pay values between prenatal and postpartum groups, and between male and female participants. Conclusions: The study demonstrates that the willingness‐to‐pay instrument is a feasible tool, and is relatively reliable to measure the benefit of different alternatives of delivery services in rural Vietnam. For wider application of the instrument, its validity should be investigated further. Meanwhile, health care managers and decision makers should be encouraged to apply the instrument in the evaluation of maternal health programs.