玉树农牧区藏族妇女孕产期保健服务可及性研究

目的:了解偏远农牧区藏族育龄妇女的孕产期保健服务可及性状况。方法:利用2009年在青海省玉树县及囊谦县大、小苏莽乡的现场调查数据,分析农牧区藏族育龄妇女的孕产期保健服务利用率与经济、教育、医疗卫生服务可及性等因素的关系。结果:仅12.4%的妇女受过孕产期保健知识教育。最近一次生孩子孕产期保健服务利用率低,产前检查率为49.1%,新法接生率为11.2%,住院分娩率为9.5%,产后访视率为6.5%,均低于同类地区;怀孕期间发生紧急情况,60.4%的妇女会求助村医或乡医;生孩子后身体出现不适,68.6%的妇女会求助村医或乡医。受过孕产期保健知识教育者服务利用率高于未受过教育者;家庭年收入较高的妇女,在怀孕期间出现紧急情况和分娩后身体不适时,求医率高于家庭年收入较低的妇女。服务利用率与到医疗机构采用的不同交通方式和所需时间长短没有明显关系。调查地区67.3%的妇女生孩子无医药费用;有费用者,其自付医药费用占家庭年收入的比例在60%～100%者占5.7%,有2.9%的妇女生孩子自付医药费用超过了过去一年的家庭总收入。受访者报告了在过去2年内有4例亲属在孕产期死亡。结论:偏远农牧区藏族妇女在孕产期保健教育、服务等方面可及性不足。应进一步促进偏远农牧区的经济发展,倡导先进的生育文化,普及育龄妇女孕产期保健知识教育,加强乡村医生孕产期保健服务能力。

Study on the accessibility of maternal health services for Tibetan women in agricultural and pastoral areas in Yushu autonomous prefecture

Objective:To understand the situation of accessibility of maternal health services for Tibetan women of childbearing age in remote agricultural and pastoral areas. Methods:The relationship between the utilization rate of maternal health services for Tibetan women of childbearing age in remote agricultural and pastoral areas and economic factor,educational factor,and the accessibility of medical and health services were analyzed based on the field survey data in Yushu autonomous prefecture,Dasumang village and Xiaosumang village of Nangqian county. Results:Only 12.4% of the women had received maternal health knowledge and education.The utilization rate of maternal health services during the last childbirth was low,the rate of prenatal examination was 49.1%,the rate of delivery with new methods was 11.2%,the rate of hospital delivery was 9.5%,the rate of visit after delivery was 6.5%,all the above-mentioned indicators were lower than those in similar areas;60.4% of the women turned to village doctors and country doctors for help when critical situations occurred during pregnancy;68.6% of the women turned to village doctors and country doctors for help when they felt discomfort after delivery.The utilization rate of maternal health services for Tibetan women who had received maternal health knowledge and education was higher than that who didn’t receive maternal health knowledge and education;when critical situations occurred during pregnancy or the women felt discomfort after delivery,the rate of seeking treatment among the women with high annual family income was higher than that among the women with low annual family income.There was no correlation between the utilization rate of maternal health services and means of transportation,time from their home to medical institutions.67.3% of the women had no medical expense for childbirth;5.7% of the women paid 60%-100% of their annual family income for medical expense of childbirth;and 2.9% of the women paid medical expense for childbirth more than their annual family income.The women investigated reported that four relatives died during pregnancy in the past two years. Conclusion:The accessibility of maternal health education and services for Tibetan women in remote agricultural and pastoral areas is poor;it is necessary to promote economic development of remote agricultural and pastoral areas,advocate advanced childbearing culture,popularize maternal health knowledge and education among the women of childbearing age,and enhance the ability of maternal health services of village doctors.