上海市流动人口孕产妇平产分娩点医院避孕服务状况调查

目的:了解流动人口孕产妇平产分娩点计划生育和避孕咨询服务现状及医务人员的产后避孕知识。方法:通过结构式问卷,对2004年上海市卫生局设立的10家流动人口孕产妇平产分娩点医疗机构进行机构设置及避孕服务调查,对机构中涉及到计划生育/避孕咨询服务的医务人员进行产后避孕知识调查。结果:10家外来人口分娩点医院中,仅有3家医院设有独立的计划生育门诊,8家医院设有计划生育咨询室,所有的二级医院均设有计划生育病床,平均提供10.5种避孕方法的咨询,可以操作落实的避孕服务项目平均为7.1种。343名调查对象中,279人(80.8%)曾为孕妇或产后妇女提供过避孕咨询服务;109人(31.8%)曾参加过计划生育/避孕咨询方面的培训。产后避孕知识得分最高为82分,中位得分为34分;多因素分析显示,调整其他可能的影响因素后,培训是影响医务人员产后避孕知识最重要的因素。结论:大部分流动人口孕产妇平产分娩点机构的计划生育设置和避孕方法咨询服务能够达到管理文件要求。但仍需加强计划生育门诊的硬件建设和针对性地加强医务人员产后避孕知识的再培训,更新知识结构。     

Changes in midwifery practice. 26. Postwar legislative guideline concerning family planning

Yoshio Furuya, who authored the 1951 legislative guidelines for family planning in Japan, designated 3 villages to model family planning upon his return from the United States in 1950. The instructors were public health nurses, midwives and regular nurses who had been trained and certified by the National Public Health Institute. They showed film strips and slides, and distributed contraceptives and medication. Population Research Group also embarked on the New Life Style Movement among Japanese industries in 1951. The new life style was said to have 3 pillars: family planning, career planning, and family morals. The idea of family planning was welcomed at the beginning by industries because it would mean less dependents of employees to provide financial aid for. The movement lasted only several years. In 1955, the International Family Planning Federation and the Japan Family Planning Federation co-sponsored the Fifth International Family Planning Conference in Tokyo. 572 participants including Margaret Sanger delivered 91 papers on techniques and practices of family planning. Soon after the conference, the Family Planning Study Committee was organized, and they met once a month to discuss socio-cultural implications of family planning, theory and practice of contraception, maternal and child health. Many of the committee members were idealistic/feminist public health officials but there were no women among them. A post-war family planning movement approved by the Japanese government resulted in the dramatic reduction in the birth rate from 34.3% in 1947 to 17.2% in 1957. Midwives played an important role in enforcing the policy but they were excluded from policy making.     

The effects of family planning education provided to different gender groups

Objective To determine whether women or men should be preferred as the target group of the family planning education.
Design Community trial (educational intervention study).
Setting Three villages having similar characteristics in Gaziantep, Turkey.
Population Currently married women aged between 15–49 and their husbands in these villages.
Methods Family planning education was given only to women in the first village, only to men in the second village and to both women and their husbands in the third village.
Main outcome measures Changes in knowledge, attitudes, the behaviour of married women and their husbands between surveys performed before and after family planning education.
Results Important changes in knowledge, attitudes, and behaviour were determined in all intervention groups after family planning education. The rate of effective contraceptive usage among women using any one of the contraceptive methods described significantly increased in all groups, especially where family planning education was given to both sexes.
Conclusions Family planning education given to one of the couples may easily affect the other. Consistent and regular education is more important than selecting target gender groups for family planning education.     

"Financing Family Planning Services: Is Categorical Legislation Still Needed?" Drs. McFarlane and Meier Respond

Authors of the article "Financing Family Planning Services: Is Categorical Legislation Still Needed?" in the September-December 1991 issue of the American Journal of Gynecological Health, respond to a charge by the Executive Director of the Los Angeles Regional Family Planning Council that data presented on California's 1987 expenditures for family planning services were erroneous. Data presented in the article were obtained and reprinted from a 1988 article in Family Planning Perspectives by Rachel Benson Gold and Sandra Guardado. The figure of $27,000 was for contraceptive services exclusive of expenditures for sterilization, infertility, or extraclinical education. This figure was later adjusted in Volume 21 of Family Planning Perspectives to $27 million. Accordingly, total state funds spent nationwide was $76 million and national expenditures were $412 million. The authors were unaware of these corrections when their article went to press and thank their critic for bringing attention to the error. Even so, the author's original conclusion holds that categorical legislation is needed for family planning.     

The need for ovulation detection before prescribing oral contraception

This study confirmed the importance of ovulation detection before oral contraceptive (OC) use is initiated in young women. Study subjects included 64 females (mean age 18.3 years) who requested initiation of OC use at the Mishmar Hayarden Family Planning Clinic in Israel in 1983-84. To determine if the subjects had ovulatory cycles, they were instructed to collect a urine sample from days 11-20 of 3 consecutive menstrual cycles and to record their basal body temperature. Urinary luteinizing hormone and biphasic basal body temperature recordings indicated that ovulatory cycles occured in 41 women (65.7), and combined or triphasic OCs were prescribed. The remaining 22 women (34.3%) had anovulatory cycles. In 11 cases, anovulation was due to intermittent hyperprolactinemia and the progesterone-only pill or a barrier method was provided. The diagnosis was polycystic ovarian syndrome in 3 cases and pituitary microadenoma in a further 3 women.     

A comparative analysis of the modification of sexual desire of users of oral hormonal contraceptives and intrauterine contraceptive devices.

OBJECTIVE: To compare the influence of oral hormonal contraceptives (OCs) and the use of intrauterine contraceptive devices (IUDs) on the modification of sexual desire. MATERIALS AND METHODS: A prospective observational study of 1073 women using OCs or an IUD at the Family Planning Center 'Marina Alta' in Alicante, Spain. In order to evaluate the relative risk regarding the decrease in libido attributed to each contraceptive method, a logistic regression analysis was undertaken which considered the factors of age adjustment, level of studies, family planning information, relationship with partner, age when sexual relationships were initiated, parity, contraceptive method previously used and the duration of use of the contraceptive method. RESULTS: No differences in the decrease of sexual desire were observed between the use of the OC and IUD (odds ratio (OR) 1.32; 95% confidence interval (CI) 0.70-2.49), yet differences were noted, however, in relation to age (OR 1.05; 95% CI 1.01-1.10). Although these differences were not statistically significant, a high level of awareness regarding family planning was shown to increase sexual desire when compared to a lower level of information on this subject (OR 0.64; 95% CI 0.41-1.01). Sexual desire was seen to decrease if the quality of the relationship with the partner was average (OR 2.24; 95% CI 1.36-3.69) or poor (OR 4.69; 95% CI 1.93-11.4). Nulliparous women showed a greater decrease in sexual desire in relation to women who had already given birth (OR 1.57; 95% CI 1.00-2.47). Sexual desire was greater if the contraceptive method had already been in use for 6-12 months (OR 0.41; 95% CI 0.17-0.98). CONCLUSIONS: Sexual desire does not vary in relation to the use of OCs or IUDs, yet it does decrease with age, in nulliparous women and in those with an average or poor relationship with their partner. Furthermore, sexual desire shows an increase between the first 6 and 12 months of contraceptive treatment.     

Postcoital Contraception: Who Uses the 'Morning After Pill'?

Summary: Postcoital contraception (PCC) is a safe and effective method of avoiding unwanted pregnancy after an occurrence of unprotected sex. It nevertheless represents an absence or failure of preventive strategies. Women engaging in unprotected sex may have been exposed to risks of sexually transmissible diseases (STDs) including HIV/AIDS. Family planning service providers have expressed concern at the number of women using this emergency measure as a form of contraception, sometimes repeatedly, but little is known about the sort of women they are and the context in which unprotected sex has occurred. This paper reports the sociodemographic characteristics of women requiring PCC in the two clinical sites of Family Planning Victoria. A self-administered questionnaire was completed by 206 women who required PCC during a 3-month period. The women were aged 14–43 years with an average age of 23 years. Over half the women had used PCC previously and more than a quarter of these women had used it more than twice before. Most of the women had had sex with a regular boyfriend, husband or partner at their own or their partner's home. The main reasons given for needing PCC were nonuse of condoms, condom breakage and missing an oral contraceptive pill.     

Change in contraceptive choices and the effect of education on use of contraception at the family planning clinic of Si?li Etfal Training and Research Hospital, Istanbul, Turkey.

OBJECTIVE: To investigate change in contraceptive use and the effect of education on fertility and contraceptive attitudes at our family planning clinic. METHODS: For this retrospective review, medical charts from Si?li Etfal Training and Research Hospital Family Planning Center were obtained. Records were evaluated for 2514 women in 1997 and 2268 women in 2002. RESULTS: During the 6-year period studied, significant decreases occurred in the number of births, elective abortions, gravidity and number of living children (p < 0.001). When the patterns of method use were compared, use of intrauterine devices and of coitus interruptus diminished whereas pill and condom use increased. Parallel with the rise in educational level, intrauterine device use declined whereas pill and condom use rose significantly (p < 0.001). CONCLUSION: The sociocultural and educational levels of women affect their contraceptive choices. Policies aimed at raising the socioeconomic and educational level of women should be supported to prevent maternal and fetal complications as a result of unwanted pregnancies.     

Induced abortion: a four-year experience at a University Gynaecological Clinic in Greece.

The aim of this study was to estimate the percentage of women who asked for pregnancy termination as an alternative to using family planning. The reasons given for requesting termination were documented and evaluated. During a 4-year period, 663 women came to the Family Planning Department. Four hundred and ninety-one (77.6%) were pregnant, in the first trimester of pregnancy and requesting an induced abortion. Consultation and counselling resulted in a 25% decrease in the number who finally had their pregnancies terminated. The low socio-economic status of most of the women and the negative attitude of our society towards an unmarried mother remain the main reasons for a high rate of therapeutic abortion.     

Young girls and contraception. A survey conducted in the MFPF family planning center,Strasbourg, in 1985

The results of a survey on contraception among 513 adolescent women attending a family planning clinic in Strasbourg, France, in 1985 are presented. "Eighty percent of them were attending school. In over half the cases, this was their first consultation for contraceptive advice. 33% of the subjects did not return after this initial consultation. The age at which sexual intercourse first occurred was between 14 and 17, with a peak at 15-16 years of age. Most of the girls attending this Family Planning Center were told about it by friends or a sister (78%) and they rarely told their parents what they were doing (76%). Most of them (63%) preferred a woman doctor for a contraceptive consultation." (SUMMARY IN ENG)     

Acceptance of Contraceptive Methods Among Postpartum Women in a Tertiary Care Center

Background

In India, a large proportion of women with an unmet need for contraception are within their first year after childbirth. Therefore, concentrating efforts to educate postpartum women on the importance of attending contraceptive clinics could have a proportionally bigger impact on increasing postpartum contraception usage.

Methods

Hundred and seventy-eight (178) women were followed up to determine the proportion of postpartum women who attended the family planning clinics for contraceptive counseling. The reason for non-attendance, choice and effectiveness of contraceptive method selected was determined.

Results

Out of 178 postpartum women who were followed up, only 12 (6.8 %) attended the contraceptive clinic. IUD, POPs and Inj-DMPA are the preferred contraceptive methods selected by postpartum women. Hundred percent of the postpartum women who attended contraceptive selected a contraceptive method as compared to only 44 % of the postpartum women who did not attend a contraceptive clinic. Only 29.2 % of these postpartum women selected highly effective contraceptive methods as compared to 83.3 % by the postpartum women who attended family planning clinics. The common reasons cited for not attending contraceptive clinic was found to be time constraint (43.9 %) followed by ‘stay far away’ (39 %), followed by ‘already have information’ (9.7 %).

Conclusions

Family planning service that is scheduled to be delivered at the 6-week postpartum is rarely attended. The common reason cited by postpartum women for poor attendance in these family planning clinics was time constraint.

     

Family planning in grand multiparous women in Diyarbakir, Turkey, 1998: the factors affecting contraceptive use and choice of method.

Family planning is an important service for preventing maternal deaths. A 3-year project on children and maternal health was conducted in suburban areas of the Diyarbakir province of Turkey. In this project, volunteer women told women resident in the area about family planning as well as other maternal and child health-related subjects. Within 3 years, all women were visited at least five times and changes in contraceptive use were recorded. A cross-sectional study was planned to understand the factors affecting contraceptive use in grand multiparous women. A total of 200 grand multiparous women were selected from visit cards and various characteristics of these women were evaluated. Odds ratios and 95% confidence intervals were calculated using logistic regression analyses. The use of contraceptives had increased from 33.5% to 59.5% by the end of the 3 years in the 200 women. The main factors affecting contraceptive use were misconceptions and concerns about health-related risks, having a child younger than 14 years working outside the home to contribute to the household income, religious opposition, a gap between the desired and actual number of sons, number of previous deaths of children and discussion with the husband about family planning.     

Family planning knowledge,attitudes and practices in women with schizophrenic spectrum disorders

This study set out to test three hypotheses about family planning in women with schizophrenic spectrum disorders, as compared to demographically comparable non-mentally ill control women: that they (1) report at least as much unprotected intercourse while not desiring pregnancy; (2) have less knowledge about contraception; and (3) perceive more, and different, obstacles to obtaining or using birth control. A semistructured Family Planning Interview was administered to subjects (n = 44) with Research Diagnostic Criteria diagnoses of schizophrenia and schizoaffective disorder, and to non-mentally ill control subjects (n = 50). The participants had high rates of unprotected intercourse, as did non-mentally ill controls. They had significantly less reproductive and contraceptive knowledge than the control subjects, and were more likely to perceive birth control as difficult to obtain. The most common reason women with schizophrenic spectrum disorders gave for failing to use birth control was that they did not expect to have sex, while that given by non-mentally ill subjects related to side-effects of birth control. Important obstacles to family planning in women with schizophrenic spectrum disorders include relative lack of knowledge and difficulty planning ahead. Although many women with schizophrenia could benefit from long-acting, reversible contraception, many may be unaware of those options and/or may find them difficult to obtain. Integrating family planning with mental health care might better address the unique needs of this population.     

Compliance and user satisfaction with the intra-uterine contraceptive device in Family Planning Service: the results of a survey in Fife, Scotland, August 2004.

OBJECTIVES: The study was designed to assess user satisfaction and duration of use of intrauterine contraceptive device (IUD) in Fife. METHODS: A questionnaire was given to 254 women attending a Fife Family Planning Clinic, in whom an IUD had been fitted over 3 years ago, with a 71% response rate. RESULTS: The majority of respondents were over age 30 years (81%) and parous (91%). The most frequently used IUD was the levonorgestrel-releasing intrauterine system (LNG-IUS: 39%), with the rest of the coils being an assortment of copper-medicated coils. Side effects were common, occurring in 92% of users and compliance was low, with 23% using for less than 1 year. Comparisons between LNG-IUS and other IUD-users showed similar side-effects, although mood disorders were higher with LNG-IUS. CONCLUSIONS: Overall satisfaction rates with the family planning service were high. Methods to improve IUD uptake and compliance are needed, particularly in younger women and nulliparous women.     

Emergency contraceptive pills in Sweden: evaluation of an information campaign

OBJECTIVE: To evaluate a community-based intervention regarding emergency contraceptive pills, including a mass media campaign and information to women visiting family planning clinics. DESIGN: Quasi-experimental. SETTING: Two counties in Sweden. POPULATION: Eight hundred randomly selected women aged 16-30 years, 400 women in the intervention group and 400 in a comparison group. METHODS: Postal questionnaires before (2002) and after (2003) the intervention. MAIN OUTCOME MEASURES: Exposure to the intervention, knowledge, attitudes, practices and intention to use emergency contraceptive pills. RESULTS: Before the intervention, the response rate was 71% (n= 564); after the intervention, the corresponding figure was 83% (n= 467); overall response rate 58%. Two-thirds (64%) of the targeted women had noticed the information campaign. One out of six who had visited a family planning clinic during the intervention year recalled being given information about emergency contraceptive pills. Specific knowledge and attitudes improved over time in both groups, but there was no difference in change between the groups. The proportion of women who had used emergency contraceptive pills increased from 27% to 31% over time. Intention to use emergency contraceptive pills in case of need was reported by 74% of the women and remained stable over time, but logistic regression showed that information during the previous year contributed to willingness to use the method in the intervention group. CONCLUSIONS: Knowledge, attitudes and practices about emergency contraceptive pills increased in both groups. Emergency contraceptive pills is gradually becoming a more widely known, accepted and used contraceptive method in Sweden, a trend that may have limited the impact of the intervention.     

Induced abortions among adolescent women in rural Maharashtra,India

In a study in rural Maharashtra, India, adolescents constituted 13.1% of the 1717 married women who had an induced abortion during an 18-month period in 1996-1998. The 197 adolescents who were subsequently interviewed had a lesser role in the decision-making process on abortion than women older than them. Most abortions were obtained in the private sector. Though spacing was the main reason for adolescents seeking abortion, prior contraceptive use among them was low. Additionally, they were less likely to receive post-abortion contraceptive counselling or to adopt contraception. Sex selection accounted for more than a fifth of abortions among adolescents. Additional qualitative data from 43 never-married and separated adolescents seeking abortion showed that non-consensual sex made many pregnancies unwanted, and cost, limited mobility, lack of family and partner support and the need for privacy to prevent stigma led many to go to traditional providers, even though safer options existed. Family planning programmes need to address the contraceptive needs of newly married adolescent women as well as unmarried adolescents. Informing adolescents of their legal rights, sensitising providers to adopt an empathetic attitude, and exploring innovative ways of increasing access to safe services for unmarried adolescents are all recommended.     

Use of injectable hormonal contraceptives: diverging perspectives of women and men,service providers and policymakers in Uganda

The unmet need for family planning in Uganda is among the world's highest. Injectable contraceptives, the most available method, were used by only 14.1% of married women in 2011. Recent data suggest that the main reason for unmet need is not lack of access, but fear of and unacceptability of side effects. In this qualitative study, 46 women and men were interviewed about their experience of injectable contraceptive side effects and the consequences for their lives. Thirty-two family planning service providers and policymakers were also interviewed on their perceptions. While using injectables, many of the women experienced menstrual irregularities and loss of libido. Both women and men experienced strained sexual relationships and expressed fear of infertility, often resulting in contraceptive discontinuation. Family planning service providers and policymakers often minimized side effects as compared to the risks of unintended pregnancy. Policymakers noted a lack of contraceptive alternatives and promoted family planning education to correct what they thought were misconceptions about side effects among both service providers and contraceptive users. Information alone, however, cannot diminish disturbances to social and sexual relationships. A common understanding of recognised side effects, not only with injectables but all contraceptives, is necessary if unmet need in Uganda is to be reduced.