医疗网络平台服务对青少年人工流产术后选择长效可逆避孕方法的影响

目的探讨通过医疗网络平台实施健康宣教和流产后关爱(post-abortion care,PAC)服务对青少年人工流产术后选择长效可逆避孕方法(long-acting reversible contraception,LARC)避孕的影响。方法选取2018年7月至2019年6月在四川省妇幼保健院行非意愿妊娠人工流产的年龄≤25岁的青少年,随机分为对照组(实施传统的健康宣教和PAC服务)和观察组(实施医疗网络平台的健康宣教和PAC服务)。观察两组术后随访率、LARC的实施情况以及重复人工流产率。结果观察组术后1月的随访率为97.95%,与对照组(96.92%)相近,差异无统计学意义(P>0.05),但术后3月、6月的随访率分别为93.98%、89.18%,明显高于对照组(90.08%、81.25%),差异有统计学意义(P<0.05)。观察组术后即刻、术后1月时LARC的应用率分别为12.45%、13.76%,与对照组(13.00%、13.49%)比较,差异无统计学意义(P>0.05),但术后3月、6月的应用率明显增高,分别为25.10%、28.67%,明显高于对照组(15.18%、17.26%),差异有统计学意义(P<0.05)。观察组半年内重复人工流产率为0.92%,明显低于对照组(3.97%),差异有统计学意义(P<0.05)。结论实施医疗网络平台服务后术后长期随访率高、重复人工流产率低,且明显提高了术后3月和6月LARC在青少年中的应用率,但目前应用率仍不理想。     

长效可逆避孕措施在人工流产后即刻实施的效果评价

目的探究长效可逆避孕措施在人工流产后即刻实施的效果。方法从2017年7月-2018年7月,抽选在广州市增城区妇幼保健院行人工流产女性1200例,按照随机数字表法分为常规组(612例)和强化干预组(588例)。常规组给予常规流产后关爱(PAC)服务,强化干预组在常规PAC服务的基础上采用长效可逆避孕措施。对比两组长效可逆避孕措施使用情况、重复人工流产率以及避孕措施的持续时间情况。结果强化干预组的高效避孕措施使用率比常规组更高,同时重复人工流产率比常规组低,差异有统计学意义(P<0.05);强化干预组长效可逆避孕措施LARC(IUS/IUD)避孕术后6个月、1年使用率明显高于常规组,差异有统计学意义(P<0.05);复方口服避孕药优思悦(COC)避孕术后3个月、6个月、1年的使用率比常规组高,差异有统计学意义(P<0.05)。结论人工流产后即刻实施长效可逆避孕措施,可提升高效避孕措施的使用率,减少意外妊娠及再次人工流产的几率,值得推广。     

未婚青少年非意愿妊娠相关因素分析

目的:分析未婚青少年非意愿妊娠相关因素,为婚前性教育提供依据。方法:选择在该校附属医院妇产科施行人工流产的1032名未婚青少年为调查对象,就一般情况、非意愿妊娠原因、避孕措施知晓和使用情况做调查。结果:≤19岁青少年占41.47%;学生占36.72%;避孕知识缺乏、避孕措施使用率低、方法低效是造成非意愿妊娠的主要原因。结论:未婚青少年非意愿妊娠是不可回避的社会问题,应加强多渠道生殖健康、避孕知识教育及避孕方法指导。     

人工流产后计划生育服务干预实施效果的问卷调查

目的 探讨人工流产后计划生育服务干预实施的效果.方法 选择1 200名行人工流产妇女在流产术前行避孕相关知识问卷调查,将其随机分为两组,干预组实施流产后计划生育服务干预措施,对照组行常规处理,1年后再次对所有研究对象进行避孕相关知识等问卷调查.结果 随访1年后,收回有效问卷1 042份,其中干预组524份,对照组518份.干预组避孕相关知识得分与对照组比较差异有统计学意义(P＜0.01),干预组未采取避孕措施比例与对照组比较有差异有统计学意义(P＜0.01),干预组非意愿妊娠率与对照组比较差异有统计学意义(P＜0.01).结论 人工流产后实施计划生育服务干预措施有利于提高避孕相关知识水平,提高避孕措施使用比率,降低非意愿妊娠率.     

女青年人工流产情况及避孕知识调查

目的:了解郑州市女青年人工流产和避孕知识知晓情况,探讨人工流产影响因素。方法:采用自填式调查问卷,对郑州市年龄≤25岁1100名人工流产女青年进行横断面调查。结果:调查对象年龄为(22.50±1.68)岁,平均月收入为800元,职业以公司职员为主(29.4%),大部分未婚,流动人口占75.1%,初中以下文化程度和常住人口相比有统计学意义;34.9%的女青年经历过流产,首次流产未婚者占72.6%,且随着年龄增加,重复流产率逐渐增高;本次妊娠原因67.9%的女青年未采用避孕措施,32.1%为避孕失败,避孕失败的主要原因是避孕套(44.5%)、安全期(25.2%)和体外排精(15.9%);过去3个月中,最常用的避孕方法是避孕套(82.3%),其次为紧急避孕(28.5%)、安全期(27.7%)、体外排精(22.7%);谈及避孕知识,深入到避孕措施具体使用方法回答正确率较低。结论:非意愿妊娠的主要原因是未采用避孕措施,而使用避孕措施的女青年中,坚持使用和正确使用有效避孕措施率低,且流产女青年掌握的避孕知识有限,应加强未婚人群和流动人口的避孕知识宣教和咨询,内容侧重坚持、正确使用高效避孕措施的宣传,提供优质的计划生育服务,从而避免非意愿妊娠和人工流产。     

PAC服务对促进未婚青少年LARC使用率的影响

我国于2016年倡导青少年实施长效可逆的避孕措施(LARC)。LARC包括避孕针、宫内节育器和皮下埋植剂,是目前最有效的避孕措施之一。LARC能预防意外妊娠,减少人工流产和重复流产,降低青少年因人流而受到的身心伤害和包括不孕不育在内的远期危害[1]。笔者观察流产后关爱(PAC)服务对提高未婚青少年LARC使用率的影响。1对象与方法1.1对象对2017年8月-2018年8月本院收治的120例未婚青少年人工流产者,随机分成观察组和对照组,每组60例。对照组对象平均年龄20(16~24)岁,观察组21(17~25)岁。所有对象均知情同意并签署知情同意书。本研究经过了医院伦理委员会批准。     

避孕方法知情选择表对剖宫产术后近期避孕行为的影响

目的研究建立避孕方法知情选择表以指导剖宫产后近期避孕,提高剖宫产后避孕措施的正确使用率,降低非意愿妊娠的发生。方法选取2015年3-5月于该院行剖宫产分娩的产妇共计306例,随机分为研究组和对照组,研究组采用避孕方法知情选择表及提供常规避孕咨询服务,对照组仅提供常规避孕咨询服务,随访产后2年两组的避孕行为及意外妊娠情况。结果研究组经常避孕的频率高于对照组(93.1%vs.74.7%,P<0.05)。研究组首次性生活避孕率高于对照组(82.5%vs.53.4%,P<0.05);前者服复方口服避孕药的比例高于对照组(17.5%vs.7.5%,P<0.05)。而对照组多次服紧急避孕药的比例(24.0%vs.11.3%)以及采用体外排精避孕的比例(14.4%vs.3.1%)更高(P<0.05)。两组采用宫内节育器、避孕套、安全期和曼月乐避孕的比例差异无统计学意义(P>0.05)。研究组意外妊娠发生率为3.1%,对照组为12.3%,两组比较差异有统计学意义(P<0.05)。结论避孕方法知情选择表有助于剖宫产后避孕措施的落实从而减少非意愿妊娠发生。     

长效可逆避孕方法的新进展

<正>长效可逆避孕方法(LARC)是近年来国际上着力推荐的避孕方法,其明显优势包括避孕效果好、停用后即可妊娠、不受使用者人为因素影响、一次放置或注射长期使用、成本效益高、有效降低非意愿妊娠及人工流产率等,同时具有避孕外益处。在人工流产后及产后即时落实LARC,可达到更好的适应性,并减少出血等副作用的发生率。LARC同时适用于青少年长期避孕及满足40岁以上女性避孕需求和非避孕获益。LARC是指不需要每个月管理并在停用后能很快恢复生育能力的避     

非意愿妊娠妇女避孕知识态度、行为调查

目的 了解非意愿妊娠的主要原因及非意愿妊娠妇女避孕知识的态度与行为,为减少非意愿妊娠、减少人工流产和提供流产后服务提供依据.方法 采用分层抽样的方法,随机选取在北京市西城区4家计划生育技术服务医疗机构中自愿要求流产的非意愿妊娠妇女,进行现场问卷调查,并对数据进行分析.结果 不同户籍对选择避孕方法的影响均无统计学意义(均P＞0.05);不同婚姻状况在选择避孕方法时,仅在“避孕药具的价钱”的选择上有统计学意义(x2=20.400,P＜0.05).不同户籍人群,本市能正确回答“多次人工流产可以增加不孕症的几率”、“安全期避孕最适合青少年使用”、“口服避孕药的正确服用方法”、“紧急避孕药在房事前服用”、“如避孕失败可用紧急避孕药作为后备方法”这几个问题的比例均高于外地,差异均有统计学意义(x2值分别5.326、8.105、10.877、8.643、7.268,均P＜0.05).结论 有效减少城市流动人口和未婚人群的非意愿妊娠,才能减少人工流产;避孕效果与能否正确计算安全期、避孕套使用技巧及方法密切相关;促进避孕药具有效使用,从而减少流动人口和未婚人群的非意愿妊娠,减少育龄妇女重复流产.     

13例系统性红斑狼疮患者避孕措施选择的临床分析

目的探讨系统性红斑狼疮(systemic lupus erythematosus,SLE)患者流产后避孕措施的选择并随访避孕结局。方法对13例2014年2月至2017年2月在四川大学华西第二医院行人工流产术并接受了流产后关爱(Post-Abortion Care,PAC)咨询的SLE患者进行回顾性分析,随访其避孕结局。结果 13例SLE患者PAC咨询前长效可逆避孕措施(long-acting reversible contraception,LARC)使用率为0%,其中意外妊娠者11例,2例为计划内妊娠胚胎停育;PAC咨询后有4例患者选择宫内节育系统,2例选择含铜宫内节育器,7例选择男用避孕套,LARC使用率为46.2%;13例患者平均随访(22.6±9.1)月,均未发生意外妊娠,无避孕不良反应、无SLE病情加重;其中有4例获得满意的计划内妊娠。结论 SLE患者的妊娠必须是有计划且高度重视。PAC咨询能明显改善SLE患者避孕观念和促进LARC落实。临床工作者应综合权衡患者个体危险因素及SLE的活动性、抗磷脂抗体状态等,给予最佳的避孕指导。     

关爱服务对女性流产后避孕方法选择的影响

目的 研究流产后关爱服务(PAC)对患者流产后避孕方法选择的影响.方法 采用方便抽样法抽取2015年4月至2016年2月于西安交通大学第一附属医院接受人工流产的患者154例,对进行人工流产的患者按来院顺序编号并按奇偶数分为干预组和对照组各77例.在流产前,对干预组患者提供流产后关爱服务,为对照组患者实施常规健康教育;两组患者接受人工流产后,通过返院咨询和电话咨询等形式,对其避孕方法和是否再次意外妊娠情况于流产后1、3、6、9个月共进行4次随访.结果 干预前,两组患者采用的避孕方法主要是不安全避孕法(干预组占71.4%,对照组占61.0%)及常规避孕法(干预组占27.3%,对照组占39.0%),差异均无统计学意义(均P>0.05).干预后1、3、6、9个月时,干预组患者的常规避孕率由干预前的27.3%迅速降低到2.6%,并在之后的随访中逐渐提高;而对照组患者的常规避孕率由干预前的39.0%增加到81.8%,并维持较高水平.干预组患者的高效避孕率由干预前的1.3%显著增长到97.4%,并保持较高水平;对照组患者的高效避孕率缓慢增长到5.2%.干预组患者的不安全避孕率由干预前的71.4%显著降低到1.3%,并保持较低水平,而对照组患者的不安全避孕率由干预前的61.0%缓慢降低到15.6%.两组患者的3种避孕方法在1、3、6、9个月随访时差异均有统计学意义(χ2=12.48~138.45,均P<0.05).结论 流产后关爱服务能提高患者的高效避孕率.经过流产后关爱服务咨询,在后续的随访中,需要巩固女性的科学避孕知识和强化其意识,维持避孕效果.     

Patients' attitudes and experiences related to receiving contraception during abortion care

Background

High risk for additional unintended pregnancies among abortion patients makes the abortion care setting an ideal one for facilitating access to contraception. This study documents attitudes of abortion patients about contraceptive services during their receipt of abortion services and identifies patient characteristics associated with desire for contraception and interest in using a long-acting reversible contraceptive method (LARC).

Study Design

Structured surveys were administered to 542 patients at five US abortion-providing facilities between March and June of 2010. Supplementary information was collected from 161 women who had had abortions in the past 5 years through an online survey.

Results

Among abortion patients, two thirds reported wanting to leave their appointments with a contraceptive method and 69% felt that the abortion setting was an appropriate one for receiving contraceptive information. Having Medicaid and having ever used oral contraceptives were predictive of wanting to leave with a method. Women having a second or higher-order abortion were over twice as likely as women having a first abortion to indicate interest in LARC, while black women were half as likely as white women to indicate this interest.

Conclusion

Many women are interested in learning about and obtaining contraceptive methods, including LARC, in the abortion care setting.     

Patients' attitudes and experiences related to receiving contraception during abortion care

BackgroundHigh risk for additional unintended pregnancies among abortion patients makes the abortion care setting an ideal one for facilitating access to contraception. This study documents attitudes of abortion patients about contraceptive services during their receipt of abortion services and identifies patient characteristics associated with desire for contraception and interest in using a long-acting reversible contraceptive method (LARC).Study DesignStructured surveys were administered to 542 patients at five US abortion-providing facilities between March and June of 2010. Supplementary information was collected from 161 women who had had abortions in the past 5 years through an online survey.ResultsAmong abortion patients, two thirds reported wanting to leave their appointments with a contraceptive method and 69% felt that the abortion setting was an appropriate one for receiving contraceptive information. Having Medicaid and having ever used oral contraceptives were predictive of wanting to leave with a method. Women having a second or higher-order abortion were over twice as likely as women having a first abortion to indicate interest in LARC, while black women were half as likely as white women to indicate this interest.ConclusionMany women are interested in learning about and obtaining contraceptive methods, including LARC, in the abortion care setting.     

Evaluating teen options for preventing pregnancy: Impacts and mechanisms

This paper presents findings from an experimental evaluation of the Teen Options to Prevent Pregnancy (TOPP) program, an 18-month intervention that consists of a unique combination of personalized contraceptive counseling, facilitated access to contraceptive services, and referrals to social services. We find that TOPP led to large and statistically significant increases in the use of long-acting reversible contraceptives (LARCs), accompanied by substantial reductions in repeat and unintended pregnancy among adolescent mothers. We provide an exploratory analysis of the channels through which TOPP achieved its impacts on contraceptive behavior and pregnancy outcomes. A back-of-the-envelope decomposition implies that the increase in LARC use can explain at most one-third of the reduction in repeat pregnancy. We provide suggestive evidence that direct access to contraceptive services was important for increasing LARC use and reducing repeat pregnancy. We did not find any spillover effects on non-targeted outcomes, such as educational attainment and benefit receipt.     

Meeting the Contraceptive Needs of Teens and Young Adults: Youth-Friendly and Long-Acting Reversible Contraceptive Services in U.S. Family Planning Facilities

PurposeIncreased use of contraceptive services, including long-acting reversible contraceptives (LARCs), among sexually active teens and young adults could significantly reduce unintended pregnancy. Objectives were to describe youth-friendly contraceptive services (including LARC) available to teens and young adults at U.S. publicly funded family planning facilities.MethodsBetween April and September 2011, center directors at a nationally representative sample of 1,196 U.S. publicly funded family planning facilities were surveyed to assess accessibility and provision of contraceptive services for teens and young adults; 584 (52%) responded.ResultsFacilities were accessible to young clients in several ways, including not requiring scheduled appointments for method refills (67%) and having flexible hours (64%). Most facilities provided outreach and/or education to young people (70%), and 27% used social network media to do this. Most facilities took steps to ensure confidentiality for young clients. These youth-friendly practices were more common at Planned Parenthood, Title X, and reproductive health focused facilities than at other facilities. Long-acting reversible contraceptive methods were regularly discussed with younger clients at less than half the facilities. Youth-friendly sites had increased rates of LARC provision among younger clients. The most common challenges to providing contraceptive and LARC services to younger clients were the costs of LARC methods (60%), inconvenient clinic hours (51%), staff concerns about intrauterine device (IUD) use among teens (47%), and limited training on implant insertion (47%).ConclusionsImproving the ability of family planning facilities to provide youth-friendly contraceptive and LARC-specific methods to younger clients may increase the use of highly effective contraception in this population.     

Associations Between Abortion Services and Acceptance of Postabortion Contraception in Six Indian States

Women receiving induced abortions or postabortion care are at high risk of subsequent unintended pregnancy, and intervals of less than six months between abortion and subsequent pregnancy may be associated with adverse outcomes. This study highlights the prevalence and attributes of postabortion contraceptive acceptance from 2,456 health facilities in six major Indian states, among 292,508 women who received abortion care services from July 2011 through June 2014. Eighty‐one percent of the women accepted postabortion contraceptive methods: 53 percent short‐term, 11 percent intrauterine devices, and 16 percent sterilization. Postabortion contraceptive acceptance was highest among women who were aged 25 years and older, received first‐trimester services, received induced abortion, attended primary‐level health facilities, and had medical abortions. Doctors receiving post‐training support were more likely to offer contraceptives, but no association was observed between such support and acceptance of IUDs or sterilization. Comprehensive service‐delivery interventions, including ensuring availability of skilled providers and contraceptive commodities, offering clinical mentoring for providers, identifying and addressing provider bias, and improving provider counseling skills, can increase postabortion contraceptive acceptance and reduce unintended pregnancy.     

Adolescent pregnancy trends and demographics

In the United States today, 9% of women aged 15 to 19 years become pregnant each year: 5% give birth, 3% have induced abortions, and 1% have miscarriages or stillbirths--rates much higher than those in other developed countries. Rates are highest among those who are older, from disadvantaged backgrounds, black or Hispanic, married, have much older male partners, and live in southern states. Teen pregnancies are overwhelmingly unintended, reflecting substantial gaps in contraceptive use, and difficulties using reversible methods effectively. Teen pregnancy, birth, and abortion levels have decreased in recent years, primarily because of more effective contraceptive use (responsible for about 75% of the decline), and because of fewer adolescents having sexual intercourse (about 25%). Much work remains to improve the conditions in which young people grow up, provide them with information and education regarding sexuality and relationships, and improve access to sexual and reproductive health services.     

Disparities in rates of unintended pregnancy in the United States, 1994 and 2001

CONTEXT: Many pregnancies are unintended, particularly in certain population groups. Determining whether unintended pregnancy rates and disparities in rates between subgroups are changing may help policymakers target reproductive health services to those women most in need. METHODS: To calculate rates of unintended pregnancy and related outcomes, data on pregnancy intendedness from the 2002 National Survey of Family Growth were combined with birth, abortion and population data from federal, state and nongovernmental sources. RESULTS: In 2001, 49% of pregnancies in the United States were unintended. The unintended pregnancy rate was 51 per 1,000 women aged 15-44, meaning that 5% of this group had an unintended pregnancy. This level was unchanged from 1994. The rate of unintended pregnancy in 2001 was substantially above average among women aged 18-24, unmarried (particularly cohabiting) women, low-income women, women who had not completed high school and minority women. Between 1994 and 2001, the rate of unintended pregnancy declined among adolescents, college graduates and the wealthiest women, but increased among poor and less educated women. The abortion rate and the proportion of unintended pregnancies ending in abortion among all women declined, while the unintended birth rate increased. Forty-eight percent of unintended conceptions in 2001 occurred during a month when contraceptives were used, compared with 51% in 1994. CONCLUSIONS: More research is needed to determine the factors underlying the disparities in unintended pregnancy rates by income and other characteristics. The findings may reflect a need for increased and more effective contraceptive use, particularly among high-risk groups.     

Contraceptive Use Patterns among Women of Reproductive Age in Two Southeastern States

BackgroundUnintended pregnancies remain an important public health issue. Modern contraception is an important clinical service for reducing unintended pregnancy. This study examines contraception use among a representative sample of women residing in two southeastern U.S. states.MethodsA cross-sectional statewide survey assessing women's contraceptive use and reproductive health experiences was conducted in Alabama and South Carolina. Characteristics of the study population were compared across contraceptive use categories and multivariable regression analysis was performed examining relationships between covariates of interest and contraceptive use outcomes.ResultsApproximately 3,775 women were included in the study population. Overall, 26.5% of women reported not using any contraception. Short-acting hormonal methods were the most commonly reported (26.3%), followed by permanent methods (24.4%), long-acting reversible contraception (LARC; 14.3%), and barrier/other methods (8.5%). Nonuse was more prevalent among women with some college or an associate's degree, incomes between $25,000 and $50,000, no health insurance, and longer gaps in care. LARC use among women with Medicaid as a pay source was higher than use among privately insured women and higher in South Carolina than Alabama. Both nonuse and LARC use were higher among women with no insurance.ConclusionsStudy findings are largely consistent with previous research using similar population-based surveys. LARC use was higher among the study population relative to what is observed nationally. Factors enabling access to contraceptive services, particularly for lower income women, were associated with contraception use patterns. These findings provide important context for understanding individuals’ access to resources and are important for fostering increased access to contraceptive services among women in these two states.