中国妇女孕产期保健服务利用地区差异分析

目的:了解我国妇女孕产期保健服务利用状况的地区差异。方法:以2008年中国卫生服务调查研究资料为基础,用差异指数和地理分布图比较分析地区差异。结果:产前检查、孕早期检查、住院分娩和产后访视4项指标中,城市妇女的住院分娩率最高(95.10%),产后访视率最低(61.00%);农村妇女的住院分娩率最高(87.10%),产前检查率最低(41.10%)。按照地理区域划分,产前检查率较高的是东北(59.50%)和华东(55.20%),最低的是西南(41.10%);孕早期检查率最高的是东北(80.30%),较低的是中南(62.30%)和西南(51.10%);住院分娩率较高的是东北(98.70%)和华东(95.70%),较低的是西北(85.00%)和西南(66.10%)。城乡居民的产前检查率分布不均衡性较大(0.12),其它3项指标显示城乡间差异均较小。产前检查率、孕早期检查率和住院分娩率在西南地区差异最大,差异指数分别为0.27、0.19和0.16;最小的都是东北地区,分别为0.15、0.05和0.01。结论:我国妇女孕产期保健服务利用存在较为明显的地域及城乡不均衡性。     

河北5县孕产妇围生保健特征

目的了解北方农村孕产妇围生保健特征的分布情况。方法对1997～2000年河北5县孕产妇的围生保健资料进行频数分析。结果早孕检查率由1997年的77．3％ (10 513／13 607)上升到2000年的81．7％(10 998／13 460);平均产前检查次数和5次以上产前检查率1997年最高,为7．0次和87．4％(11 893／13 607),2000年时最低,为5．8次和73．2％ (9 850／13 460);1997年的住院分娩率为87．4％(11 879／13 607),2000年时上升到97．3％ (13 103／13 460);4年间3次及3次以上产后访视率均在95．0％以上,最高为(3．4±0．7)次, 最低为(3．3±0．6)次。结论河北省农村地区的住院分娩率已接近南方经济发达地区的水平;孕妇平均产前检查次数与5次及5次以上产前检查率呈逐年下降的趋势,这一问题有待进一步研究。     

宁夏彭阳县农村育龄妇女健康保健及孕产妇分娩情况调查

目的了解宁夏彭阳县农村育龄妇女健康保健及孕产妇分娩情况。方法采取分层随机抽样的方法抽取彭阳县33个村1 275名育龄妇女进行现场问卷调查。调查内容包括一般情况、育龄妇女健康体检情况及孕产妇分娩情况。结果调查的1 275名妇女中,接受过妇科检查的育龄妇女占28.20%(359/1 275)。30~39岁组育龄妇女的妇科检查率高于15~29岁组,汉族育龄妇女的检查率高于回族,不同文化程度育龄妇女妇科检查率不同;有分娩史的171名育龄妇女中,住院分娩率为88.30%。在家中分娩占11.70%,主要原因为来不及(70.00%)和没有必要去医院(20.00%),且家中分娩主要请家人接生(65.00%)。93.57%孕妇做过产前检查,41.52%产妇有产后访视。结论对彭阳县育龄妇女加强生殖健康知识教育,鼓励主动参加妇科检查,对孕产妇加强孕产期保健知识教育,提高产前检查率和住院分娩率,加大产后访视服务工作力度,规范产后访视工作。     

山东省日照市东港区孕期保健综合服务模式效果分析

目的：通过实施孕期保健综合服务模式项目，提升孕期保健服务覆盖率，保障母婴安全，降低孕期死亡率，提高孕期保健服务水平。方法：2019年在日照市在东港区试点开展孕期保健综合服务模式，比较2017-2020年孕期保健服务模式实施前后情况，分析相关考察指标。结果：孕期保健综合服务模式实施后，接受孕期保健综合服务并完成妊娠的孕产妇共7778例，产前检查7586例。30～34岁孕产妇逐年增加，25～29岁孕产妇逐年减少；一胎比例逐年增加，二胎、三胎比例逐年减少(均P<0.05)。项目实施后孕期保健覆盖率明显提高，其中产前检查参检率(97.5%)高于项目实施前(93.4%、93,1%),产前检查≥5次(94.3%)以及早期产前检查率(95.6%)提高；孕期住院分娩率保持100%,剖宫产率波动在35.1%,产后访视率(93.3%)提升，2019年项目实施以来孕产妇死亡率为零。结论：本次调查的孕产妇年龄逐年增加，2胎、3胎占比逐年下降，高龄产妇占比增加，应加强孕产期管理。通过孕期保健综合服务模式实施，使本地区孕期保健服务水平明显提升，各项保健服务指标得到提升，母婴安全水平得到提高。     

青海省农村妇女不同年份孕产期保健服务分析

孕产期保健是指从怀孕开始到产后42d对孕妇、产妇和胎儿、新生儿的保健服务,产前检查、分娩期保健和产后访视是孕产期保健的重要组成部分^〔1〕。良好的孕产期保健服务是保护和促进母婴健康、提高婴儿出生质量与人口素质的重要保证^〔2〕。为了解中国西部农村地区孕产期保健服务质量和改善情况,于2008年10月对青海省农村地区15~69岁有分娩史的妇女进行了有关孕产期保健服务调查。结果报告如下。     

西藏农牧区妇女孕产期保健现状分析

目的 了解西藏自治区农牧区妇女孕产期保健现状.方法 采用横断面调查方法,分层随机抽样,入户访问了1512名3岁以下儿童的母亲.结果 妇女产前检查覆盖率为77.6%,平均产前检查次数为3.89次,5次以上产前检查率为26.3%,住院分娩率为40 4%,83.9%的妇女接受过孕期卫生保健宣传教育,产后访视的比例为66.2%.家庭有无副业收入、是否牧区、个人卫生状况、产前保健宣传教育、动员住院分娩、孕期保健知识等是影响是否进行产前检查的主要因素.结论 该地区妇女孕产期保健状况有显著改善,但目前产前检查次数仍然偏低,住院分娩率偏低,缺乏孕产期保健常识是影响孕产期保健利用的主要因素之一.建议加强健康教育,普及孕期卫生保健知识,促进产前保健和住院分娩.     

新疆生产建设兵团已婚育龄妇女孕产期保健状况调查

目的：了解新疆生产建设兵团1971-2006年间孕产期保健状况。方法：采取分层整群、四阶段、概率比例随机抽样方法,调查员入户面对面问卷调查。结果：共调查有活产已婚育龄妇女6624人,2001年以来,产前检查率、孕早期（妊娠≤12周）检查率、师直≥8次产前检查率、团场≥5次产前检查率、住院分娩率分别达到了86.60％、66.64％、58.70％、65.19％、82.01％,在家分娩率降到14.10％,而产后访视率仅为32.01％。育龄妇女的分娩时期、民族、受教育程度、生育史、家庭年收入、职业与是否参加产前检查有关。结论：近几年孕产期保健状况有明显改善,但产前检查率、孕早期检查率和产后访视率偏低,应特别加强对文化程度低、从事农业、少数民族孕妇的健康教育,普及孕产期卫生保健知识,规范产后访视,提高孕产期保健服务质量和服务利用率。     

河北省孕产妇卫生保健现状调查

目的:了解河北省孕产妇保健状况,找出今后工作重点。方法:采取整群抽样的方法,对930名1998年1月1日~2003年8月1日在我院做产前检查的孕产妇保健状况进行直接问卷调查。结果:产前检查率城市为100·00%,农村为95·03%。被调查地区妇女产前检查次数少,40·85%的孕产妇接受过5次以上产前检查,且63·33%的妇女是在孕12周以后才接受第一次产前检查。产前检查的地点主要在县级以上医院和妇幼保健机构,农村主要在乡镇卫生院。产后访视率城乡分别为49·46%和33·78%。剖宫产农村为12·87%,城市为44·57%,城市是农村的3倍。产妇住院分娩率城乡差异大,农村产妇在家中分娩的比重高,城市住院分娩率为74·46%,而农村仅为45·40%。农村产妇在家中分娩的主要原因:经济困难占13·33%,来不及去医院占17·58%,认为没必要去医院的占58·7%,交通不便占10·30%。在家中分娩的产妇中,非专职接生人员占相当比重。农村产妇分娩花费在1100元及以上的为17·29%,城市为78·80%,城市是农村的4倍。结论:提高孕产妇产前检查率、住院分娩率、降低住院费用,改善旧的生育观,提高孕产妇的健康教育是当前妇女保健工作的重要任务。     

贫困地区孕产妇住院分娩服务利用评价与影响因素分析

目的:了解贫困地区住院分娩服务利用情况及其关键影响因素,为今后针对性地采取干预措施改善妇幼健康状况提供依据。方法:通过分层随机抽样,在卫生Ⅷ项目县(区)抽取592名育龄妇女入户进行问卷调查,并采用Logistic回归模型进行相关因素分析。结果:项目地区住院分娩率增长快于全国农村监测地区;在其他条件相同时,到乡卫生院交通方便的妇女住院分娩的可能性是交通不方便妇女的6.29倍,享受特困救助减免的妇女住院分娩的可能性是不能享受特困救助妇女的5.23倍,生育观念正确的妇女住院分娩的可能性是生育观念不正确的妇女的61.3倍。供方服务能力与服务质量对住院分娩利用也存在影响。结论:要多方筹集资金,建立住院分娩特困救助制度,针对性地开展健康教育,改善当地交通状况,把计划外生育妇女也纳入系统管理,加强乡卫生院产科建设。     

项目地区孕产妇保健情况干预效果评价

[目的]评价“农村初级卫生保健项目”中母亲安全活动的干预措施的效果,为改善项目地区孕产妇保健状况提供科学依据。[方法]2001年和2005年的7～8月间,采用人口比例抽样法(PPS)在中国西部农村项目地区分别进行了基线和终线调查,用SPSS软件,选用χ2检验等方法。[结果]基线调查和终线调查的产前检查率分别为85.8%和98.0%,住院分娩率分别为46.2%和84.9%,项目执行后均有明显提高。[结论]项目的干预措施有效,使项目地区的孕产妇保健工作有了较大的改善。这些措施可以在一定程度上推广到类似的地区。     

Health care financing and utilization of maternal health services in developing countries

BACKGROUND: The Millennium Development Goals call for a 75% reduction in maternal mortality between 1990 and 2015. Skilled birth attendance and emergency obstetric care, including Caesarean section, are two of the most important interventions to reduce maternal mortality. Although international pressure is rising to increase donor assistance for essential health services in developing countries, we know less about whether government or the private sector is more effective at financing these essential services in developing countries. METHODS: We conducted a cross-national analysis to determine the association between government versus private financing of health services and utilization of antenatal care, skilled birth attendants and Caesarean section in 42 low-income and lower-middle-income countries. We controlled for possible confounding effects of total per capita health spending and female literacy. FINDINGS: In multivariable analysis, adjusting for confounders, government health expenditure as a percentage of total health expenditure is significantly associated with utilization of skilled birth attendants (P = 0.05) and Caesarean section (P = 0.01) but not antenatal care. Total health expenditure is also significantly associated with utilization of skilled birth attendants (P < 0.01) and Caesarean section (P < 0.01). DISCUSSION: Greater government participation in health financing and higher levels of health spending are associated with increased utilization of two maternal health services: skilled birth attendants and Caesarean section. While government financing is associated with better access to some essential maternal health services, greater absolute levels of health spending will be required if developing countries are to achieve the Millennium Development Goal on maternal mortality.     

青海省10年孕产妇保健服务利用状况分析

目的 了解青海省妇女孕产期保健服务利用状况.方法 以青海省2002～2011年妇幼卫生统计年报表数据为基础,采用妇女孕产期保健服务利用指标,比较和分析妇女孕产期保健服务利用状况.结果 在2002～2011年期间,青海省妇女孕早期检查率由2002年的50.3 %上升到2011年的84.3 %,产后访视率由2002年的73.8 %上升到2011年的87.6 %,孕产妇系统管理率由2002年的59.0 %上升到2011年的81.3 %,都呈逐年上升趋势;产前检查率稍有起伏.另外,青海省孕产妇死亡率从2002年的142.2/10万下降到2011年的46.1/10万,呈逐年下降趋势.结论 青海省妇女孕产期保健服务利用效果显著,孕产期保健服务工作稳步有进,这对提高出生人口质量、降低孕产妇死亡率具有重要意义.     

Migration and maternal health services utilization in rural Guatemala

This article examines the relationship between migration and the use of formal maternal health-care services among rural women in Guatemala. We identify assimilation, diffusion, and remittances as three potential pathways through which migration can affect health-care service utilization in rural areas. Using data from the 1995 Guatemalan Survey of Family Health and multi-level regression models, we estimate the impact of migration experience at the individual, household, and community level on the use of formal prenatal care and delivery assistance. We find that urban migration experience and having relatives abroad are associated with a greater likelihood of formal prenatal care utilization, after taking account of background characteristics and enabling resources. Migration experience at all levels is also strongly associated with formal delivery assistance; however, this association operates primarily through the positive association between migration and enabling resources. The differential effects of out-migration on maternal health-care service utilization reflect the different barriers to service use that exist for formal prenatal care and delivery assistance. Financial cost and geographic access are the most important barriers to formal delivery assistance, whereas awareness and acceptance remain as important barriers to the use of formal prenatal care in rural Guatemala. Urban migration experience and social ties to urban and international migrants lower the barriers to formal maternal health-care utilization through the acquisition and diffusion of new ideas and practices, and the return flow of financial resources.     

中国贫困县妇幼卫生服务现状分析

目的了解贫困县妇幼卫生服务现状,为改善贫困县妇幼卫生服务、实现精准脱贫提供决策依据。方法在全国832个贫困县737个妇幼保健机构开展问卷调查,分析全县医疗卫生机构孕产妇分娩情况、妇幼保健机构孕产妇服务能力情况和孕产期保健水平。结果 2014年平均每贫困县的孕产妇在县级医院分娩占55.35%,其中在县级妇幼保健机构分娩占22.23%;妇幼保健机构剖宫产人次数占分娩人次数的36.78%;高危孕产妇率为17.92%,孕产妇死亡率为17.68/10万。结论贫困县县外分娩比例大;剖宫产中非因病理产科问题占比高;中西部地区住院分娩率低;高危孕产妇和孕产妇死亡率控制较好。     

Gender differences in the utilization of health care services

BACKGROUND: Studies have shown that women use more health care services than men. We used important independent variables, such as patient sociodemographics and health status, to investigate gender differences in the use and costs of these services. METHODS: New adult patients (N = 509) were randomly assigned to primary care physicians at a university medical center. Their use of health care services and associated charges were monitored for 1 year of care. Self-reported health status was measured using the Medical Outcomes Study Short Form-36 (SF-36). We controlled for health status, sociodemographic information, and primary care physician specialty in the statistical analyses. RESULTS: Women had significantly lower self-reported health status and lower mean education and income than men. Women had a significantly higher mean number of visits to their primary care clinic and diagnostic services than men. Mean charges for primary care, specialty care, emergency treatment, diagnostic services, and annual total charges were all significantly higher for women than men; however, there were no differences for mean hospitalizations or hospital charges. After controlling for health status, sociodemographics, and clinic assignment, women still had higher medical charges for all categories of charges except hospitalizations. CONCLUSIONS: Women have higher medical care service utilization and higher associated charges than men. Although the appropriateness of these differences was not determined, these findings have implications for health care.     

Migration, health status and utilization of health services

Abstract Evidence concerning the relations of migration to health status and health care utilization is inconclusive. This paper outlines the theoretical positions on these relations and reviews the empirical findings supporting varying positions. The paper also presents the findings of a survey of a probability sample of the U.S. population concerning these issues. The analysis is organized around comparisons among immigrants from other societies, internal migrants, and non-migrants on important dimensions of health status and the utilization of different types of health services. Comparisons were also made among first generation, second generation, and'old stock.'Finally, immigrants were grouped by country and area of origin to assess the influence of cultural differences on health and the utilization of services. Attempts were made to control the influence of demographic characteristics while assessing the relations between migration and health status. The controlled analysis showed immigrants to enjoy better health conditions followed by migrants and then the non-migrants. Significant differences in physical performance were manifested among immigrants from varying areas of origin, and also among generations of nativity. Controlling for both demographic characteristics and health status, immigrants were consistently the least utilizers of services and internal migrants the highest. An increase in utilization was associated with generational residence in the U.S. First generation were least utilizers, followed by second generation with the'old stock'being the greatest utilizers. Immigrants from different countries and regions of the world also exhibited significant differences in the patterns of utilization of health services.     

Inequity in maternal health care utilization in Vietnam

ABSTRACT: INTRODUCTION: Vietnam has succeeded in reducing maternal mortality in the last decades. Analysis of survey data however indicate that large inequities exist between different segments of the population. We have analyzed utilization of antenatal care and skilled birth attendance among Vietnamese women of reproductive age in relation to social determinants with the aim to reveal health inequities and identify disadvantaged groups. METHOD: Data on maternal health care utilization and social determinants were derived from the Multiple Indicator Cluster Survey (MICS) conducted in Vietnam in 2006, and analyzed through stratified logistic regressions and g-computation. RESULTS: Inequities in maternal health care utilization persist in Vietnam. Ethnicity, household wealth and education were all significantly associated with antenatal care coverage and skilled birth attendance, individually and in synergy. Although the structural determinants included in this study were closely related to each other, analysis revealed a significant effect of ethnicity over and above wealth and education. Within the group of mothers from poor households ethnic minority mothers were at a three-fold risk of not attending any antenatal care (OR 3.06, 95 % CI 1.27-7.41) and six times more likely not to deliver with skilled birth attendance (OR 6.27, 95 % CI 2.37-16.6). The association between ethnicity and lack of antenatal care and skilled birth attendance was even stronger within the non-poor group. CONCLUSIONS: In spite of policies to out rule health inequities, ethnic minority women constitute a disadvantaged group in Vietnam. More efficient ways to target disadvantaged groups, taking synergy effects between multiple social determinants into consideration, are needed in order to assure safe motherhood for all.     

凉山州孕产妇围产保健服务利用现状分析

目的了解凉山州艾滋病感染孕产妇与正常孕产妇围产保健服务利用现状。方法以艾滋病高发区四川省凉山州为样本地区,选取2013~2014年检测确诊并可追踪的212例人类缺陷免疫病毒(human immunodeficiency virus,HIV)感染孕产妇为研究组,随机等距抽取402例正常孕产妇作为对照组,开展围产保健服务利用的问卷调查。结果两组孕产妇在民族、文化程度和家庭年收入比较,差异有统计学意义(P0.05)。HIV感染孕产妇的住院分娩比例、产后访视比例高于对照组,产检次数低于对照组(P0.05)。文化程度和家庭年收入的差异是两组孕产妇利用围产保健服务状况不同的主要原因。结论凉山州HIV感染和正常孕产妇的围产保健服务利用受诸多因素影响,在精准扶贫中应有针对性地推行免费孕产期保健和住院分娩项目,提高边远地区孕产妇系统管理率。