计划生育的四大循证基石性技术指南

世界卫生组织(WHO)在近十余年里,致力于建立和更新有关计划生育技术服务的指南,形成了一个包括四部文献的技术指南系列,因其重要性而被命名为“四大基石性指南”:《避孕方法选用的医学标准》(简称《医学标准》),《避孕方法使用的选择性实用建议》(简称《实用建议》),《给计划生     

浅议计划生育技术服务中的告知说明义务与知情同意权利

计划生育技术服务（简称技术服务）是计划生育技术服务人员（简称服务人员）对计划生育技术服务的对象（简称服务对象）进行包括：避孕和节育的医学检查；计划生育手术并发症和计划生育药具不良反应的诊断、治疗；施行避孕、节育手术和输卵（精）管复通手术；开展围绕生育、节育、不育的其他生殖保健项目。因为服务对象主要是健康的育龄群众，技术服务又是解决健康人的生理问题，所以广大群众认为在技术服务中是不会出问题的。随着群众法律意识和维权意识的不断增强，技术服务纠纷的比率也在不断增加，虽然近些年来，经过各级人口计生委和计生服务机构不懈努力，技术服务质量管理有了明显进步，各项管理措施也在不断落实到位，但纵观技术服务全过程，仍存在一些问题和隐患，绝大部分不属技术问题，而是多与服务态度不好、服务质量不高、相互沟通不够和服务不全面、不到位有关。在技术服务中，服务人员对服务对象告知说明义务与知情同意权利了解不全面，履行落实不够，成为诸多问题和隐患中重要且常见的问题，也常为此发生一些不该发生的纠纷。     

浅谈基层避孕药品质量管理

<正> 避孕药,在避孕节育中发挥着重要作用。随着《计划生育技术服务管理条例》和《人口与计划生育法》的实施,节育措施知情选择的深入开展,育龄人群选择避孕药避孕的越来越多。避孕药的质量直接关系到使用人群的安全和计划生育目标的实现。笔者就这一问题浅析如下。     

狠抓计划生育技术服务质量管理确保群众身心健康与事业发展

<正> 经过多年努力,福建省计划生育技术服务工作取得了显著成绩,有力地保障了人口计划的完成,为稳定低生育水平、提高人口素质创造了条件。但是,由于受到种种因素的影响,计划生育技术服务的质量已难以满足市场经济体制下计划生育工作新的形势和任务的需要。在新形势下,如何顺应计划生育技术服务发展的需要,狠抓质量管理,促进技术服务工作的     

山东省颁布《山东省计划生育技术服务管理办法》

<正> 2004年6月9目,山东省政府第31次常务会议通过了 《山东省计划生育技术服务管理办法》(简称《办法》),8月4     

西藏自治区计划生育技术服务需求初探

<正> 为促进西藏人口与计划生育工作的发展,2000年9月国家计生委人事司、政策法规司在西藏举办了西藏自治区人口与计划生育管理干部培训班。本人作为四川生殖卫生学院的教师,有幸参加了此次教学活动,并深入部分农牧区,参观了当地的妇幼保健院、乡卫生院,走村串户,同医务人员、计划生育工作者以及当地农牧民进行了面对面的交谈,了解到一些西藏自治区开展人口与计划生育工作的情况,他们的优势,工作中的困难以及计划生育技术服务中迫     

山东省召开计划生育技术服务专家委员会第二次会议

<正> 2004年2月10日,山东省计生委和省卫生厅共同召开省计划生育技术服务专家委员会第二次会议。会议的主要议题是,通报全省计划生育和科技工作形势任务,总结交流一年来专家委员会工作情况,讨论《山东省避孕方法知情选择工作规     

计划生育的四大循证基石性技术指南

1994年在埃及开罗召开的国际人口与发展大会（ICPD），提出生殖健康的概念，并得到国际社会广泛认同和诸多国家政府的承诺。世界卫生组织（WHO）在近十余年里，致力于建立和更新有关计划生育技术服务的指南，形成包括四部文献的技术指南系列，因其重要性而被命名为“四大基石性指南”，这四部文献为《避孕方法选用的医学标准》（简称《医学标准》），《避孕方法使用的选择性实用建议》（简称《实用建议》），《给计划生育服务人员和服务对象的决策工具》（简称《决策工具》）和《计划生育服务提供者的手册》（简称《手册》）。     

计划生育指导站信息系统管理探索

计划生育指导站的信息管理以计划生育技术服务对象信息管理为主,涉及计划生育技术服务业务项目间数据交换,具有鲜明的行业特点。本站1999年建立信息管理系统,经过了多次升级及更新,现已基本满足了站内各科室的日常管理工作,系统运行日趋完善。笔者现将从事信息管理工作的经验作     

全国避孕节育并发症防治学术会议纪要

<正> 为了提高对防治避孕节育并发症重要性的认识,对并发症发生原因进行科学的分析,通过学术交流、总结和专家讲座对并发症的防治技术给予规范化指导,国家计生委科技司委托中国计划生育学杂志编辑部和中华医学会计划生育学会于1996年9月17～22日在四川省都江堰市召开全国避孕节育并发症防治学术会议。来自基层计划生育服务机构和科研单位的200余名代表及专家参加了这次会议。国家计生委科技司司长朱耀华出席     

计划生育技术服务机构人工流产状况及服务能力分析

目的：基于2012年度海淀区29家计划生育技术服务机构实施非意愿妊娠人工流产手术情况,了解妇女的生殖健康状况,为制定干预措施提供理论依据。方法根据医疗机构级别,从71家从事计划生育技术服务的医疗机构中抽取29家不同级别的计划生育技术服务机构,将《计划生育门诊人流手术登记本》登记信息进行数据录入及统计分析。结果29家医疗机构人工流产总例数为46492例,占人工流产总例数（52031）的89．35％。未婚者选择无痛人工流产的人群明显高于已婚者,差异有统计学意义（χ2＝1280．569,P＜0．01）;人工流产次数多者,选择无痛人工流产终止妊娠的比率高于人工流产次数少者,差异有统计学意义（χ2＝227．602,P＜0．01）。未婚人群选择在二级医疗保健机构就医多于其他机构,差异有统计学意义（χ2＝25．903,P＜0．01）;非本市户籍人群选择在一级医疗机构就医的比例高于本市人群,差异有统计学意义（χ2＝646．112,P＜0．01）。结论非户籍人口流产率高、未婚人群流产率高,计划生育技术服务机构应拓展服务范围,加强避孕知识普及和人工流产术后的避孕指导,有效降低非意愿妊娠和重复人工流产。     

人工流产后计划生育服务干预效果观察

目的探究人工流产（人流）后对患者进行计划生育服务干预所产生的临床效果。方法对2011年5月-2013年5月山东省枣庄市峄城区计划生育服务站门诊及住院部收治的76例行人流手术者为研究对象,对其进行流产后计划生育服务干预,分析比较干预前后患者对计划生育知识的掌握情况。结果干预前患者对计划生育服务知识总体掌握率为23.68%,干预后提升到85.53%,干预前随访1年后患者计划生育服务知识总体掌握率比较（χ2=58.2432,P=0.0000）,患者避孕无措施的比例减少（χ2=4.6093,P=0.0318）,高效避孕方法（干预前42.11%、干预后92.11%）和低效避孕方法的整体掌握情况均提高（干预前43.42%、干预后68.42%）,差异均具有统计学意义（χ2=42.7537,P=0.0000;χ2=9.5717,P=0.0020）。结论对人流后的患者行计划生育服务干预,提高了患者对计划生育知识的掌握,促进患者生殖健康水平的提高,值得在临床上运用。     

中国乡级计划生育服务站技术服务提供及服务能力跨地区分析

目的根据2001年全国计划生育和生殖健康调查资料,对我国东、中、西部三大经济地区乡级计划生育服务站的技术服务提供及服务能力进行跨地区比较分析。方法全国抽样调查,采用分层、三阶段、概率比例抽样方法。对776个计划生育服务站和负责人采用观察与询问的方式进行问卷调查。结果全国农村样本点乡站放置和取出宫内节育器年均258.5例次,开展女性绝育术年均38.5例次,实施人工流产术年均29.6例次,三地区间差异有统计学意义(P<0.05)。开展男性绝育术和皮下埋植术年均分别为10.4例次和2.5例次,三地区间差异无统计学意义(P>0.05);在样本点中,95%(737/776)的乡站有B超设备,其中B超服务用于宫内节育器检查和妇科疾病诊断的乡站比例分别为69.5%(509/737)和55.0%(405/737);提供常见妇科疾病诊治、产前检查、不育症诊治的比例分别为84.1%、76.8%和25.4%,提供性病诊治比例为19.5%;提供妊娠试验、血尿便常规检查和宫颈涂片的比例分别为91.4%、18.6%和9.8%。精液检查比例为3.5%;提供短效、长效和速效口服避孕药的比例分别为95.6%、89.7%和71.3%。提供紧急避孕药的比例为24.7%。提供避孕套的比例为97.8%;能提供咨询服务的乡站比例75.6%,设有“悄悄话”室乡站的比例为52.1%;提供术后和产后随访服务的比例分别为85.4%和38.3%。结论全国农村样本点乡站在提供计划生育手术服务、发放避孕药具,以及围绕着生育、节育和不育开展力所能及的生殖保健服务方面已经具备相当能力,但各地的技术服务提供和服务能力发展并不均衡,东、中、西部地区的差别明显。表明我国基层计划生育服务站改革已是一种必然趋势,改革的方向应遵照国家人口计生委关于服务站建设的总体发展格局对乡站进行优化和整合。只有改革才能加快乡站服务能力建设,才能提高服务水平,才能适应客观需求,才能让广大农村育龄群众得到满意的服务。     

Return on Investment: A Fuller Assessment of the Benefits and Cost Savings of the US Publicly Funded Family Planning Program

Context

Each year the United States’ publicly supported family planning program serves millions of low-income women. Although the health impact and public-sector savings associated with this program''s services extend well beyond preventing unintended pregnancy, they never have been fully quantified.

Methods

Drawing on an array of survey data and published parameters, we estimated the direct national-level and state-level health benefits that accrued from providing contraceptives, tests for the human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs), Pap tests and tests for human papillomavirus (HPV), and HPV vaccinations at publicly supported family planning settings in 2010. We estimated the public cost savings attributable to these services and compared those with the cost of publicly funded family planning services in 2010 to find the net public-sector savings. We adjusted our estimates of the cost savings for unplanned births to exclude some mistimed births that would remain publicly funded if they had occurred later and to include the medical costs for births through age 5 of the child.

Findings

In 2010, care provided during publicly supported family planning visits averted an estimated 2.2 million unintended pregnancies, including 287,500 closely spaced and 164,190 preterm or low birth weight (LBW) births, 99,100 cases of chlamydia, 16,240 cases of gonorrhea, 410 cases of HIV, and 13,170 cases of pelvic inflammatory disease that would have led to 1,130 ectopic pregnancies and 2,210 cases of infertility. Pap and HPV tests and HPV vaccinations prevented an estimated 3,680 cases of cervical cancer and 2,110 cervical cancer deaths; HPV vaccination also prevented 9,000 cases of abnormal sequelae and precancerous lesions. Services provided at health centers supported by the Title X national family planning program accounted for more than half of these benefits. The gross public savings attributed to these services totaled approximately $15.8 billion—$15.7 billion from preventing unplanned births, $123 million from STI/HIV testing, and $23 million from Pap and HPV testing and vaccines. Subtracting $2.2 billion in program costs from gross savings resulted in net public-sector savings of $13.6 billion.

Conclusions

Public expenditures for the US family planning program not only prevented unintended pregnancies but also reduced the incidence and impact of preterm and LBW births, STIs, infertility, and cervical cancer. This investment saved the government billions of public dollars, equivalent to an estimated taxpayer savings of $7.09 for every public dollar spent.     

Contraceptive use at the family planning clinic of the University of Nigeria Teaching Hospital, Enugu, Nigeria

During the five year review period (January 1993-December 1997), 19,470 clients visited the family planning clinic of the University of Nigeria Teaching Hospital, Enugu. Of these, 2402 clients (12%) were new patients and 17,068 (88%) were old patients. Among the new clients, 2262 (94%) eventually accepted a contraceptive method. The majority of the women (60%) chose the intrauterine contraceptive device (IUCD), 20% chose the injectables, while bilateral tubal ligation and norplant were chosen by 8% and 7%, respectively, of the clients. The oral contraceptive pill was the least popular (1%). Variations in the pattern of contraceptive use among clients at the family planning clinic were discussed. Measures to increase the contraceptive prevalence, and particularly strategies to meet the specific contraceptive needs of clients at the clinic, were also examined.     

Assessing health status and service utilization in Athens: the implications for policy and planning

Morbidity, subjective health and health care utilization werestudied in two populations, living in two municipalities inthe major area of Athens, characterized by different socio-economicand educational levels. In each area studied, a random householdsample was selected. All subjects in the selected householdsaged 15 and over were included in the study. A total of 248individuals in area I and 303 individuals in area II respondedto the survey. Data were collected through personal interviewsarranged for each respondent. The results of the study suggestthat there exist similar trends as well as some differencesbetween the two populations studied, concerning mainly subjectivehealth and the use of drugs. These findings indicate that amorbidity and health care utilization survey carried out ina large and representative sample of inhabitants of the majorAthens area could be a sufficient basis for rational healthplanning in every municipality of the metropolitan area.     

乡级计划生育服务效果案例分析

云南省双柏县2个乡11年间计划生育服务的案例分析结果显示,2乡的计生服务对人口数量的控制均起了重要作用。2乡比较,鄂嘉乡由于有乡计生所常年不懈地提供孕前型服务,其计划生育的质量优于大庄乡。     

上海市社区计划生育综合服务站工作人员紧急避孕知晓程度调查

目的:了解上海市社区计划生育综合服务站工作人员紧急避孕意识和服务水平,探讨社区紧急避孕规范化服务。方法:2010年1月～2010年12月对上海市闵行区和徐汇区25个街道计划生育服务站的275名服务人员进行问卷调查(紧急避孕相关知识及可接受性情况),同时进行紧急避孕专业培训。结果:社区计划生育服务人员均知道有紧急避孕,但在工作中应用比例为38.5%,73.8%调查对象知道紧急避孕的具体方法,能够正确回答紧急避孕使用常见问题的比例有33.87%。社区计划生育服务人员能够区别紧急避孕与常规的避孕方法,而对紧急避孕的局限性、副作用和失败后的处理方法认识还不足。通过紧急避孕专业培训,78.65%服务人员能够正确回答紧急避孕常见问题,同时纠正了原有的一些认识误区,提高了紧急避孕的知晓度和服务意识。结论:社区人口与计划生育服务人员应定期接受紧急避孕知识及技术培训,及时更新知识,提高服务水平。     

Adolescent demand for contraception and family planning services in low- and middle-income countries: A systematic review

ABSTRACT

An estimated 23 million adolescent girls age 15–19 in low- and middle-income countries (LMICs) have an unmet need for contraception. Despite the recognised importance of expanding access to appropriate methods of contraceptives for adolescents in LMICs, the evidence base on their total demand for contraception is limited, and there is no consensus on how to measure this important phenomenon. The aim of this study was to review the published literature in order to better understand the level of adolescent demand for contraception in LMICs and to explore what demand-related indicators are being measured. A total of 1375 articles were identified and 18 met the inclusion criteria. Included studies reported findings from 29 LMICs, revealing high adolescent demand for contraception. The demand for contraception among adolescents and young women ranged from 22% among married adolescents in Azerbaijan to 98% in Peru. However, measures of this phenomenon were limited, with most studies only reporting current contraceptive use or unmet need. Most studies relied on cross-sectional data, and young, unmarried, and male adolescents were largely excluded. We make several recommendations for alternative approaches for a more comprehensive understanding of adolescent demand for contraception in LMICs.