避孕方法知情选择干预对咨询服务效果的影响

目的 :评价咨询技巧培训对门诊服务提供者咨询服务效果的影响。对象和方法 :以计划生育门诊为基础 ,在基线调查后 ,对干预门诊服务提供者进行咨询技巧培训 ,项目结束时 ,通过对到干预门诊就诊的合格对象进行终末调查 ,来评估咨询服务情况及干预效果。结果 :培训干预措施显著提高了咨询服务水平 ,但仍有部分对象反映在咨询中存在服务提供者限制其使用某种避孕方法的现象。咨询服务质量的高低影响对象的避孕知识水平及其对现用避孕方法的满意程度。结论 :使咨询服务规范化 ,进一步提高服务提供者的咨询技巧 ,提高育龄群众的避孕知识普及程度。     

避孕方法知情选择干预措施对已婚育龄妇女避孕知识水平的影响

目的:评价避孕方法知情选择干预措施对已婚育龄妇女避孕知识、知情选择相关知识和态度的影响,探索影响干预效果的潜在因素。对象和方法:本研究以计划生育门诊为基础的干预研究,进行基线调查后对到干预门诊就诊的妇女进行避孕节育知情选择宣教,培训干预门诊的服务人员并提供咨询服务,干预后进行效果评估调查。结果:干预措施显著提高了干预组服务对象避孕知识、知情选择知晓率和正确理解程度,提高了服务提供者的咨询技巧。计划生育干部和技术人员认为基层技术人员数量少、素质低,给知情选择的开展带来一定的困难。结论:应通过多种渠道给予育龄群众更广泛全面的信息,加强基层服务提供者的培训。     

计划生育工作人员咨询服务状况调查

目的:了解计划生育工作人员的咨询服务状况及可能的影响因素,为下一步在该人群中开展咨询培训提供依据。方法:通过结构式问卷,调查了来自于全国31个省、市、自治区和直辖市的271名计划生育工作人员,对他们的咨询服务状况及可能的影响因素进行分析。结果:271名调查对象中,255人曾为服务对象提供过咨询服务。咨询服务相关知识得分最高为100.0分,中位数为76.9分;咨询服务知识得分单因素分析显示,不同年龄组、不同文化程度对象之间的差别有统计学意义(P<0.05);多分类反应变量多元Logistic回归分析显示,文化程度越高,研究对象的咨询服务知识得分越高。结论:计划生育工作人员咨询服务的总体状况良好,但研究对象的年龄,文化程度等因素可能对他们的咨询服务产生影响。建议加强咨询培训的针对性,提高计划生育工作人员的整体素质。     

外来孕妇与本地孕妇产前检查和妊娠结局的对照研究

目的:调查上海户籍与非上海户籍孕妇围产保健方面存在的差距,分析流动人口平产分娩点对改善外来孕妇围产期保健状况、减少不良妊娠结局发生的作用。方法:回顾分析2004年7月至2005年6月在复旦大学附属上海第五人民医院浦江分院流动人口平产分娩点及上海市第五人民医院产科住院分娩的5528例孕妇。分为分娩点非上海户籍、五院非上海户籍和五院上海户籍3组。结果:分娩点外来孕妇产前检查覆盖率为92.98%,仅次于综合医院沪籍孕妇,但产检4次以上的比例不足1/3,与其他两组差异显著。分娩点调查对象的妊娠结局普遍好于综合医院的外来孕妇,剖宫产率仅为21.10%,明显低于其他两组。两组外来孕妇中,不良妊娠结局的发生随产检次数的增加而减少,来自分娩点孕妇的低体重儿、过期产的发生并未因产检次数增加而得以抑制。结论:通过普及产前检查,流动人口平产分娩点在改善外来孕产妇妊娠结局方面有成效。但外来孕产妇仍缺乏足够的围产保健,应进一步加强系统产前检查和提高质量,切实改善外来流动人口的母婴保健状况。     

避孕节育咨询与知情选择对农村地区已婚育龄妇女的影响

目的:了解农村地区已婚育龄妇女避孕知识状况并探讨其影响因素。方法:对国家人口和计划生育委员会知情选择项目四个试点县的3 901名 20~49岁已婚育龄妇女的避孕知识状况及其影响因素进行问卷调查,并采用SAS8.2对调查数据进行统计分析。结果:①调查对象的避孕知识综合得分平均为25.44分,50分以上的仅有4.36%。得分最高的避孕方法为宫内节育器(72.17分),最低的为宫颈帽(2.57分)。不同知识类别得分中名称知晓得分和用法得分两者较高,避孕方法原理、优点及缺点得分均较低。②调查对象的避孕知识主要通过培训班、讨论会、咨询(56.17%)的形式从乡镇或村(社区)计生人员处获得(68.21%)。③影响避孕知识得分的因素包括年龄、家庭人均收入、文化程度、对象的咨询状况以及与避孕知情选择有关的知识和态度等。④88.57%的对象认为面对面交流、培训班为获得避孕知识的最佳方式,88.40%的对象认为是乡镇或村(居委会)的计划生育技术人员,是提供避孕知识咨询的最佳人选。结论:农村已婚育龄妇女避孕知识水平较低,亟需通过宣传教育来提高,以期能使知情选择在广大农村育龄妇女中更好地推广。     

孕妇产后的避孕意愿及其影响因素

本文对上海市黄浦区、普陀区、青浦县、奉贤县 40 37名孕妇对产后避孕意愿及影响因素进行了分析。结果显示 :79.96 %的妇女考虑产后避孕。2 5～ 2 9岁的妇女较其它年龄段的妇女考虑产后避孕的比例要高。产后避孕意愿与本人文化程度及职业无关 ,而亲戚朋友的文化程度对产后避孕意愿有影响。工作单位要求在 1年内落实避孕措施、接受过有关避孕知识教育或为此进行咨询或查阅书籍的妇女考虑产后使用避孕方法的比例较高。单位或计划生育部门建议使用的避孕方法以宫内节育器最高 ,占 97.1 4% ,避孕套仅为 1 .0 2 % ;妇女自我选择的避孕方法中宫内节育器为多 ,占 82 .34% ;其次为避孕套 ,占 1 1 .2 1 %。 L ogistic回归分析表明 :年龄、文化程度、职业、家庭收入等对产后避孕意愿影响不大。产后愿意哺乳者、接受过避孕教育、咨询或查阅书籍者、了解避孕知识年龄较小者、知晓宫内节育器者对产后避孕意愿有正面作用。建议在计划生育服务中 ,今后需加强产后避孕教育 ,开展各种避孕方法知情选择的教育和咨询 ,指导妇女在产后选择最适合于自己的避孕方法 ,从而减少产后意外妊娠的发生     

宣州市已婚育龄妇女避孕知识状况及其影响因素分析

目的 :了解已婚育龄妇女对避孕知识的掌握程度。方法 :对 70 7例 2 0～ 40岁已婚育龄妇女的避孕知识状况及其影响因素进行了分析。结果 :(1 )大部分对象的避孕知识得分在2 0～ 6 0分之间 ,约占 70 %。得分在 80分以上的对象仅占 1 .6 %。在听说过的各种避孕方法中 ,宫内节育器位居首位 (99.7% ) ,其次是避孕套 (97.2 % )和口服避孕药 (96 .6 % )。(2 )研究对象获得避孕知识的首要途径是书籍和手册 (50 .1 % ) ,其次是咨询医务人员(39.9% )。 (3)影响避孕知识得分的因素包括职业、文化程度、家庭收入、避孕知情选择的知识和态度等     

市-区-社区三级服务机构对流动人口避孕节育服务的比较性研究

目的:探索适宜于流动人口推广应用避孕节育技术的服务模式。方法:对到市-区-社区三级服务机构寻求避孕节育服务的流动人口以自填式问卷进行问卷调查。结果:通过开展"优质服务",各类流动育龄人口均可在不同级别的计划生育服务机构得到相应的避孕节育服务。市级服务机构的优势是能提供综合性的生殖健康服务,专业技术水平较高;但在避孕信息与宣传材料提供、避孕药具发放及咨询服务提供方面有待改进。而区级机构则在避孕节育的宣教、咨询、药具发放专业指导上以及服务环境等方面具有较强的优势,受到被服务者的普遍好评;但在个人隐私的保护方面还需进一步完善。社区健康中心在开展社区预防保健和医疗服务的同时,较好地发挥社区优势,开展避孕节育服务,优势是能吸引已婚、未婚的各类育龄人群参与,服务便捷,利于随访等;但需在服务环境和避孕节育的专业水平上进一步加强。结论:流动人口避孕节育方法应采取市-区-社区相结合的方式,优势互补,各有侧重。社区机构服务重点是避孕药具的发放和随访指导,区级的服务重点是避孕节育技术的落实,市级的重点是并发症的处理和综合性的生殖保健服务。     

剖宫产后节育方法的效果研究

本研究对１９８９年４月到１９９０年３月间在国际和平妇幼保健院及纺织局第二医院内剖宫产及自然分娩产妇各１０００例进行了为期两年的回顾性调查。调查内容包括产后避孕方法采用时间、各类避孕方法的效果及产后人流等情况。结果显示：两组产后两年内年人均人流人次类似，差别无显著性；产后落实避孕措施越早，产后人流的可能性越小。两组人流原因中均以无措施导致为主。各类避孕方法中以宫内节育器效果为最佳，宫内节育器中以活性非圆形ＩＵＤ为最好。因此，在剖宫产后及时落实高效安全的避孕方法，特别是使用活性非圆形宫内节育器，在妇女中大力普及各种避孕知识的同时，加强计划生育技术指导，对降低剖宫产后的人流可能性具有重要的作用。     

我国孕产妇妊娠合并症/并发症发生情况及其影响因素

目的：调查我国孕产妇妊娠合并症/并发症发生情况及其影响因素。方法：选取我国东、中、西部地区15个省（区、市）60家医院,采用结构式问卷调查,对分娩1～2年的产妇进行调查,记录其妊娠期、产时和产后合并症/并发症以及人口学特征、既往生育和疾病史等情况,采用无序多分类Logistic回归模型分析妊娠合并症/并发症的影响因素。结果：共调查18 045例产妇,妊娠合并症/并发症发生率为25.04%,其中妊娠合并内外科疾病发生率为8.98%,胎儿及其附属物异常发生率为7.99%,妊娠并发症发生率为6.79%,分娩、产褥异常发生率为1.29%。妊娠合并症/并发症的发生风险与孕产妇年龄、流产次数、产次、分娩方式相关,且存在地区差异。结论：我国孕产妇妊娠合并症/并发症发生率较高,加强避孕服务,减少人工流产,对高风险妊娠患者增加产检次数并加强孕期保健,建议妊娠合并症/并发症较严重者就诊/转诊于三级医院,有助于降低妊娠合并症的发生风险及并发症的严重程度。     

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.

     

加强计划生育技术服务机构能力建设的调查

为配合《计划生育技术服务管理条例》的贯彻实施 ,加强计划生育技术服务能力的建设 ,我们利用国家计划生育委员会举办的“第二期地市级计生干部学习《计划生育技术服务管理条例》培训班”,对学员进行了调查。调查发现 ,现有县乡级机构技术服务能力仍有明显不足 ,尤其在乡级单位最为明显。主要表现为有资格的技术服务人员和设备器材的缺乏以及服务项目的不足 ,且东、西部省份间存在明显差异。建议抓好技术服务人员的全面培训 ;规范乡级技术服务机构的服务项目和范围 ;保证各级政府部门对计划生育事业的财政投入和改进现行的不相适应的考核制度。     

Postpartum contraceptive needs in northern Haiti

Objective

To assess the knowledge of, attitudes toward, and practices regarding postpartum contraception among healthcare providers and postpartum women in northern Haiti.

Methods

Six focus groups were conducted with postpartum patients and 3 were conducted with maternity service providers; a structured questionnaire was then administered to postpartum patients.

Results

In total, 282 postpartum women were included in the present study: 249 in the survey and 33 in focus groups. Although 97.9% of women expressed a desire for family-planning counseling before discharge from the postpartum ward, only 6.0% of women received such counseling. Most women wanted to space or limit their pregnancies; 79.8% of women, including those with only 1 child, wanted to choose a contraceptive method before discharge. Providers expressed concern for the volume of induced abortions and maternal deaths within the hospital, which many felt could be averted by improving postpartum family planning. However, there was no postpartum contraceptive counseling or method provision in the present setting, and no providers had experience in initiating methods immediately postpartum.

Conclusion

Efforts to integrate family planning into postpartum care services could help to reduce the unmet need for family planning, and help patients and providers reach their goals.     

眉山市不同机构流产服务的现状及其评价

目的:了解和评价眉山市不同服务系统和等级医疗机构流产服务质量。方法:采用服务机构现场观察、技术人员深入访谈和流产妇女半结构式访谈等研究方法。结果:结果表明,该市流产服务可获得性良好,但服务对象对多数机构的服务环境和硬件设施以及技术人员优质服务意识和态度或多或少存在不满。观察发现多数服务的基础设施与群众对流产优质服务的要求存在不少差距,国家计划生育技术常规没能够严格执行,特别是预防术后感染、药物流产方案的执行、流产后避孕服务等重视不够。结论:要加强流产服务基础设施建设,提高技术人员优质服务意识,特别要加强流产服务整个过程中生殖道感染预防、流产后计划生育服务及严格执行药物流产技术常规。     

On-the-job training through follow-up visits to improve the quality of family planning services

As part of a broader set of activities to strengthen family planning training and improve the quality of family planning services in Turkey, follow-up visits were performed at different family planning sites across the country in order to conduct on-the-job training. The objective of on-the-job training was to refresh and improve family planning counselling skills for all methods as well as to refresh and improve intrauterine device insertion/removal skills and also some determinants of quality care. It was also aimed at transferring up-to-date information to family planning practitioners, identifying frequently encountered problems and helping with solution approaches for problems both at the individual and programmatic levels. The results of the follow-up visits reflect issues about both the staff and the clinical facility itself in terms of conforming with the standards of the ‘National Family Planning Guidelines’ set forth by the Ministry of Health.

The follow-up team consisted of nine members who were specially trained. They represented different sectors such as a non-governmental organization, a medical school and the Ministry of Health. The follow-up team performed 90 visits to 16 clinics in 11 provinces between 1995 and 1998. Methods used were structured observations via standard checklists, meetings with the clinic staff, self-assessment, role plays, demonstration, coaching and the provision of feedback. During this period, a total of 130 health professionals working in 16 clinics were trained on-the-job. A significant improvement was observed in the performance of the family planning practitioners and the quality of care provided in clinics. While none of the service providers were found to have a standard skill level in general counselling during the first visit, at the end of the fifth visit all were capable of providing counselling services according to the national standards. Intrauterine device insertion skills were high at the beginning of the visits, and 16 of the 17 observed service providers (94%) were assessed as conforming to the standards, At the fifth visit, all of the 42 service providers (100%) were found to be adequate. At the facility level, all 16 clinics established separate counselling rooms in the follow-up period. Additionally, the number of clinics conforming to infection prevention standards increased from two clinics in 15 at the first visit to all 16 clinics at the fifth visit. This study showed that the ultimate success of family planning programs depend on structured and well-supervised on-the-job training through follow-up visits to the sites.     

A family planning risk scoring system for health care providers

The potential usefulness of a Family Planning Risk Scoring Sheet was studied in 1720 consecutive women who completed a family planning visit and were prescribed a specific contraceptive method. The results demonstrated that many women had relative or absolute contraindications to their prescribed method that were detected later by the Family Planning Risk Scoring Sheet. There were 29 women in the oral contraceptive and intrauterine device groups who had absolute contraindications detected (2.8 and 2.4%, respectively). The nurse practitioners tended to have fewer unrecognized problems in their groups than did the physicians. The usefulness of the Family Planning Risk Scoring Sheet was demonstrated and its routine use in a busy family planning unit is recommended.     

On-the-job training through follow-up visits to improve the quality of family planning services.

As part of a broader set of activities to strengthen family planning training and improve the quality of family planning services in Turkey, follow-up visits were performed at different family planning sites across the country in order to conduct on-the-job training. The objective of on-the-job training was to refresh and improve family planning counselling skills for all methods as well as to refresh and improve intrauterine device insertion/removal skills and also some determinants of quality care. It was also aimed at transferring up-to-date information to family planning practitioners, identifying frequently encountered problems and helping with solution approaches for problems both at the individual and programmatic levels. The results of the follow-up visits reflect issues about both the staff and the clinical facility itself in terms of conforming with the standards of the 'National Family Planning Guidelines' set forth by the Ministry of Health. The follow-up team consisted of nine members who were specially trained. They represented different sectors such as a non-governmental organization, a medical school and the Ministry of Health. The follow-up team performed 90 visits to 16 clinics in 11 provinces between 1995 and 1998. Methods used were structured observations via standard checklists, meetings with the clinic staff, self-assessment, role plays, demonstration, coaching and the provision of feedback. During this period, a total of 130 health professionals working in 16 clinics were trained on-the-job. A significant improvement was observed in the performance of the family planning practitioners and the quality of care provided in clinics. While none of the service providers were found to have a standard skill level in general counselling during the first visit, at the end of the fifth visit all were capable of providing counselling services according to the national standards. Intrauterine device insertion skills were high at the beginning of the visits, and 16 of the 17 observed service providers (94%) were assessed as conforming to the standards. At the fifth visit, all of the 42 service providers (100%) were found to be adequate. At the facility level, all 16 clinics established separate counselling rooms in the follow-up period. Additionally, the number of clinics conforming to infection prevention standards increased from two clinics in 15 at the first visit to all 16 clinics at the fifth visit. This study showed that the ultimate success of family planning programs depend on structured and well-supervised on-the-job training through follow-up visits to the sites.