北京市无痛人工流产育龄妇女接受流产服务的现状调查

目的:了解选择行无痛人工流产术的育龄妇女接受流产服务的现状。方法:采用分层随机抽样的方法在北京市18个区县中抽取6个区县的18家开展计划生育技术服务的医疗机构,在门诊对早孕后选择终止妊娠的育龄妇女进行问卷调查。结果:在至少有1次流产史的1 005例行无痛人工流产调查对象中,前次流产有49.2%的人选择了无痛人工流产,在前次流产时有77.9%接受了避孕宣传教育,只有50.1%获得了避孕药具,前次流产告知流产后需避孕者其流产后首次性生活避孕的比例明显高于未告知者,而且提供避孕宣传教育服务与流产的地点有关。本次流产83.6%为意外妊娠,外地户籍、大学或大专学历、收入>3 000元、丈夫或性伴年龄<25岁的育龄妇女选择无痛人工流产的比例较高,选择无痛人工流产的育龄妇女中有29.0%存在高危因素,仅有61.9%被告知无痛人工流产可能发生并发症。结论:无痛人工流产育龄妇女高危流产的比例较高,其流产前、后获得的知识和信息不足,应开展多种形式的生殖健康知识宣传教育,落实避孕措施,减少非意愿妊娠。     

Abortion in Puerto Rico: The limits of colonial legality

As a colony of the United States, abortion became legal in Puerto Rico, as a consequence of the US Supreme Courtrulingin Roe v. Wade, rather than as a consequence of intemal political developments. In spite of a wide variety of foreign-sponsored population experiments and policies, developed with the active participation of government, opposition to abortion emerged in Puerto Rico and women's right to abortion has not been fully accepted by government officials or health professionals. Using data from a survey carried out in 1991–1992 of women attending 10 of the 13 private abortion clinics, and other sources of historical information, this paper examines the current practice of abortion and the hurdles women face to obtain this service, taldnginto consideration the impact of colonial subordination. The colonial legality of abortion in Puerto Rico has both supported and deterred Puerto Rican women's right to abortion, and other means of ensuring that right need to be found.     

Sterilization needs in the 1990s: the case for quinacrine nonsurgical female sterilization.

Much evidence suggests that demand for sterilization is a function of supply of surgical sterilization services in less-developed countries. If such services were greatly expanded, the number of procedures performed would grow dramatically. While the prevalence of sterilization is estimated to increase from 23.5% to 28.8% of married women of reproductive age in the 1990s, there will actually be 106,432,000 more couples of reproductive age at the end of this decade than at its beginning who use either no method or a far less effective method with much lower continuation rates than sterilization--nearly a 20% increase. To achieve a mean sterilization prevalence of 47% of married women of reproductive age in the less-developed world, as now seen in the Republic of Korea and Puerto Rico, the number of sterilizations would need to be more than double the current projection for the 1990s: 328,429,000 rather than 159,000,000. The quinacrine pellet method for nonsurgical female sterilization offers hope that this enormous shortfall in sterilization services can be overcome in this decade.     

Risk factors for cesarean delivery among Puerto Rican women

OBJECTIVE: The rate of primary cesarean delivery in Puerto Rico in 2002 was 52% higher than in 1996 and 85% higher than among Puerto Rican women delivering on the U.S. mainland. Reasons for these differences were explored using birth certificate data. METHODS: Distributions of mothers' age, education, parity, level of prenatal care, pregnancy weight gain, medical risk factors, labor induction, labor or delivery complications, and infant birth weight among births in Puerto Rico in 2002 (n=40,489) were compared with births in Puerto Rico in 1996 (n=51,357) and births to Puerto Rican women delivering on the mainland in 2002 (n=47,800). Multivariable log-linear regression models were used to estimate relative risks for primary cesarean delivery by year, place of delivery, and selected risk factors. RESULTS: Risk for cesarean delivery was higher in Puerto Rico in 2002 than in both 1996 (relative risk 2.1, 95% confidence interval 2.0, 2.3) and on the mainland in 2002 (relative risk 2.4, 95% confidence interval 2.2, 2.6). This translates into one additional cesarean delivery in Puerto Rico in 2002 for every 4.2 live births, controlled for examined risk factors. Higher rates of cesarean delivery in Puerto Rico in 2002 could not be explained by examined risk factors. CONCLUSION: Until further research reveals ways to safely reduce the rate of cesarean delivery in Puerto Rico, physicians, public health practitioners, and other stakeholders may want to focus their efforts on reducing rates among low-risk women and those with no labor complications. LEVEL OF EVIDENCE: II.     

Review of human immunodeficiency virus infection in women in the United States

In this review, available human immunodeficiency virus (HIV) seroprevalence data are presented for United States women attending clinics related to reproductive health and for women in other settings. At family planning clinics, prenatal clinics, and in delivery room settings (cord blood testing), studies that have not targeted women at high risk for HIV infection have shown prevalence rates ranging from 0-4.3%. Higher rates (greater than 1%) have been observed in more urban areas--Newark, New York City, Baltimore, Miami, and San Juan; rates at settings outside these areas have generally been below 1%. Filter-paper testing for maternal HIV antibodies from neonatal heel-stick specimens has been conducted statewide in Massachusetts and New York; prevalence rates were 0.3% in Massachusetts in 1987, and 0.2% in upstate New York and 1.3% in New York City in 1987-1988. Prevalence rates of female military applicants and female blood donors are below 0.03% and 0.1%, respectively, and have been relatively stable over time. Where age data are available, prevalence rates are near 0 in women below age 20 years, are higher for young adult and early middle-aged women, and decline thereafter. Studies have also been conducted using blood samples from women undergoing premarital testing for syphilis serology, from women attending sexually transmitted disease clinics and drug treatment centers, and from patients at sentinel hospital sites. Information on the prevalence of HIV infection in United States women is useful to identify specific populations at risk for HIV infection and to target and evaluate education and prevention efforts.     

人类免疫缺陷病毒感染对妊娠结局的影响

目的 探讨夫类免疫缺陷病毒（HIV）感染对妊娠结局的影响及母婴垂直传播的发生情况。方法 应用酶联免疫吸附试验对2678例孕妇及其婴幼儿的外周血HIV抗体进行检测,其中资料完整的86例HIV抗体阳性孕妇为HIV组,另选择与HIV组年龄、孕周相匹配的HIV抗体检测阴性的40例健康孕妇及其婴幼儿作为对照组。采用回顾性分析的方法,对两组孕妇的妊娠结局进行跟踪随访。结果 （1）HIV组孕妇中,流产、早产、低体重儿及小于胎龄儿的发生率分别为9．3％（8／86）14．0％（12／86）、16．3％（14／86）及10．5％（9／86）,明显高于对照组的2．5％（1／40）、5．0％（2／40）、7．5％（3／40）及2．5％（1／40）。两组比较,差异有显著性（P＜0．05）。（2）HIV组孕妇中,合并念珠菌性阴道尖及尖锐湿疣的发生率分别为9．3％与8．1％,明显高于对照组的2．5％及2．5％,两组比较,差异有显著性（P＜0．05）。（3）HIV组孕妇中,母婴HIV垂直传播发生率为12．8％;而对照组孕妇所分娩的婴儿中,HIV抗体检测均为阴性,发生率为0％。两组孕妇HIV感染垂直传播率比较,差异有极显著性（P＜0．01）。结论 孕妇感染HIV后可显著增加流产、早产、低体重儿及小于胎龄儿等不良妊娠结局的发生率,同时增加念珠菌性阴道炎、尖锐湿疣的感染机会,母婴HIV垂直传播的发生率亦明显升高。加强孕期保健、预防HIV感染至关重要。     

Obstetrician-initiated counseling and testing for HIV infection: a cross sectional study

Abstract

Objective: To assess the practice of provider-initiated counseling and testing (PICT) for HIV infection by Nigerian Obstetricians and estimate missed opportunities at the gynecological and family planning clinics.

Methods: Online cross-sectional survey of members of the Society of Gynaecology and Obstetrics of Nigeria (SOGON) over a 4-week period using SurveyMonkey®. Frequencies were used to present responses of participants.

Results: There were 201 (29%) respondents. Participants’ mean age was 46?±?7.2 (SD) years and majority (93.3%) held consultant positions. Most respondents (92.2%) cared for HIV-infected pregnant women with dedicated HIV counselors (77.4%), and in dedicated counseling rooms (71%). Majority (75.7%) had been trained on HIV management in pregnancy and 95.3% routinely counseled and tested women attending the booking antenatal clinic. Fourteen per cent (14%) and 16% of respondents conducted routine counseling and testing for women attending the gynecological and family planning clinics, respectively, for the first time. For every 100 women tested at the antenatal clinic, 317 women were missed at each of the two clinics.

Conclusions: PICT of HIV infection in Nigeria has focused on pregnancy. To eliminate new HIV infections in children, PICT should be routine at the gynecological and family planning clinics.     

The need for family planning and safe abortion services among women sex workers seeking STI care in Cambodia

In Cambodia, clinics established for the prevention and management of sexually transmitted infections (STIs) in women sex workers do not address other reproductive health services. The aim of this study was to assess the need for more comprehensive sexual and reproductive health services for women sex workers in Cambodia. In January 2000, relevant documents were reviewed, interviews with key informants carried out and group interviews with women sex workers conducted. Medical records from women sex workers were also reviewed and some data collected prospectively in one government STI clinic. Interviews with the women and data from the government clinic indicated that excluding condoms, a very low proportion of women sex workers were currently using a modern contraceptive method--5% of 38 women and 1.6% of 632 women, respectively. Induced abortion was widely used but was perceived to be risky and costly. Data from a mobile team intervention and the government clinic respectively showed that 25.5% (n = 1744) and 21.9% (n = 588) of women sex workers reported at least one previous induced abortion. These findings reveal the need for accessible contraception and safe abortion services among sex workers in Cambodia, and raise the issue of the reproductive rights and reproductive health needs of women sex workers in general.     

Seroprevalence of human immunodeficiency virus in parturients at Boston City Hospital: implications for public health and obstetric practice.

OBJECTIVE: We measured the seroprevalence of human immunodeficiency virus in women seeking reproductive services. STUDY DESIGN: Demographic and risk behavior data from women were linked anonymously to human immunodeficiency virus antibody results. RESULTS: The overall human immunodeficiency virus seropositivity rate of cord blood was 22 per 1000. Crude seroprevalence rates were higher for black women versus white women (25/1000 vs 22/1000) but lower for black Americans versus white Americans (21/1000 vs 29/1000). Human immunodeficiency virus infection was significantly higher for those women who acknowledge intravenous drug use (odds ratio 12.9, 95% confidence interval 7.3 to 22.7), were born in Haiti (odds ratio 2.6, 95% confidence interval 1.6 to 4.1), lacked prenatal care (odds ratio 2.2, 95% confidence interval 1.1 to 4.2), or received prenatal care at the hospital clinic versus a neighborhood health center (odds ratio 3.0, 95% confidence interval 1.7 to 5.3). The seroprevalence rates were 18/1000 for women seeking abortion and 16/1000 for women seeking family-planning services. CONCLUSION: Intravenous drug use and country of origin are major risk factors for human immunodeficiency virus infection in women, which may explain differences in seroprevalence rates in various racial or ethnic groups. Hospital-specific data on human immunodeficiency virus infection may be useful for monitoring the epidemic and allocating resources for education, counseling, testing, and prevention.     

Risk factors for HIV-1 seroprevalence among family planning clients in Dar es Salaam, Tanzania

Between March and September of 1995, women receiving family planning (FP) services in three large clinics in Dar es Salaam, Tanzania were invited to participate in a cross-sectional study. Consenting women were interviewed to obtain information about HIV risk factors, and blood for HIV testing was collected. The prevalence of HIV was 16.9% (95% CI: 14.4%-19.3%). The risk of HIV increased significantly with age. Compared with married women, the risk of HIV was significantly higher among cohabiting women (age-adjusted OR = 2.3; 95% CI = 1.5-3.5) and among women who were single, divorced or widowed (age-adjusted OR = 2.3; 95% CI = 1.2-4.4). The risk of HIV was also significantly higher among hotel workers (age-adjusted OR = 4.3; 95% CI = 1.4-12.9). Women with laboratory evidence of sexually transmitted diseases were at increased risk of HIV. This study shows that HIV is a major public health problem among FP clients in Tanzania. Innovative HIV interventions are needed to reduce further spread of HIV infection.     

Sexual behaviour of young people

20% of the world's population is aged 10-19 years. Annually, almost 15 million young women under age 20 become mothers. However, surveys in developing countries show that 20-60% of the pregnancies and births to women under age 20 are mistimed or unwanted. While later marriage age in many places has provoked a decline in birth rates among young women, levels of sexual relations before marriage are increasing. Such sexual behavior opens sexually active young women to the risks of unwanted pregnancies, unsafe abortion, and sexually transmitted diseases (STDs). Millions of young people become infected with STDs annually. Among all age groups in the US, young women aged 15-19 have the highest incidence of gonorrhea among females and young men aged 15-19 have the second highest incidence among males. At least half of all people infected with HIV are under age 25. The UNDP/UNFPA/WHO/World Bank Special Program of Research, Development, and Research Training in Human Reproduction (HRP) completed 9 studies in 1996 on adolescent reproductive health. 14 studies were completed before 1996, and 18 are still underway.     

Mandatory prenatal screening for the human immunodeficiency virus: the experience in south-eastern France of a national policy, 1992–1994

Objective To evaluate the impact of the 1993 French National Policy which made it mandatory to offer screening for the presence of human immunodeficiency virus (HIV) to all pregnant women who planned to give birth, although women remained free to refuse the test.
Design Successive surveys in April 1992 and May 1994 in south-eastern France. Logistic regressions were performed to identify factors which affected access to HIV testing for women who gave birth and those who terminated their pregnancy, and for each year of study.
Main outcome measures Attitudes and access to HIV testing among pregnant women, irrespective of pregnancy outcome.
Setting All obstetrics and gynaecology departments and abortion clinics in the region.
Population 3497 women in 1992 (2775 who were delivered and 722 who chose termination) and 3407 in 1994 (2701 who were delivered and 766 who chose termination). The response rates were 82% and 88%, respectively.
Results In 1994 of women who were delivered, 73% had an HIV test, compared with 63% in 1992 (   P < 0.001  ); however of women who terminated their pregnancy, only 28% had an HIV test, compared with 245% in 1992 ( P not significant), although they were more at risk for HIV infection. Socioeconomic differences affecting access to testing were reduced between 1992 and 1994, but only among women who gave birth.
Conclusion Introduction of a policy which makes it mandatory to offer HIV screening to all women who intended to have their baby improved access to screening but did not improve the rate of preventative counselling. A mandatory requirement to offer HIV screening should be extended to women who request termination of pregnancy.     

The AIDS pandemic: a catalyst for women's rights.

The rates of HIV infection among women are rising at a higher rate than among men. After citing the reasons for women's vulnerability, this report argues the potential role of gynecologists and obstetricians through integration of HIV/AIDS into sexual and reproductive health services to strengthen the response to the epidemic.     

Evaluation of a new testing policy for human immunodeficiency virus to improve screening rates.

OBJECTIVE: To assess the effect of a change in human immunodeficiency virus (HIV) testing policy on HIV testing rates in an urban maternity clinic population. METHODS: Since 1995, our institution has provided pretest counseling and voluntary HIV testing to all pregnant women. After the 1999 Institute of Medicine recommendation of HIV testing with patient notification as a routine component of prenatal care, we conducted a prospective study to determine whether this policy would increase our HIV screening rates. The intervention incorporated HIV testing into the routine battery of tests drawn at antenatal care. Not to be tested required active refusal. The intervention group was comprised of all women receiving an initial antenatal visit in one of our eight maternity clinics between August 1, 1999, and July 30, 2000. The control group was comprised of all women presenting for prenatal care in the same clinics during the year before the intervention. RESULTS: The 3415 women in the intervention group and 3778 controls were similar with respect to most demographic and risk factors. After the intervention, HIV testing increased from 75% to 88% (P <.001). Among all women in both years of the study, women who were in the intervention group, less than 20 years of age, or who had a history of substance abuse, were more likely not to refuse testing. CONCLUSION: After implementation of a policy of routine HIV testing with active patient refusal, HIV testing rates increased among pregnant women in our large, urban obstetric clinic population.     

Contraceptive practice after women have undergone "spontaneous" abortion in Indonesia and Sudan

Studies of hospitalized "spontaneous" abortion patients in two Muslim countries (Indonesia and Sudan) revealed the need for contraception in this group of married women and indicated the potential role of maternity hospitals in providing them with contraceptive counseling. It could not be determined which of the abortions were induced outside the hospital and which were truly spontaneous. Of the 893 women treated at the Djakarta Hospital, 15.3% used contraceptives during the month of conception of the index abortion, compared to 10.0% of the 2 759 patients in Khartoum. After hospitalization for completion of the abortion, the rates of contraceptive use increased by more than one third in both cities. The highest rates of increase in contraceptive use after abortion were noted among poorly educated women, women with large families, and women with abortions diagnosed as septic. Among the nonseptic patients at all hospitals, those experiencing complications associated with the abortion reported a slightly higher rate of postabortion contraceptive use. In hospitals where contraceptive counseling was provided, there was a proportional increase in postabortion use of contraceptives by the study population.     

Post-abortion family planning counselling practice among abortion service providers in China: a nationwide cross-sectional study

Objective: To assess the practice of post-abortion family planning (PAFP) counselling among Chinese abortion service providers, and identify the influencing factors.

Methods: A cross-sectional questionnaire survey was conducted between July and September 2013 among abortion services providers in 30 provinces in China. Univariate and multivariable logistic regression analyses were used to identify the factors that influenced PAFP counselling.

Results: 94% of the 579 service providers responded to the questionnaire in the survey. The median age was 39 years (range 20–72), and 95% were females. 92% providers showed a positive attitude and had promoted the PAFP counselling services; however, only 57% spent more than 10?min for it. The overall knowledge on PAFP was limited to the participants. After adjusting for potential confounding factors: providers from the middle region (compared with ‘east region’, OR_adj?=_?3.33, 95% CI: 2.12–5.21) conducted more PAFP counseling; providers with more knowledge (OR_adj?=_?2.08, 95% CI: 1.38–3.15) provided more counseling; and compared with ‘middle school and below’, providers with higher education gave more counseling [OR_adj(95% CI)] for ‘college’, ‘university’ and ‘master/doctor’ [1.99 (1.01,3.92), 2.32 (1.22,4.40) and 2.34 (1.06,5.17), respectively].

Conclusions: The majority of providers could provide PAFP counselling to women undergone an abortion, but some of them had insufficient time to make it available. Education, knowledge about fertility and reproductive health and residence region were the main factors influencing the practice. Training of health providers and integrating family planning as a part of abortion services are essential to provide adequate PAFP to abortion seekers, thereby reducing the risk of unintended pregnancy.     

Determinants of antepartum human immunodeficiency virus testing in a non-Medicaid obstetric population.

OBJECTIVE: To determine voluntary human immunodeficiency virus (HIV) testing rates and factors influencing testing in a private obstetric practice. METHODS: Antepartum patients were offered HIV testing after completing a self-assessment questionnaire. Perceived risks and demographics were correlated with testing rates. RESULTS: Overall, 348/600 (58%) women consented to HIV testing. In a univariate analysis, patients with "any" perceived risk(s) were more likely to be tested. Single women and those with an at-risk partner(s) or a history of sexually transmitted disease (STD) were more likely to desire testing. These factors remained independently associated with voluntary testing in a multivariate regression model. No patients tested positive for HIV. CONCLUSIONS: In our private obstetric practice, 26% of women perceived themselves at risk for HIV infection, and testing rates depended on the various risks identified. A history of STDs or an at-risk sexual partner were stronger predictors of voluntary testing than was marital status. Focused HIV counseling among pregnant women at relatively low risk for infection may be possible.     

Treatment options for human immunodeficiency virus-infected pregnant women. Obstetric-Gynecologic Working Group of the AIDS Clinical Trials Group of the National Institute of Allergy and Infectious Diseases.

The increasing seroprevalence of human immunodeficiency virus (HIV) among women of reproductive age and the risks of vertical transmission of HIV have led to recommendations for routine prenatal HIV counseling and testing. The incentive to undergo such testing is related not only to fetal concerns, but also to the potential benefit of early and comprehensive therapy for women. Treatments that should be considered for use during pregnancy include the antiretroviral agent zidovudine and prophylactic agents to prevent Pneumocystis carinii pneumonia, the most common opportunistic infection seen in patients progressing to AIDS. Assessment of the risks and benefits of these treatments during pregnancy is complex and requires discussions between physician and patient. This paper reviews current information and provides recommendations for incorporating therapies into obstetric practice.     

Morbidity in the first year postpartum among HIV-infected women in Kenya.

OBJECTIVE: To assess the effects of HIV infection on morbidity and the needs of infected women for services in the first year postpartum. METHODS: A cross-sectional study with 500 women attending a child-health clinic in Mombasa, Kenya. RESULTS: Postpartum duration was a median of 3.3 months (interquartile range, 1.9-6.1 months). The 54 HIV-infected women had a lower income and less financial support than the uninfected women, and they were more likely to experience fever, dyspnea, and dysuria, and to have genital warts (odds ratio [OR], 9.6; 95% confidence interval [CI], 2.6-35.6; P<0.001), candidiasis (OR, 2.9; 95% CI, 1.2-6.8; P=0.012), and bacterial vaginosis (OR, 1.8; 95% CI, 0.95-3.3; P=0.066). Six (nearly 15%) of the HIV-infected women had low- or high-grade squamous intraepithelial lesions, and 21 (42%) had an unmet need for contraception. More than half of all women were anemic, and normocytic anemia was predominant among the HIV infected. CONCLUSION: Compared with uninfected women, morbidity was increased for HIV-infected women during the year following delivery. This period could be used to offer these, and all-women, family planning services, cervical cancer screening, and treatment for anemia and reproductive tract infections.     

Risk factors for repeat abortion in Nepal

ObjectiveTo examine the incidence of and risk factors for repeat abortion in Nepal.MethodsData were analyzed from a survey of 1172 women who had surgical abortions between December 2009 and March 2010 in 2 clinics in Kathmandu, Nepal. Bivariate and multivariate logistic regressions were performed to estimate odds ratios for the risk factors.ResultsAmong the respondents, 32.3% (95% confidence interval, 29.6–34.9) had repeat abortions. This incidence rose sharply with age and parity, and was higher among those with no intention of having a future child, those attaining primary or secondary level education, and those attending the non-governmental sector clinic. Women with repeat abortion were similar to those with 1 abortion in terms of contraceptive practice. Among women not using contraceptives at the time of the unintended pregnancy, the 3 most commonly cited reasons were ill health, non-compliance with the method intended for use, and dislike of the method. Women with repeat abortion showed a pattern of contraceptive acceptance immediately after the procedure similar to that of women who had 1 abortion.ConclusionRepeat abortion is emerging as a major public health issue in Nepal, with implications for counseling and provision of abortion, and for family planning services.