成都市未婚流动人群性和生殖健康状况与需求调查

目的:了解成都市未婚流动人群的性和生殖健康状况与需求。方法:以匿名问卷调查方式收集资料进行统计分析。结果:共有效调查615人,未婚流动人群中有过性行为56.9％,16.72％至少有过一次人工流产;这组人群的性与避孕知识相对缺乏,而对婚前性行为的看法较开放。2/3以上的调查对象认为社会向他们提供的性与生殖健康信息和服务不足。未婚流动人群更希望得到有关避孕方法及使用的信息与服务。结论:社会应关注流动人群的性和生殖健康状况与需求,向他们提供相关教育与服务。     

Service provider perspectives on post-abortion contraception in Nepal

The government of Nepal has articulated a commitment to the provision of post-abortion contraception since the implementation of a legal safe abortion policy in 2004. Despite this, gaps in services remain. This study examined the perspectives of abortion service providers and administrators regarding strengths and shortcomings of post-abortion contraceptive service provision. In-depth interviews were conducted with 24 abortion providers and administrators at four major health facilities that provide legal abortion in Nepal. Facility factors perceived to impact post-abortion contraceptive services included on-site availability of contraceptive supplies, dedicated and well-trained staff and adequate infrastructure. Cultural norms emerged as influencing contraceptive demand by patients, including method use being unacceptable for women whose husbands migrate and limited decision-making power among women. Service providers described their personal views on appropriate childbearing and the use of specific contraceptive methods that influenced counselling. Findings suggest that improvements to a facility’s infrastructure and training to address provider biases and misinformation may improve post-abortion family planning uptake. Adapting services to be sensitive to cultural expectations and norms may help address some barriers to contraceptive use. More research is needed to determine how to best meet the contraceptive needs of women who have infrequent sexual activity or who may face stigma for using family planning, including adolescents, unmarried women and women whose husbands migrate.     

The experience of young people with contraceptive consultations and health care workers

In the United Kingdom, services for contraceptive consultation and family planning were first opened in the 1960s. Early and relevant information to adolescents is of importance. The aim of this paper was to examine young people's attitudes towards and experiences of consultations with health care providers about contraception, taking account of the context of their contraceptive use. Young people aged 16-21 years were recruited to the study from health services (young people's contraceptive and sexual health clinics and a termination of pregnancy clinic), secondary schools and community projects (a youth club, a young mothers' support group, a community education project and a young women offenders unit). As part of the needs' assessment, in-depth interviews and focus groups were conducted. Thirty-two young male and females were interviewed. Knowledge about contraception, sexually transmitted infections and the risk of pregnancy was often high. Many respondents noted that in a five to ten minute consultation there was not the time to discuss personal factors that may affect contraceptive decision making and effective use of methods. Many described a feeling of being rushed through the service and did not feel they had the opportunity to ask questions. What young people said they wanted from consultations with health care workers and their experiences of the consultation process often conflicted. They wanted the time and opportunity to discuss their options. Often the young men, who were accessing services, described how initially they had gone in to collect condoms, but once they knew the clinic and staff would consider making an appointment. It is concluded that young people want to be given choices and information regarding contraception that fit their lifestyles. Improving the structures of contraceptive and sexual health services for young people will help to remove some of the barriers that prevent some young people from accessing them. However, it is just as important that barriers in the service delivery are tackled to ensure young people receive effective contraceptive advice.     

Provider attitudes toward dispensing emergency contraception in Michigan's Title X programs

In 1997, the US Department of Health and Human Services instructed all Title X delegate agencies to provide emergency contraceptive pills as part of their standard family planning services. The results of a survey conducted in the state of Michigan in October 1996, prior to this policy development, elucidate potential obstacles to implementation of this directive. Questionnaires were completed by the family planning coordinator of all 53 Michigan health departments and Planned Parenthood affiliates that receive Title X funding. At the time of the survey, only 32 programs were providing emergency contraception and 27 of these agencies were offering the method to no more than one woman per month. 75% of providers agreed that poor or underprivileged women would benefit from more widespread access to emergency contraception through Title X programs. Barriers to translating this commitment into practice included inadequate staffing, the logistics of scheduling emergency appointments, lack of federal service guidelines, few client requests, and reservations about the impact on sexual risk-taking and contraceptive practice. In several cases, the decision not to dispense emergency contraception was made by a medical doctor or health officer who viewed the method's medicolegal status as unclear or considered the associated political risk too great. The subsequent marketing of a product specifically designated for emergency contraception should alleviate provider concerns about the method's status. The logistic concerns suggest a need to consider provision of emergency pills to clients in advance of actual need.     

Ecological factors predicting adolescent contraceptive use: implications for intervention

Questionnaires addressing areas expected to relate to contraceptive use were completed by 230 female adolescents. Contraceptive use among the 130 sexually active subjects were predicted by a model composed of 12 scales assessing social permissiveness, costs and benefits of contraception, parent communication, boyfriend support, sex education and knowledge, attitudes about pregnancy and contraception, and access to contraception services. Scales from the predictive model which raise ideas for potential intervention strategies assessed parent communication, boyfriend support, and perceived costs and benefits related to contraception. Since there has been public concern that intervention programs for enhancing adolescent contraceptive use might also stimulate sexual activity, correlations were computed between the predictive scales and the measure of sexual experience among all 230 subjects. These data indicated that positive parent communication about sexuality and a perception of high benefits and low costs associated with contraceptive use were not positively correlated with sexual experience. Implications for the prevention of adolescent pregnancy are discussed with an emphasis on designing innovative sex education, improving parent-child communication, resolving conflicts in contraceptive decisionmaking, and supporting the role of boyfriends in contraceptive use.     

Involving communities in health service planning in primary care

Recent health service policy in the United Kingdom has emphasized the need to involve local people in health service planning. This paper will describe how local communities were involved in the development of Primary Care Resource Centres. These centres are designed to provide a base for the delivery of a range of health, social welfare and information services within a community setting. Four centres in the process of being developed in one region were selected for in-depth study. The main method of data collection consisted of semi-structured interviews with key “stakeholders”, namely purchasers and providers of primary health care, social care providers, hospital outreach staff and local community and voluntary group workers (Weiss 1983). This paper examines how the health service organizations developing the centres involved local communities in planning them and the obstacles and difficulties encountered. The paper suggests lessons that can be learned for future community involvement in the planning of local health services.     

年轻女性务工人员生殖健康状况分析

目的:了解工厂里年轻女性(流动人口)生殖健康的现况及影响因素,为年轻女性的生殖健康保健提供参考依据。方法:采用社会学领域的定性研究方法,对工厂里年轻女性进行了个人深入访谈;对工厂管理者、卫生服务提供者及决策者进行了关键人物访谈。结果:年轻女工普遍缺乏避孕知识、性保健知识;未婚先孕、人工流产是主要的健康问题;到私立医院就诊,就诊费用高、时间紧、生殖健康知识缺乏是影响生殖健康服务利用的主要因素。结论:年轻女性务工人员是生殖健康保健的弱势人群,政府和企业应将生殖保健政策更倾向于女性务工人员,开展行之有效的措施及健康宣传,以提高生殖健康服务的利用。     

Community attitudes to the sexual behaviour of young people in an urban area with high rates of sexual ill-health

CONTEXT: Adults in any community are a potentially important source of sexual health information for young people. Open discussion of sexual health issues is associated with low rates of sexual ill-health. Adults who disapprove of teenage sexual behaviour are poor sources of advice. The study of adult attitudes to the sexual behaviour of young people is relevant to work on improving access to sexual health services. SETTING: Adults' attitudes to the sexual behaviour of young people in an urban area with high indices of sexual ill-health were documented. DESIGN: Data were collected via questionnaires administered in popular shopping areas by local people after training. RESULTS: A total of 283 interviews were completed. Eighty-eight percent of respondents thought that the likely age of first sex among young people was under the age of consent but only 8% thought that the acceptable age of first intercourse was under 16 years. Knowledge of local services was suboptimal. Twenty percent of respondents did not know where young people could get contraception or advice on sexual health issues. Less than half (42%) suggested a general practitioner with a similar proportion suggesting a family planning clinic (FPC) or Brook clinic. When asked what services FPCs provide, only 40% mentioned contraception and 32% did not know. Despite their lack of knowledge, the majority (84%) of respondents would tell a young person where they could obtain contraception or sexual health advice. Seventy-six percent thought parents and 56% thought schools are the key sources of sexual health information for young people.CONCLUSIONS: Adults resident in this area have negative attitudes to the sexual behaviour of local young people and suboptimal knowledge of local contraceptive services. They do, however, identify themselves as potentially important sources of sexual health advice and may therefore benefit from more information and an opportunity to discuss their attitudes.     

Motivations of Persons with Psychiatric Disabilities to Work in Mental Health Peer Services: A Qualitative Study Using Self-Determination Theory

Introduction Individuals with psychiatric disabilities have low rates of employment and occupational rehabilitation success. Mental health peer services are a new occupational modality that opened a promising occupational path: persons with serious mental illnesses employed to provide support to others with psychiatric conditions. However challenges to successful peer work exist. Work motivation is central to understanding and supporting peer workers, yet little is known about sources of motivation to work as mental health peer providers. The aim of this study was to identify what drives individuals to mental health peer work using self determination theory (SDT). Methods Motivations of 31 mental health peer workers were explored as part of a larger study. A theory driven approach was employed to emerging qualitative data using SDT concepts: external motivation and internally regulated motivations derived from basic needs (autonomy, competence, relatedness). Results External motivations included generic occupational goals and getting away from negative work experiences. Internal motivations corresponded with SDT basic needs: autonomy met-needs was reflected in having freedom to disclose and finding that work accords with personal values; competence met-needs was reflected in using personal experience as a resource to help others; and relatedness met-needs were reflected in having opportunity to connect intimately and reciprocate with consumers. Conclusion This study identified external and internal motivations of persons with psychiatric disabilities to work as peer providers—a novel occupation in mental health. Employing personal experience and enabling peer contact emerge as major motivational tenets of mental health peer work. According to SDT instrumental occupational goals are considered more external than satisfaction of basic psychological needs. The study demonstrates the applicability of SDT in the design of autonomy supported environments to promote work engagement and sustenance of mental health peer providers.     

Risk-taking sexual behaviour and self-reported depression in middle adolescence--a school-based survey

Background Early sexual activity has been widely studied in the context of pregnancies, substance use and antisocial behaviour, but the aspects of psychosexual health have received less attention. Aim To study the associations of early sexual activity and self‐reported depression. Setting A school survey in Finland in 1999 and 2000 in the eighth and ninth grades. Methods Adolescents with experience of sexual intercourse were studied (11 793 girls and 10 443 boys, mean age 15.5 years). Scores of 8 or more in the Beck Depression Inventory were regarded as indicative of self‐reported depression. Associations with sexual behaviour variables were analysed using logistic regression models. Results In both genders, self‐reported depression increased in proportion to the number of sexual partners and with the non‐use of contraception. A higher number of coital experiences correlated with depression only among boys. Adjusting for age and age at menarche/oigarche did not affect the associations detected. In stepwise logistic regression, an increasing number of partners increased the risk for self‐reported depression [for boys with at least five partners odds ratio (OR) 2.5, 95% confidence intervals (CI) 2.2–3.0, and for girls OR 2.7, 95% CI 2.3–3.2]. Boys and girls who did not use contraception showed roughly twice as high a risk as contraceptive users. However, girls with five or more coital experiences had a significantly lower risk for depression compared to girls with only one sexual intercourse. Conclusions Multiple sexual partners and non‐use of contraception may reflect a depressive disorder in both genders. While adolescent health service providers should be aware of the risk for depression among sexually active adolescents, the sexual health of depressed adolescents also warrants special attention.     

Sixteen to nineteen year olds' use of, and beliefs about, contraceptive services

Unwanted pregnancies, sexually transmitted diseases and unprotected sex in young people highlight a need to improve the provision of contraceptive services for this age group. The aim of the present study was to examine young men and women's use of and beliefs about, contraceptive services. A questionnaire was completed by 967 16 to 19 year olds from South Thames concerning their use of and beliefs about, a range of services which provide contraception. The results showed variability in both service use and belie about services which related to the respondent's sexual experience and gender In terms of use, the chemist and the condom machine had been used by the largest number of respondents, with more men using the condom machine and women favouring the GP or family planning clinic. In terms of beliefs, the condom machine was regarded as the easiest and most comfortable to use but the least confidential for all respondents with men reporting higher ratings for ease of use than women and non virgins reporting more positive beliefs for all criteria. The results are discussed in terms of the implications for health education. It is suggested that contraception use in young people could be promoted by embracing rather than challenging this variability. Accordingly, health education interventions would involve providing young people with information about contraception services which was designed to be in line, rather than conflict, with their existing concerns and beliefs. Such an approach would enable them to make informed choices about the kind of contraceptive service which matched their own personal needs.     

河北省未婚青年生殖健康服务需求调查

为了解对未婚青年提供性和生殖健康服务的观念、态度、看法,确定未婚青年对避孕、性和生殖健康服务的需求及向他们提供服务存在的困难,探讨可接受及可行的服务方法,并提出政策建议,河北省计划生育研究所在石家庄对四类未婚青年进行了座谈讨论及个人深入访谈。结果表明:婚前性行为和人工流产的现象是存在的,多数未婚女青年认为是不该发生的事情,未婚男青年则反应平淡;应加强对未婚青年进行性、避孕、性知识方面的教育;未婚青年发生婚前性行为应该使用避孕措施;有必要为未婚青年开设生殖健康咨询服务点;根据调查结果对如何为未婚青年提供生殖健康服务提出了建议。     

城市女性生殖健康知识现状调查

目的 了解城市女性卫生保健知识及相关行为、避孕知识及行为、性观念／行为和生殖健康服务需求。方法采用互联网调查的方式,对共25055名城市女性进行匿名问卷调查,应用SPSS11．5进行数据统计分析。结果对女性生殖道的生理特点、常见阴道炎（如霉菌、滴虫等）的预防保健知识“非常了解”的比例仅为14．21％和8．78％;在回答避孕知识相关问题的调查对象中,仅有16．13％的人对各种避孕知识和方法都“非常了解”;对于性行为,表示“一定要结婚才可以”的人只占回答此问题的调查对象的17．52％;面对生殖健康问题,受调查女性的就医意识和就医行为普遍偏低。结论城市女性拥有一定的生殖健康知识,但多停留在一般常识阶段,自我保健意识也有待提高,故医疗保健工作者在加大健康教育力度、倡导健康行为的同时,也要注意改进工作方式,提供更具优势的服务,以促使其主动利用正规的生殖健康保健服务。     

A review on adolescent childbearing in Taiwan: its characteristics, outcomes and risks

In Taiwan, the age-specific fertility rate for adolescent girls aged 15-19 years has remained at 14-18/1,000 births during the past two decades, which is the highest among developed countries in Asia. There was a surprisingly high age-specific fertility rate for married women aged 15-19 years at 726 per 1,000 in 1994, much higher than that of the United States. Adolescent childbearing causes many adverse outcomes including unwanted and unstable marriage, repeated childbearing during adolescence, and increased risks of having low birth weight and preterm births and neonatal mortality. Studies in Taiwan showed that adolescent childbearing is associated with their poor knowledge but open attitude and behaviour on sexuality, the inadequate contraceptive services for the adolescents in need, some risk-taking behaviors, family dysfunction and low socioeconomic status of the adolescents' families. About two-thirds of the fathers of infants born to adolescent girls were adults, even old adults with a low education level Effective strategies for adolescent childbearing prevention range from sex education, the direct provision of contraceptive supplies, and to life options programmes, especially for the adolescents with high risk of adolescent pregnancy. Reducing the incidence of adolescent childbearing by active use of contraception is more important and practical than prohibiting adolescent sexual activity.     

成都地区未婚流动青年生殖健康现状和需求分析

目的:了解城市未婚流动青年的性与生殖健康知识、相关行为和生殖健康服务需求。方法:在成都地区抽取工厂和服务场所,对15～24岁未婚外来务工青年进行匿名问卷调查。结果:有效调查780例。调查对象性与生殖健康知识的各项得分均很低。60.8%的男性和37.7%的女性曾有性行为,发生性行为时有时使用避孕措施者80%,每次都使用者仅占12.7%,从不使用者占7.5%。调查对象的生殖健康服务需求依次为相关知识教育、相关咨询服务和避孕药具服务。认为接受生殖健康服务的主要障碍分别是不好意思、不知道地方、没有时间以及担心服务人员的态度。结论:调查对象的生殖健康知识贫乏,不安全的性行为较多,生殖健康服务需求未得到满足。这一现状应引起相关部门和人员予以重视和思考。     

What contraception do women use after abortion? An analysis of 319,385 cases from eight countries

Contraception is an essential element of high-quality abortion care. However, women seeking abortion often leave health facilities without receiving contraceptive counselling or methods, increasing their risk of unintended pregnancy. This paper describes contraceptive uptake in 319,385 women seeking abortion in 2326 public-sector health facilities in eight African and Asian countries from 2011 to 2013. Ministries of Health integrated contraceptive and abortion services, with technical assistance from Ipas, an international non-governmental organisation. Interventions included updating national guidelines, upgrading facilities, supplying contraceptive methods, and training providers. We conducted unadjusted and adjusted associations between facility level, client age, and gestational age and receipt of contraception at the time of abortion. Overall, postabortion contraceptive uptake was 73%. Factors contributing to uptake included care at a primary-level facility, having an induced abortion, first-trimester gestation, age ≥25, and use of vacuum aspiration for uterine evacuation. Uptake of long-acting, reversible contraception was low in most countries. These findings demonstrate high contraceptive uptake when it is delivered at the time of the abortion, a wide range of contraceptive commodities is available, and ongoing monitoring of services occurs. Improving availability of long-acting contraception, strengthening services in hospitals, and increasing access for young women are areas for improvement.     

Program Fidelity and Patient Satisfaction among Women Served by the Zika Contraception Access Network Program in Puerto Rico

BackgroundThe Zika Contraception Access Network (Z-CAN) was designed to provide women in Puerto Rico who chose to delay or avoid pregnancy during the 2016–2017 Zika virus outbreak access to high-quality client-centered contraceptive counseling and the full range of reversible contractive methods on the same day and at no cost through a network of trained providers. We evaluated the implementation of Z-CAN from the patient perspective.MethodsAn online survey, administered to a subset of women served by the Z-CAN program approximately 2 weeks after their initial Z-CAN visit, assessed patient satisfaction and receipt of services consistent with select program strategies: receipt of high-quality client-centered contraceptive counseling, same-day access to the contraceptive method they were most interested in after counseling, and no-cost contraception.ResultsOf 3,503 respondents, 85.2% reported receiving high-quality client-centered contraceptive counseling. Among women interested in a contraceptive method after counseling (n = 3,470), most reported same-day access to that method (86.8%) and most reported receiving some method of contraception at no cost (87.4%). Women who reported receiving services according to Z-CAN program strategies were more likely than those who did not to be very satisfied with services. Women who received high-quality client-centered contraceptive counseling and same-day access to the method they were most interested in after counseling were also more likely to be very satisfied with the contraceptive method received.ConclusionsA contraception access program can be rapidly implemented with high fidelity to program strategies in a fast-moving and complex public health emergency setting.     

Telehealth for Contraceptive Services During the COVID-19 Pandemic: Provider Perspectives

BackgroundTelehealth use rapidly increased during the COVID-19 pandemic, including for contraceptive care (e.g., counseling and method provision). This study explored providers’ experiences with contraceptive care via telehealth.MethodsWe conducted a survey with open-ended responses among contraceptive providers across the United States. The study population included physicians, nurse practitioners, health educators, and other health professionals (n = 546). Data were collected from April 10, 2020, to January 29, 2021. We conducted qualitative content analysis of the open-ended responses.ResultsProviders highlighted the benefits of telehealth, including continuing access to contraceptive services and accommodating patients who faced challenges attending in-person contraceptive visits. Providers at school-based health centers reported telehealth allowed them to reach young people while schools were closed. However, many providers noted a lack of patient awareness about the availability of telehealth services and disparities in access to technology. Providers felt there was less personal connection in virtual contraceptive counseling, noted challenges with confidentiality, and expressed concern about the inability to provide the full range of contraceptive methods through telehealth alone.ConclusionsThe pandemic significantly impacted contraceptive health care delivery. Telehealth has sustained access to contraception in important ways, but has been accompanied by various challenges, including technological access and confidentiality. As hybrid models of care evolve, it is important to assess how telehealth can play a role in providing contraceptive care while addressing its barriers.     

广东省城市流动人口年轻女性避孕现况调查

目的 :调查广东省城市流动人口年轻女性避孕现况及需求 ,探讨加强该人群避孕意识、降低人工流产率的有效措施。方法 :采用个人问卷调查和小组访谈方式调查了 2 0 0 6名 15～ 35岁流动人口女性。结果 :有婚前性行为者占 2 3 4 % ,其中有人工流产史者占 6 6 8% ,75 7%是由于未采用避孕措施造成的。未婚人工流产者性行为中无避孕措施的高达 93.9%。 2 0 0 6人中避孕知识答卷得分≥6 0分占 35 9% ,<6 0分占 6 4 1% ,其中 0分占 7 6 % ;有人工流产史者避孕知识得分≥ 6 0分占18 7% ,<6 0分占 81 3%。能说出 3种以上避孕药具及正确使用方法的仅占 8 0 %。能正确描述紧急避孕方法者占 12 % ;听说过紧急避孕但不能正确描述者占 34 0 % ;不知道紧急避孕者占 5 3 9%。结论 :流动人口年轻女性避孕生殖健康知识贫乏 ,婚前性行为普遍 ,无防护性行为率高。     

Do family-planning workers in China support provision of sexual and reproductive health services to unmarried young people?

OBJECTIVE: To ascertain the perspectives of family-planning service providers in eight sites in China on the provision of sexual and reproductive health services to unmarried young people. METHODS: Data were drawn from a survey of 1927 family-planning workers and 16 focus group discussions conducted in eight sites in China in 1998-99. FINDINGS: Family-planning workers recognized the need to protect the sexual health of unmarried young people and were unambiguous about the need for government agencies to provide information and education on sexual and reproductive health to unmarried young people; however, perceptions about the appropriate age for and content of such education remained conservative. While about 70% of family-planning workers were willing to provide contraceptives to unmarried young people, and about 60% approved government provision of contraceptive services to unmarried young people, only one quarter agreed that the services could be extended to senior high schools. CONCLUSION: Family-planning workers in China are ambivalent about the provision of sexual and reproductive health services to unmarried young people, which potentially poses a significant obstacle to the adoption of safe sex behaviours by young people, as well as to the provision of sexual and reproductive health information and services to young unmarried people in China. Training programmes for family-planning workers are urgently needed to address this issue.