以自助发放为突破口 提质药具“最后一公里”

<正>计划生育药具免费发放是全国药具管理系统的职责所在,面对数量越来越大、人口迁移速度越来越快、需求越来越多的流动育龄群众,传统的药具免费发放点在"最后一公里"方面后劲明显不足。如何通过最有效的服务方式为更多的育龄群众提供更好的服务,就成为避孕药具工作者亟需考虑的问题。本文通过分析药具自助发放模式,力求有效提升药具发放的工作水平。1自助发放的适用范围1.1药具发放的形势变化30多年来,药具工作已初步构建了一个覆盖全     

计生药具管理问题研究

计划生育药具的供应、发放与管理工作是人口与计划生育工作的重要组成部分.避孕节育方法及向农村实行计划生育的群众免费提供避孕药具已写进了计划生育法,避孕药具免费发放和随访是优质服务的重要内容.本文就就如何进行药具工作改革,探讨了加强其管理的工作思路与对策,以提高药具管理的实效性.     

乡村医生志愿发放避孕药具的探索和实践

河南省新县属山区县,群众居住较为分散,在农村计划生育药具服务中存在“领取药具难”和“发送药具难”等问题。为落实好计划生育优惠政策,让山区育龄群众真正受益,新县积极寻求药具网络发放的有益补充,在原县、乡、村三级避孕药具发放网点的基础上,招募乡村医生志愿者免费发放避孕药具,为群众开辟一条免费领取避孕药具的有效渠道,受到广大育龄群众的称赞。一、主要做法1.严格选聘志愿者。乡村医生具有一定医疗知识,经常直接与群众打交道,担负药具发放任务是最合适的。但免费发放计划生育避孕药具是一项政策性很强的工作,所以,要挑选遵纪守法…     

基层免费宫内节育器使用管理情况的调查分析

<正>避孕药具服务是落实节育措施的重要支撑,是计划生育工作的重要组成部分。我国控制人口增长的工作取得了举世瞩目的成就,避孕药具的供应在计划生育工作中发挥了重要的作用。规范避孕药具管理工作,应该严格按照药具管理规范,坚持免费发放、满足供应、减少浪费、方便群众的工作原则,使得药具管理服务做到"四个到位":责任落实到位,制     

关于制定《计划生育药具自助发放机行业标准》的思考

<正>计划生育药具(指国家每年投入专项资金采购的避孕药具)免费发放是政府为实现人口目标,满足育龄人群避孕节育需求而提供的公共服务产品。随着婚育观念和生活方式的转变,计划生育药具已经成为育龄人群避孕节育、促进生殖健康和提高生活质量的必需品。计划生育药具免费发放的传统方式是手工发放,是从省、市、地区各级计划生育药具发放部门,逐级向下发放到机关、企事业单位,以及各街道居民社区,再到每个需求的个体[1-5]。改革开放     

北京市育龄人群免费避孕药具使用现状及需求的定性调查

目的:了解北京市育龄群众对免费避孕药具发放和使用的评价及需求。方法:对北京市8个区县65名育龄群众进行小组访谈,对14名计划生育人员进行个人深入访谈。结果:访谈对象主要是户籍地常住育龄妇女,初、高中文化者居多,现多在使用避孕套;药具质量可靠和方便获取是访谈对象利用免费避孕药具发放网络的主要原因;对避孕套、口服避孕药、杀精剂有不同看法;虽然获取信息的途径多样,但访谈对象不能全面准确地掌握药具知识;对自助设备、避孕药具及生殖健康知识等有需求。结论:北京市免费避孕药具发放工作具有成效,但存在药具品种单一,知识宣传不够等问题。为推进工作,建议增加免费避孕药具品种,加强使用指导和宣教咨询,促进计划生育人员培养和队伍建设。     

山区农村避孕药具管理工作面临的问题及对策

<正> 避孕节育方法知情选择和向农村实行计划生育的育龄群众提供免费的避孕药具,已作为公民的权利写进了《中华人民共和国人口与计划生育法》,做好避孕药具的免费主渠道供应发放和药具随访是计划生育优质服务的重要内容,是落实“三为主”工作方针、保护育龄群众身心健康的重要举措;让广大育龄群众安全、方便地使用到品种齐全的避孕药具,是对计划生育药具工作者的基本要求。     

避孕药具管理的思考与对策

在新时期、新形势下,人口和计划生育事业对药具工作提出了更新、更高的要求,赋予了艰巨的任务,药具工作新的思路、新的对策势在必行.避孕药具工作必须坚持以人为本,提高优质服务质量,探索出一条符合政府与群众双满意的途径,坚持把避孕药具作为政府提供给育龄群众的计划生育公共服务和公共产品的重要内容,深化药具管理体制和工作机制改革,切实把药具免费发放供应落到实处,确保广大育龄群众使用安全、有效、价廉、便捷的药具产品,不断提高育龄群众对避孕药具的易得性和服务的满意度,从而推进计划生育工作可持续发展.     

浅谈计划生育避孕药具管理存在的问题及对策

在新时代的背景下,计划生育这一理念逐渐贯彻到千家万户。计划生育这一国策的提出对避孕药具工作提出了更大的挑战,使避孕药具的管理工作显得更加艰巨。深化药具管理体制的改革,使避孕药具免费发放的工作落到实处,保证广大人民群众使用方便、安全成为药具管理的重点。本文分析探讨了避孕药具管理存在的问题,针对问题提出相关应对措施,促进计划生育工作的可持续发展。     

“特殊人群”药具发放的探索

随着社会的快速发展,流动人口计划生育管理服务给我们广大计生工作者提出了新的难题,特别是对“特殊人群”避孕药具发放难的问题更为突出。为应对新时期人口计划生育避孕药具工作,本文对这些新的问题进行简单的讨论,并结合我县当前育龄群众的实际情况给出相关建议。目的：通过对流动人口、聋哑、弱智、盲人精神病、避孕药具不良反应人员等特殊人群避孕药发放的探索和研究,可以让每位药具工作者在面对不同育龄群众时采取最合适的药具发放与服务方武,从而提高了我县计划生育避孕节育措施落实率,育龄群众使用药具避孕的满意度也不断提高,促进了全县人口和计划生育工作的开展特殊人群。     

Contraceptive failure in the United States

This review provides an update of previous estimates of first-year probabilities of contraceptive failure for all methods of contraception available in the United States. Estimates are provided of probabilities of failure during typical use (which includes both incorrect and inconsistent use) and during perfect use (correct and consistent use). The difference between these two probabilities reveals the consequences of imperfect use; it depends both on how unforgiving of imperfect use a method is and on how hard it is to use that method perfectly. These revisions reflect new research on contraceptive failure both during perfect use and during typical use.     

Contraceptive failure in the United States

This review provides an update of previous estimates of first-year probabilities of contraceptive failure for all methods of contraception available in the United States. Estimates are provided of probabilities of failure during typical use (which includes both incorrect and inconsistent use) and during perfect use (correct and consistent use). The difference between these two probabilities reveals the consequences of imperfect use; it depends both on how unforgiving of imperfect use a method is and on how hard it is to use that method perfectly. These revisions reflect new research on contraceptive failure both during perfect use and during typical use.     

Trends in the use of contraceptive methods and voluntary interruption of pregnancy in the Spanish population during 1997-2007

Background

This study was designed to acquire information about the use of contraceptive methods in order to reduce the number of elective abortions.

Study Design

Since 1997, representative samples of Spanish women of childbearing potential (15–49 years) have been surveyed by the Daphne Team every 2 years to gather data of contraceptive methods used.

Results

During the study period, 1997 to 2007, the overall use of contraceptive methods increased from 49.1% to 79.9%. The most commonly used method was the condom (an increase from 21% to 38.8%), followed by the pill (an increase from 14.2% to 20.3%). Female sterilization and IUDs decreased slightly and were used by less than 5% of women in 2007. The elective abortion rate increased from 5.52 to 11.49 per 1000 women.

Conclusions

The factors responsible for the increased rate of elective abortion need further investigation.     

Contraceptive discontinuation attributed to method dissatisfaction in the United States

BACKGROUND: This study examines contraceptive discontinuation due to method dissatisfaction among women in the United States. STUDY DESIGN: The study population, drawn from the 2002 National Survey of Family Growth, consisted of 6724 women (15-44 years of age) who had ever used a reversible contraceptive method. We first estimated the overall proportion of women who had ever discontinued their contraceptive due to dissatisfaction. We then calculated method-specific discontinuation risks due to dissatisfaction and analyzed the reasons for dissatisfaction given by women who had ever stopped using Norplant, Depo-Provera, oral contraceptives or condoms. RESULTS: Overall, 46% of women had ever discontinued at least one method because they were unsatisfied with it. Dissatisfaction-related discontinuation risks varied widely by method: the diaphragm and cervical cap showed the highest proportions of such discontinuation (52%), followed by long-acting hormonal methods (42%). Oral contraceptives were associated with an intermediate risk of dissatisfaction-related discontinuation (29%), while condoms had the lowest risk (12%). CONCLUSION: A broader understanding of women's concerns and experiences using contraception could help health care providers redesign counseling strategies to improve contraceptive continuation.     

向产后妇女事先提供紧急避孕药对意外妊娠率影响的研究

目的:了解对产后妇女事先提供紧急避孕药能否降低产后意外妊娠率,从而明确事先提供紧急避孕药在临床上有无重要意义。方法:随机接纳2000例产后妇女,教育组(1002例)接受常规产后避孕教育,教育+药物组(998 例)除接受常规教育外事先提供3次剂量的10mg米非司酮。两组妇女均在产后16周、32周和52周接受电话随访。结果:产后1年内教育+药物组妇女服用紧急避孕药物的人数较教育组多,但两组产后1年内的意外妊娠率无显著差别;两组妇女的避孕模式基本相同。结论:对产后妇女事先提供紧急避孕药不能显著减低意外妊娠率,在临床上更应加强对产后妇女的避孕指导工作。     

北京市高校大学生避孕知识、态度及避孕行为的现况分析

本文报告了北京市五所高校1310名大学生避孕知识、态度及避孕行为的现状。调查结果表明,半数以上的学生听说过宫内节育器、避孕套和避孕药的名称,但少于1/3的学生回答“知道如何使用”这些避孕措施;半数以上的被调查对象对大学生避孕相关问题持肯定和赞同的态度。15％的男生和13％的女生承认有过婚前性交行为。但首次性行为发生时,只有16％的人回答他们或他们的性对象采用过现代避孕措施(避孕套和避孕药等)。另外,3.1％的被调查对象报告他们曾怀孕过或使对方怀孕过一次或多次。Logistic回归分析结果表明,避孕知识、大学生对怀孕易感性和严重性的认知以及对避孕措施获得性难易程度的认知与避孕行为有关。提示:应在北京大学生中开展适当的避孕知识与技能的教育,同时提供必要的生殖健康服务。     

Young women’s consistency of contraceptive use — does depression or stress matter?

Background

We prospectively examined the influence of young women’s depression and stress symptoms on their weekly consistency of contraceptive method use.

Study Design

Women ages 18-20 years (n= 689) participating in a longitudinal cohort study completed weekly journals assessing reproductive, relationship and health characteristics. We used data through 12 months of follow-up (n= 8877 journals) to examine relationships between baseline depression (CES-D) and stress (PSS-10) symptoms and consistency of contraceptive methods use with sexual activity each week. We analyzed data with random effects multivarible logistic regression.

Results

Consistent contraceptive use (72% of weeks) was 10–15 percentage points lower among women with moderate/severe baseline depression and stress symptoms than those without symptoms (p<.001). Controlling for covariates, women with depression and stress symptoms had 47% and 69% reduced odds of contraceptive consistency each week than those without symptoms, respectively (OR 0.53, CI 0.31–0.91 and OR 0.31, CI 0.18–0.52). Stress predicted inconsistent use of oral contraceptives (OR 0.27, CI 0.12–0.58), condoms (OR 0.40, CI 0.23–0.69) and withdrawal (OR 0.12, CI 0.03–0.50).

Conclusion

Women with depression and stress symptoms appear to be at increased risk for user-related contraceptive failures, especially for the most commonly used methods.

Implications

Our study has shown that young women with elevated depression and stress symptoms appear to be at risk for inconsistent contraceptive use patterns, especially for the most common methods that require greater user effort and diligence. Based upon these findings, clinicians should consider women’s psychological and emotional status when helping patients with contraceptive decision-making and management. User-dependent contraceptive method efficacy is important to address in education and counseling sessions, and women with stress or depression may be ideal candidates for long-acting reversible methods, which offer highly effective options with less user-related burden. Ongoing research will provide a greater understanding of how young women’s dynamic mental health symptoms impact family planning behaviors and outcomes over time.     

产后妇女避孕节育知识及避孕应用调查

目的:了解产后妇女避孕节育知识及避孕应用情况,以便为提高产后妇女避孕率,降低意外妊娠提供依据。方法:选取桂林市的191名产后1年内妇女为研究对象,采用问卷调查法调查避孕节育知识及避孕应用情况。结果:①产后1年妇女避孕率为62.8%,使用工具避孕占88.9%,避孕方式夫妻共同选择的占66.5%。②避孕相关知识总体掌握平均(56.7±13.3)分,知识维度得分排名在最后2位的分别是生育能力恢复时间及对人流危害的认知。结论:应采取多种措施加强对产后避孕的宣教,提高产妇避孕相关知识及产后的避孕率,从而避免意外妊娠,保证母婴健康。     

The creeping pearl: why has the rate of contraceptive failure increased in clinical trials of combined hormonal contraceptive pills?

Background

Despite several drawbacks, the Pearl Index continues to be the most widely used statistical measure of contraceptive failure. However, Pearl indices reported in studies of newer hormonal contraceptives appear to be increasing.

Study Design

We searched PubMed and Medical Intelligence Solutions databases for prospective trials evaluating oral contraceptive (OC) efficacy to examine potential factors that could contribute to increasing Pearl indices.

Results

Numerous potential factors were identified, including an increased rate of failures of newer OCs, deficiencies in methods of calculating contraceptive failure rates, differences in study design and changes in patient populations resulting in increased rates of contraceptive failures due to the inappropriate or inconsistent use of the method.

Conclusions

The two most likely important contributors to the increase in Pearl indices are more frequent pregnancy testing with more sensitive tests and less adherent study populations. Because study populations appear to be increasingly representative of the likely actual users once the product is marketed, we can expect to see even higher failure rates in ongoing and future studies. This result poses challenges for companies and regulatory agencies.     

Estimates of contraceptive failure from the 2002 National Survey of Family Growth

BACKGROUND: In 2001, the US government's "Healthy People 2010" initiative set a goal of reducing contraceptive failure during the first year of use from 13% in 1995 to 7% by 2010. We provide updated estimates of contraceptive failure for the most commonly used reversible methods in the United States, as well as an assessment of changes in failure rates from 1995 to 2002. STUDY DESIGN: Estimates are obtained using the 2002 National Survey of Family Growth (NSFG), a nationally representative sample of US women containing information on their characteristics, pregnancies and contraceptive use. We also use the 2001 Abortion Patient Survey to correct for underreporting of abortion in the NSFG. We measure trends in contraceptive failure between 1995 and 2002, provide new estimates for several population subgroups, examine changes in subgroup differences since 1995 and identify socioeconomic characteristics associated with elevated risks of failure for three commonly used reversible contraceptive methods in the United States: the pill, male condom and withdrawal. RESULTS: In 2002, 12.4% of all episodes of contraceptive use ended with a failure within 12 months after initiation of use. Injectable and oral contraceptives remain the most effective reversible methods used by women in the United States, with probabilities of failure during the first 12 months of use of 7% and 9%, respectively. The probabilities of failure for withdrawal (18%) and the condom (17%) are similar. Reliance on fertility-awareness-based methods results in the highest probability of failure (25%). Population subgroups experience different probabilities of failure, but the characteristics of users that may predict elevated risks are not the same for all methods. CONCLUSION: There was no clear improvement in contraceptive effectiveness between 1995 and 2002. Failure rates remain high for users of the condom, withdrawal and fertility-awareness methods, but for all methods, the risk of failure is greatly affected by socioeconomic characteristics of the users.