1520例寻求人工流产妇女的避孕实践

为了探讨寻求人工流产(简称人流)妇女最近和以往避孕使用和避孕失败情况,从1996年3月至1996年5月,对河南省郑州市8家大医院1520例来院寻求人流服务的妇女进行了问卷调查。结果表明,本次意外妊娠最常见的原因是避孕失败(1093例,占71.9％),其中有511例的避孕失败是可以及时确认的,426例由于未避孕而造成意外怀孕。在避孕失败中,避孕套失败占比例最高,为29.7％。大多数人流者(77.1％)以往曾经使用过某种避孕方法。但是仅有19.5％的人在初次同房时使用了避孕方法。以往曾用过避孕套的占57.6％,其中有套失败的占50.9％;曾用过避孕片的占16.8％,其中有过片失败的占58.9％。在避孕套和避孕片失败者中,大多数属于使用失败。曾经有过人流史的高达56.4％。结论:大多数人流者适合使用紧急避孕(EC)方法。使用避孕套和安全期避孕法的人群是EC宣教的重点对象。有必要普及避孕套和避孕片具体使用方法的知识。本项目为美国帕斯适宜卫生科技组织(PATH)资助项目,是PATH小规模资助规划的一部分。     

Trends and determinants of contraceptive use in Rakai District, Uganda, 1995-98

A prospective study conducted between 1995 and 1998 assessed trends in contraceptive use in rural Rakai District, Uganda. Over a period of 30 months, women's use of modern contraceptives increased significantly from 11 percent to 20 percent. Male condom use increased from 10 percent to 17 percent. The prevalence of pregnancy among sexually active women 15-49 declined significantly from 15 percent to 13 percent. Women practicing family planning for pregnancy prevention were predominantly in the 20-39-year age group, married, better educated, and had higher parity than others, whereas women or men adopting condoms were predominantly young, unmarried, and better educated. Condom use was particularly high among individuals reporting multiple sexual partners or extramarital relationships. Contraceptive use was higher among women who desired fewer children, among those who wished to space or terminate childbearing, and among women with previous experience of unwanted births or abortions. Self-perception of HIV risk increased condom use, but HIV testing and counseling had only modest effects. Contraception for pregnancy prevention and for HIV/STD prophylaxis are complementary.     

The challenge of the 1990s

The most pressing challenges in reproductive health and family planning in the 1990s are enumerated: doubling of contraceptive users, improving consistent use of pills and IUDs, providing condoms for AIDS prevention, allocating funds, expanding social marketing, sterilizing those in need, quality assurance and finally, dealing with demand for abortion if contraceptive needs are not met. New contraceptive users will be found in the Soviet Union and Eastern Europe who currently have no access, as well as a 33% increase in numbers of young couples. Much can be done with packaging and counseling to improve on the 5-20% failure rates of pill users in developing countries. Similarly, improvement in IUD technology in China and elsewhere will save on costs of failures and removals. Funds provided by donors for contraceptive supplies alone will almost double, despite social marketing, because of the higher numbers of users. A much higher proportion of the program costs will be direct expenditures on supplies. New rapid and less invasive methods of sterilization will be needed to meet the needs of vast numbers of couples desiring to limit births, especially in the Soviet bloc nations. If these challenges are met, millions of mothers and infant lives will be saved, yet the world population will stabilize at closer to 10 rather than 15 billion by the end of the next century.     

Eurothemes. Love, lust and suffering in Eastern Europe

In the Soviet Union, Poland, Romania, and Bulgaria contraceptives are often in short supply or unavailable. In Russia alone, 700 women/year suffer the consequences of illegal abortion. In 1988 there were 4.5 million births and 7.5 million abortions performed in state-subsidized hospitals. There are long waiting lists for free abortions, a 3-day stay is customary, and the employer is notified about the cause of hospitalization. Minor-age girls must sign a letter to their parents about how possible harmful effects of abortion in young age. In state hospitals, hygiene is below standard, there is a great need for analgesics, and humane treatment of patients is lacking. Only 1.5 million out of 7.5 million abortions were done by vacuum aspiration, the rest required a more invasive procedure. Condoms are rarely available, and they are expensive. East Germany and Czechoslovakia, the traditional condom exporters in Eastern Europe, have stopped deliveries. Hungary produces condoms under license, and imports them from Japan and the US. Only 11% of the demand in the Soviet Union is met by domestic production according to official data. In 1989, the Armavir condom plant produced only 24 million pieces instead of the 200 million planned. Recently, $7.5 million were arranged for the London Rubber Co. (maker of Durex condoms) to equip[ 2 condom factories in the Soviet Union. Together with a 3rd Japanese plant, an expected 400 million condoms will be manufactured soon. In 1989, the production of Russian-made contraceptive pills was discontinued because of inferior quality. Only 20% of the demand for pills is met mostly from Poland and Hungary. Tampons are not yet available, but they have a reputation among some young people as a wonder agent against pregnancy. Other alternative methods Russian women use are douching with water and lemon after intercourse, or immediately thereafter sitting in a hot bath.     

Relations between taking contraceptive pills, condom use and sexually transmitted disease history among female sex workers

PURPOSE: The aim of this study was to analyze how taking contraceptive pills and condom use are related to each other, and their links to sexually transmitted disease (STD) history among female sex workers. METHOD: A cross-sectional study was performed by means of a standardized questionnaire self-administered by sex workers who attended a STD Clinic in Osaka between 1st April, 1998 and 31st March, 1999. They came to the clinic for routine screening for STDs and HIV (Human Immunodeficiency Virus) infection, and for treatment. The responses of a total of 92 sex workers, who are basically expected to use condoms and identified themselves as "sex workers at bath houses", "sex workers in former red light districts", "sex massage providers on call" and "call girls" on the questionnaires, were analyzed. RESULT: The proportion of sex workers who were diagnosed with chlamydial infection either currently or over the previous year was higher among sex workers who answered they take contraceptive pills "regularly" (pill users) than in those who answered "irregularly" or "not" (non-pill users). This finding was statistically significant for those whose education was less than 12 years, whose professional career as a sex worker was 1 year or more, and whose average daily income was 50,000 yen (US$450) or more. Except for the group whose income was less than 50,000 yen, the proportion of sex workers in all groups who were diagnosed with chlamydial infection was greater, although the difference was not statistically significant, among pill users than among non-users. The proportion of sex workers who use condoms "regularly and correctly" was significantly higher for non-pill users than for those using the pills. Multiple logistic regression analysis showed that pill use was significantly related to condom "not or irregular or incorrect" use (Odds ratio: 4.43, CI 1.12-17.60). The proportion of sex workers with a chlamydial infection history was significantly lower with those using condoms "regularly and correctly" than in those who do not use condoms or employ them "irregularly or incorrectly" (Odds ratio: 0.08, CI 0.01-0.68). CONCLUSION: This study showed the proportion of sex workers diagnosed with chlamydial infection to be higher among pill users than among non-users and the proportion of sex workers who use condoms "regularly and correctly" was higher among non-pill users than among users. These findings suggest that irregular, incorrect or non use of condoms among pill users may cause chlamydial infection.     

Hormonal contraception and HIV acquisition risk: implications for individual users and public policies

BackgroundA recent observational study among HIV-1 serodiscordant couples (uninfected women living with an infected partner) raised concerns about the safety of injectable contraceptives, especially depot medroxyprogesterone acetate (DMPA). The purpose of this paper is to assess the implications of potentially elevated risk of Human Immunodeficiency Virus (HIV) acquisition with the use of hormonal contraceptives for individual users and public policies.Study DesignTwo indicators expressing costs (additional unwanted births and additional maternal deaths) in terms of the same unit of benefit (per 100 HIV infections averted) are estimated by using data on competing risks of unwanted birth and HIV acquisition associated with the use of various contraceptive methods. Elevated HIV acquisition risks associated with hormonal contraception observed in the observational studies of family planning users, sex workers and HIV-1 serodiscordant couples are used. Other relevant data for Kenya, South Africa and Zimbabwe are used to illustrate the potential effect of withdrawal of DMPA at the population level.ResultsBoth the risks of unwanted birth and HIV acquisition with sterilization, intrauterine devices (IUDs) and implants at the individual level are lower than those with DMPA. A shift from DMPA to an oral contraceptive (OC) or male condom by an individual could result in about 600 and a shift to no method in about 5400 additional unwanted births per 100 HIV infections averted. At the population level, the withdrawal of DMPA from Kenya, for example, could result in 7600 annual additional unwanted births and 40 annual additional maternal deaths per 100 HIV infections averted.ConclusionIndividual DMPA users may be advised to shift to sterilization, IUD or implant depending upon their reproductive needs and circumstances, but not to no method, OC or even condom alone. At the macro level, the decision to withdraw DMPA from family planning programs in sub-Saharan Africa is not warranted.     

Use of 'dual protection' and other combinations of contraceptive methods in Australia

OBJECTIVE: To examine the demographic profiles of contraceptive users in Australia, paying particular attention to the use of condoms with other methods. METHOD: Data from a specific section on contraceptive use in the 2005 Wave 5 of the nationwide, longitudinal Household Income and Labour Dynamics in Australia (HILDA) were analysed. The section was restricted to 2,221 women aged 18-44; women were excluded if they were pregnant or subfecund, or if they or their partner had been sterilised. RESULTS: Two-thirds of respondents were using contraception, including more than 15% who indicated use of more than one method. The contraceptive pill (39%) was the most widely used method, followed by the condom (28%). Women using sex-related methods were more likely to be using more than one method. More than one-quarter of pill users (28%) were using condoms as well. The combination of pill and condom was significantly associated with age, being a student, and country of birth. Less than 3% of women reported using rhythm methods and of these two-thirds were using another method. CONCLUSIONS: Dual protection provided by the combination of the condom with the pill or other methods has become an important factor in the prevention of sexually transmitted infections and unwanted pregnancies, but continuing education on dual protection and better access to treatment is still necessary for both men and women, particularly among at-risk groups.     

Utilization of contraception and abortion and its relationship to HIV infection among female sex workers in Tashkent, Uzbekistan

OBJECTIVE: This study aimed to describe reported contraceptive and abortion utilization and their relationship to human immunodeficiency virus (HIV) infection among female sex workers (FSW) in Tashkent, Uzbekistan. METHODS: For this cross-sectional study, women were recruited through outreach workers affiliated with Istiqbolli Avlod. Participants completed a self-administered questionnaire and underwent HIV testing. RESULTS: Of 448 participants, the majority (86.2%, n=386) used contraception; 39.6% reported inconsistent use. Methods most frequently utilized were condoms (50.9%) and intrauterine devices (16.1%). One fourth (24.3%, n=109) reported multiple (>or=3) prior abortions. Inconsistent contraceptive users were more likely to be infected with HIV (AOR=2.72, 95% CI=1.19-6.22), but such infection was not related to a specific contraceptive method, including condoms, or utilization of abortion. CONCLUSIONS: Inconsistent contraceptive use is common and may be a predictor of HIV infection among Tashkent FSW. Factors preventing consistent contraceptive use may be related to HIV risk and require further study in this population.     

Prospects for increased contraceptive pill use in Japan.

Although oral contraceptives are not commercially available in Japan, a low-dose contraceptive pill is expected to become available soon. The current rate of pill use is less than 1 percent, but recent survey data indicate that about 10 percent of currently married women of reproductive age intend to use the pill when it comes on the market. Those who favor the pill do so because it is highly effective in preventing unwanted pregnancies, and because it reduces the need for abortions. Many other women report uncertainty about the pill because of concern about side effects. Given that Japan has a contraceptive failure rate of about 25 percent, with 29 percent of women having had at least one abortion, many women who do not yet favor the pill may shift to it once the low-dose pill comes on the market and they are reassured about its safety. Thus, the rate of pill use is likely to rise well above 10 percent.     

Conflicting advice? Australian adolescents' use of condoms or the pill.

CONTEXT: Teenagers are exposed to two potentially conflicting sexual health messages, one emphasizing the prevention of sexually transmitted diseases (STDs) and the other stressing pregnancy prevention. To protect teenagers from both STDs and unwanted pregnancy, it is important to know what method choices they make and why. METHODS: Data from a 1997 national survey of 3,550 Australian secondary school students were used to examine teenagers' method choice and patterns of advice-seeking about contraception and STD prevention. Logistic regression analyses were conducted to identify factors associated with the exclusive use of condoms or the pill. RESULTS: Virtually all 961 currently sexually active students were using at least one contraceptive method--primarily condoms (78%) or the pill (45%). Some 31% were using condoms exclusively, and 10% were using the pill exclusively. Older students and those who had sought contraceptive advice had elevated odds of using the pill rather than condoms exclusively (odds ratios, 4.4 and 2.6, respectively), while those who had had only casual partners in the last year had a reduced likelihood of exclusive pill rather than condom use (0.1). Furthermore, the more students believed that their peers used condoms, the less likely they were to report exclusive pill use (0.4). Parents were the most frequent source of advice about contraception, followed by physicians and teachers. The most common sources of advice about HIV and other STDs were parents, teachers and then physicians. CONCLUSIONS: Young people must be educated about the distinction between safer sex and contraception, and about how to prevent both STDs and pregnancy. Providing parents with current sexual health information may help to improve young people's sexual health.     

女青年人工流产情况及避孕知识调查

目的:了解郑州市女青年人工流产和避孕知识知晓情况,探讨人工流产影响因素。方法:采用自填式调查问卷,对郑州市年龄≤25岁1100名人工流产女青年进行横断面调查。结果:调查对象年龄为(22.50±1.68)岁,平均月收入为800元,职业以公司职员为主(29.4%),大部分未婚,流动人口占75.1%,初中以下文化程度和常住人口相比有统计学意义;34.9%的女青年经历过流产,首次流产未婚者占72.6%,且随着年龄增加,重复流产率逐渐增高;本次妊娠原因67.9%的女青年未采用避孕措施,32.1%为避孕失败,避孕失败的主要原因是避孕套(44.5%)、安全期(25.2%)和体外排精(15.9%);过去3个月中,最常用的避孕方法是避孕套(82.3%),其次为紧急避孕(28.5%)、安全期(27.7%)、体外排精(22.7%);谈及避孕知识,深入到避孕措施具体使用方法回答正确率较低。结论:非意愿妊娠的主要原因是未采用避孕措施,而使用避孕措施的女青年中,坚持使用和正确使用有效避孕措施率低,且流产女青年掌握的避孕知识有限,应加强未婚人群和流动人口的避孕知识宣教和咨询,内容侧重坚持、正确使用高效避孕措施的宣传,提供优质的计划生育服务,从而避免非意愿妊娠和人工流产。     

人工流产女青年性行为和避孕现状研究

目的:了解北京市人工流产女青年的性行为和避孕现状,探讨人工流产、特别是重复流产的影响因素。方法:采用自填式问卷的方法,对北京市1 008名自愿要求人工流产、在1980年8月1日之后出生的女青年进行现状调查。结果:研究对象首次性行为的平均年龄为(20.70±1.95)岁,54%的人在20岁之前就开始了性生活;首次人工流产的平均年龄为(21.96±1.81)岁,首次流产在20岁之前的占17.0%;将近25%的人曾与2名及以上的男性发生过性关系;人流女青年本次怀孕的原因,60.2%是因为没有避孕,39.7%由于避孕失败;没有避孕的主要原因是"在没有准备好避孕药具的情况下同房"(41.5%)和"知道避孕方法但不想用"(39.7%);避孕失败的主要原因是全安期和体外射精(39.0%)、避孕套(32.7%)和紧急避孕(18.5%);过去3个月中,最常用的避孕方法为避孕套(75.5%)、全安期和体外射精(11.0%)、紧急避孕(8.2%);在避孕套使用者中,只有9.3%能坚持每次同房都用;77.2%的人认为口服避孕药对身体不好;32.4%的研究对象有重复流产。单因素分析发现,文化程度低、未婚同居、首次性生活和首次流产的年龄小、多性伴和不能坚持、正确使用避孕措施是重复流产的影响因素。结论:女青年首次性行为开始早、多性伴比例高、避孕药具使用率低或使用低效的避孕方法是非意愿妊娠和人工流产的主要原因,且重复流产现象比较严重;同时,流动人口在人流女青年中占了相当大的比例。因此,应当对未婚人群和流动人口女青年进行人工流产的危害以及避孕知识的宣传教育,提高现代科学的避孕药具使用率,避免不必要的意外妊娠和人工流产。     

Does the use of a condom involve a risk for contacting sexually transmitted infections,HIV/AIDS?

The aim of this study is to elucidate and review the risk of sexually transmitted infections (STIs) among condom users. Men and women of reproductive age are the subjects of this study. Data were extracted from the literature through the MEDLINE service for the period 2000–2006. Female condoms (0.1%) were reported to be less liable to break than male condoms (3.1%), while slippage occurs more often with female condoms (5.6%) than with male condoms (1.1%). The nonlatex condoms have a higher frequency of breakage or slippage during intercourse or withdrawal (4%) than latex ones (1.3%). Adolescents having multiple sexual partners and/or having sex with someone they met on that same day are about 80% more likely to report condom failure. Condom breakage or slippage is associated with never having received instructions on correct condom use, more than one sexual partner and more frequent condom use. Ineffective condom use is common among young adults. A younger age, primary partner, lack of partner support, multiple recent sexual partners and use of condoms for contraception are positively associated with delayed condom use. However, condoms do offer 30–90% protection against STIs and HIV passed in the semen and 0–30% protection against diseases due to skin-to-skin contact. This inversely implies that there is always a risk of contacting Chlamydia, gonorrhoea and HIV, or genital herpes and warts even when using a condom during sexual intercourse. Only correct – rather than consistent – condom use reduces the risk of STIs and HIV during intercourse. Therefore, condom users need to be cautioned that some risks are involved with the use of this method.     

Acceptance and use of the female condom among women with incomplete abortion in rural Tanzania

BACKGROUND: This study describes the outcome of a postabortion care intervention aimed at introducing the female condom as a means of preventing women from having unwanted pregnancies and sexually transmitted infections (STIs)/HIV. METHODS: Postabortion contraceptive counseling and services were offered to 548 women admitted to the Kagera Regional Hospital for incomplete abortion. The counseling included information about STI/HIV and the use male or female condom. In total, 521 (95%) women accepted contraception. RESULTS: Contraceptive use was assessed 3 months after abortion among 475 (91%) women. The female condom was accepted by 201 of 521 (39%) and was used by 158 of 521 (30%). Women who had experienced an unsafe abortion, had attended secondary school or earned an income were more likely to accept the female condom. The women were generally satisfied with the method, and the majority intended to use it again. CONCLUSION: Postabortion care programs provide an excellent entry point for introducing the female condom as a contraceptive method for the prevention of both repeat unwanted pregnancies and STI/HIV infection.     

Cutting unsafe abortions

The use of drugs to terminate pregnancy could cut the number of unsafe abortions, according to the Wellcome Trust and the Population Council. A specialist conference in January this year concluded that the technique is safe and effective and would be particularly valuable in resource-poor countries. In an article in the journal Science staff of the two organizations outline the research that will be necessary before medical abortion can be made widely available in the developing world. It is estimated that half of all surgical abortions are conducted in unsafe conditions. Drug-induced (medical) abortion has been available in developed countries for over 10 years, usually involving the use of the drug mifepristone. A cheaper drug, misoprostol, is already in use in some developing countries. Meanwhile, WHO has published a booklet on "emergency contraception." The term refers to contraceptive methods that can be used by women in the first few days following unprotected intercourse to prevent an unwanted pregnancy. This would not be considered as abortion by most authorities. The emergency methods available are: increased doses of combined oral contraceptive pills, high doses of progestogen-only pills, or inserting of copper releasing IUDs.     

Prévention des grossesses non prévues chez les jeunes en France : pour une double protection des premiers rapports sexuels ?

BackgroundDespite the expanded range of contraceptive options and the fact that the first acts of intercourse are well protected, abortion rates among young women in France have increased in the last 15 years. These contraceptive failures could result from the lower effectiveness of the condom compared with the pill, and/or the occurrence of contraceptive gaps when switching from the condom to the pill. Adding to the existing literature, this paper explores the conditions by which women and men discontinue using the condom.MethodsThe study sample was comprised of 1552 men and 1849 women under the age of 30, who participated in the National Survey on Sexual Health in France. Respondents answered questions on contraceptive use, duration of condom use, condom discontinuation and the switch to another method of contraception at the time of condom discontinuation in the context of their first and last sexual relationships.ResultsCondoms, used by a large majority of respondents during the first acts of intercourse, were rapidly discontinued in favor of other methods, particular the pill, for continuing relationships. However, one in ten respondents (women and men alike) had unprotected intercourse after condom discontinuation, when condom use was discontinued in the first trimester of their relationship. Abortions were more frequent among respondents who reported they did not use a condom at the start of a relationship or among women who did not switch to another form of contraception after discontinuing condom use.ConclusionWhile condoms are widely used during the first acts of intercourse, the rising abortion rates among young people suggests frequent contraceptive failures, which partly result from unprotected intercourse following condom discontinuation. These results question the dichotomy between HIV campaigns based on condom use and campaigns to reduce unintended pregnancies, which promote use of other forms of contraception, such as the pill. To reduce the incidence of unprotected intercourse, it would be important to promote the use of condoms at sexual debut, both as a contraceptive and preventive method against STIs, and provide counseling about all available contraceptive options, including the use of emergency contraception as a backup option in case of errors of use of the condom.     

Bridging emergency contraceptive pill users to regular contraception: results from a randomized trial in Jamaica

Background

Emergency contraception research has shifted from examining the public health effects of increasing access to emergency contraceptive pills (ECPs) to bridging ECP users to a regular contraceptive method as a way of decreasing unintended pregnancies.

Study design

In a randomized controlled trial in Jamaica, we tested a discount coupon for oral contraceptive pills (OCPs) among pharmacy-based ECP purchasers as an incentive to adopt (i.e., use for at least 2 months) this and other regular contraceptive methods. Women in the intervention and control arms were followed up at 3 and 6 months after ECP purchase to determine whether they adopted the OCP or any other contraceptive method. Condom use was recorded but was not considered a regular contraceptive due to its inconsistent use.

Results

There was no significant difference in the proportion of women who adopted the OCP, injectable or intrauterine device in the control group or the intervention group (p=.39), and only 14.6% of the sample (mostly OCP adopters) used one of these three methods. Condom use was high (44.0%), demonstrating that ECP users were largely a condom-using group.

Conclusions

The discount coupon intervention was not successful. Although a small proportion of ECP users did bridge, the coupon did not affect the decision to adopt a regular contraceptive method. The study highlighted the need for bridging strategies to consider women's reproductive and sexual behaviors, as well as their context. However, in countries like Jamaica where HIV/AIDS is of concern and condom use is appropriately high, bridging may not be an optimal strategy.     

山东省已婚育龄妇女避孕套使用情况调查

目的调查农村已婚育龄妇女避孕套使用状况及分析避孕失败原因，以提高避孕套使用效率，减少非意愿妊娠。方法采用横断面调查方法，分层整群随机抽样问卷调查山东省8个市县农村20543名已婚育龄妇女在2002年1月-2005年6月期间的生育避孕情况；采用病例对照研究方法，分析使用避孕套避孕的失败率和危险因素。结果近3年的避孕模式中，单纯使用避孕套的比例为45．1％，与节育器合用的比例为38．1％。避孕套避孕失败率为11．2％。避孕套避孕失败主要原因是未能坚持使用、套破裂和套滑脱。低年龄组使用避孕套失败的危险性增加，月经规律及没有月经期症状可降低避孕套使用的失败率，怀孕次数少和无流产史与使用避孕套避孕失败呈负关联。结论山东省农村避孕套使用率不断增加。但在使用过程中存在较多问题。应加强宣传教育。提高避孕套的正确使用率。     

未婚女青年流产及接受流产后服务的现况调查

目的:了解未婚女青年流产原因以及避孕知识、行为和在医院接受的流产后服务现况。方法:采用分层整群随机抽样的方法,选取在郑州市8家医院自愿要求流产、年龄≤25岁的女青年进行横断面现场问卷调查,获得合格调查问卷992名,本文仅分析其中的705名未婚妇女数据。结果:调查对象年龄在16.4～25岁之间,62.1%未婚同居,33.3%有流产史。本次流产原因未避孕66.7%,避孕失败33.3%。58.2%曾使用过避孕措施,既往使用的避孕方法构成为:避孕套47.2%、紧急避孕药18.3%、安全期16.0%、体外射精13.8%、口服避孕药4.6%、宫内节育器0.1%。避孕和生殖健康知识得分无1人满分,13个问题中能正确回答7个问题的占44.7%。术后接受宣教内容最多的是流产后注意事项(95.6%),最少的是避孕药具的优缺点(26%)。没有接受过医生提供的咨询服务有83.0%;医生没有提供免费的避孕药具和转诊服务。93.9%的愿意接受流产后宣教服务。结论:未婚女青年流产原因多为未避孕,她们缺乏避孕知识,避孕措施使用率低,现医院提供的流产后服务不能满足育龄妇女的需求。     

Dual protection against unwanted pregnancy and HIV / STDs

"Dual protection" refers to the use of methods which will prevent both unwanted pregnancy and HIV/STD infections during sexual intercourse. Such protection may be achieved through either the use of a barrier method such as a male or female condom together with another contraceptive method, or through the use of the male or female condom alone. In descending order of effectiveness, the following methods can protect against unwanted pregnancy: abstinence; sterilization; Norplant; injection; oral contraceptive pill; IUD; male condom with spermicide; male condom; female condom, diaphragm, or cervical cap; vaginal spermicide alone; and natural family planning. In descending order of effectiveness, the following methods can protect against the transmission of HIV and STDs: abstinence, nonpenetrative sex, long-term mutual monogamy with HIV testing, male condom with spermicide, male condom, female condom, diaphragm and cervical cap, and vaginal spermicide alone. When attempting to provide clients with the family planning and HIV/STD prevention method(s) which best suits their needs, clients' degrees of reproductive health, HIV/STD risk, and motivation must first be assessed. Counseling upon and selection of particular methods may then ensue, followed by skills building of method use and other prevention strategies, follow-up counseling, and HIV/STD testing and treatment either on-site or through referral.