上海市两社区初婚已分娩夫妇人工流产后开始选用避孕措施状态及影响因素的分析

对上海市两社区 71 0 1对于 1 987～ 1 988年初婚并于婚后 5～ 6年时已有孩子的夫妇进行 8年的前瞻性队列调查。结果显示 ,其中 9.3 % (6 6 3对 )的夫妇是于人工流产(人流 )术后开始选用避孕措施 (在本次调查的 2 52 7例产后至少有一次人流者中占2 6 .2 % )。在 6 3 3例产后完全暴露于妊娠危险状况的夫妇中 ,1 / 3的妻子因感避孕麻烦而原就准备于人流术后放环避孕。 51 .3 %的夫妇认为产后夫妇性生活少、哺乳期或未转经、月经量少不会受孕等而未于产后及时避孕。近 80 %未及时避孕的妻子于恢复性生活后 1年内受孕。56 .4 %未及时避孕的妻子均于人流术后放置环 ,其中 1 / 2的妻子认为于该时放环最有效。在产后非人流术后开始避孕的妻子中仅 8.1 %首选放环 ,从有效性出发首选放环的仅占 1 / 3。拟合双反应 L ogistic回归模型显示夫妇人口统计学 (妻子婚龄、宗教信仰、夫妇月收入 ) ,生育意愿 (婚后推迟生育时期 ) ,心理学因素 (产后妻子健康状况 ) ,妻子对人流的态度 ,夫妇的避孕知识 (特别丈夫在二访时 ) ,性生活状况等多种因素均显著影响到夫妇产后是否及时避孕。结果显示 :(1 )要加强对夫妇 ,特别是妻子 ,产后一旦恢复性生活及时避孕的教育 ;(2 )对有关人流后放环和人流术本身对妇女健康潜在危险性等开

Analysis of starting adoption of contraceptive method only after induced abortion among women after first birth and its determinants in Shanghai municipality

Objectives:To describe the status and reasons of adoption of contraceptive method only after induced abortion in some couples after their first birth and explore its social and behavioral determinants Method:A prospective cohort study of couples up to 5～6 year after their marriage registration in two defined districts in Shanghai Results:About 9.3% (663/7 101)of the couples did not adopt any contraceptive method until after the induced abortion following their first birth, i.e. among those who had at least one induced abortion after their first delivery, about 26.2% of re conceiving women (663/2 527) wsa totally exposed to the risk of pregnancy. The main reason was that about 1/3 of them (223/663) originally intended to have postabortion IUD insertion. Actually, 56.4% of them had IUD inserted. Logistic regression model revealed that women who thought induced abortion would not damage their health, or couple's, especially husband's, contraceptive knowledge score low at the revisit. Younger women, or women whose health status were not very well during puerperium, or those who resumed their sexual life within 2 months after delivery, would be the risky couples who had not adopted any contraceptive method, until after the induced abortion. Conclusion:This cohort study indicates that there is an urgent need for Family Planning Personnel to advise couples to use contraceptive method, as soon as they have resumed their sexual life after birth. Family Planning Personnel should also keep a scientific point of view with the immediate post abortion insertion of IUDs in order to further lowering the rate of induced abortion.