中国9省农村育龄妇女IUD使用及失败现状的流行病学研究

目的:了解中国9省农村育龄妇女IUD使用现状。方法:采用多阶段分层整群抽样的方法,对9省农村18922例放置IUD妇女进行横断面及前瞻随访研究。结果:69.9%IUD使用者的年龄≤30岁,农民占61.5%,初中文化程度者占58.7%,有过阴道分娩史者占80.1%,初次放置IUD者占61.8%,在月经间期和哺乳期月经未恢复时放置IUD者各占53.8%和31.3%;放置国家避孕药具采购目录中IUD者占72.1%;76.5%的IUD使用者在乡级计生服务机构放置。近50%的IUD放置人员有大专及本科学历和初级职称。IUD使用12个月总累计失败率(包括妊娠、脱落、下移取器和因症取器)为每百妇女年10.71。不同种类IUD的失败率有较大差别。在哺乳期月经未恢复时及乡级计划生育机构放置IUD的失败率较低。结论:为降低IUD使用失败率,需要对IUD类型进行客观评价,加强对不同时期放置IUD妇女的指导,培训置器人员规范操作。

Epidemiologic Study on IUD Use and Failure in Nine Provinces of China

Objective:To understand the status of IUD use and failure in nine provinces of China. Methods: Multi-phase stratified cluster sampling method was adopted, and an epidemiological study with a cross-sectional, retrospective and prospective design was conducted to investigate 18,922 IUD users in nine provinces of China. Results: 61.5% of subjects were farmers whose ages were ≤30, and 58.7% of them were with junior secondary school education, 80.1% of them had the experience of virginal delivery, and 61.8% of them shared the first IUD use which starts in certain physiological periods. 72.1% of IUDs used by subjects were primarily procured in terms of the national recommendation list. 76.5% of IUD insertions were operated by family planning facilities at township level. Nearly half of IUD service providers with some experience in IUD operation were at junior college and university degree and primary title. The cumulative IUD failure rate over 12 months came to 10.71 per 100 women. The main failure outcomes included extrusion, removal due to downward dislocation and medical reasons. Different IUDs contributed to varying failure rate. The IUD failure rate was at a lower level for those who received IUD insertion during lactation or at township level family planning facilities. Conclusion: To ensure the effectiveness of IUD use, it is necessary to conduct objective assessment of IUDs, strengthen guidance of IUD insertion in different physiological periods, and regulate IUD service provision.