上海市外来孕产妇保健管理现况与政策研究

Study on the situation and policies of health care for floating pregnant women in Shanghai

目的针对外来孕产妇死亡已构成影响上海市孕产妇死亡率下降的“瓶颈”问题,分析外来孕产妇保健管理的问题及原因,提出加强外来人口孕产妇保健管理的适宜模式与方案,为完善出台外来孕产妇保健管理的相关政策和措施提供科学的决策依据。方法应用专家咨询与焦点组访谈方法、卫生政策分析与评价方法等相关知识,采用定量和定性相结合的方法来进行研究。结果(1)上海市目前仍是采用自20世纪70年代后期建立的以户籍所在地为基础的孕产期系统保健管理模式,并针对外来孕产妇保健管理出台了相关政策;(2)上海市近10年来平均孕产妇死亡率为26.92/10万,其中本市户籍者为11.58/10万,外来孕产妇为57.98/10万,本市户籍孕产妇死亡率从1996年的22.47/10万下降到2005年的1.64/10万,外来孕产妇死亡率从1996年的54.68/10万下降到2005年的48.46/10万;(3)外来孕产妇的建册率、产前检查率、产前诊断率和产后访视率均低于本市户籍孕产妇;(4)10个外来孕产妇平产分娩点在2004年8月1日至2005年7月31日1年期间共接产外来产妇12529例,比前年同期增加248.41%。1年期间未发生外来孕产妇死亡,围生儿死亡率为4.65‰(低于前一年的5.94‰)。结论需要建立一种新的机制去落实外来孕产妇保健管理,包括政府对“面的控制”——政策保障、资金支持、舆论覆盖;医疗保健机构对“点的建设”——观念的转变、适宜技术的推广、服务项目的精简以及质量的提高;卫生行政部门对“链的操作”——网络的建设、健康教育项目的深入普及、管理流程的简约便捷、保健关口的前移、服务平台的合理科学搭建及其人、财、物的必要支持、执法力度的加大,严肃查处非法接生、老法接生和个体医生进行产前检查的行为等。

Objective In order to explore the main problems and related influencing factors on maternal health care and management of floating population, so as to provide the reference for the modification of related policies on maternal health care for floating population. Methods Qualitative and quantitative methods, for instance, expert consultation, focus group discussion, health statistics method, health economic analysis and health policy study, were applied to collect the data in this study. Results （1） The model of maternal health care management was based on the registered permanent residence which has been used since 1978 in Shanghai. There were 2 regulations related to the maternal health care of floating population in Shanghai. （2） The average maternal matality rate （MMR） was 26.92/105 in recent 10 years （11.58/105 for Shanghai residents, 57.98/105 for floating population）. MMR decreased from 22.47/10s in 1996 to 1.64/105 in 2005 for Shanghai residents, and from 54.68/105 to 48.46/105 for floating population. （3） The rates of registration, antenatal health check-up, prenatal diagnosis, and postpartum home visit in floating pregnant women were significantly lower than those in Shanghai residents. （4） Total number of births from floating women was 12 529 in 10 maternity hospitals which increased 248.41 % over the same period of the prior year. No maternal death was found. Perinatal mortality rate was 4.65 ‰ which lower than that of the same period of the prior year. Conclusion A new model based on the living residence should be established so as to meet the need of maternal health care of floating population. It is necessary to set up a new system to improve the management for floating pregnant women, including support and control from government, convenient service with improved quality and affordable cost for maternity hospital and running related programs for health administration.