山东省农村已婚育龄妇女人工流产决定因素与对策的研究

Study on determinants and preventive strategy of induced abortion among married women of child bearing age in rural Shandong province

本研究试图从人群角度探讨农村妇女人工流产的决定因素和制定相应对策。研究设计采用现况调查方法，通过两阶段等比例抽样方法从山东省高密、平邑、茬平三县的２９９个自然村共抽取４４５０７名已婚育龄妇女作为随机样本，总抽样比为１０％。调查率达９９％。调查结果显示，三县的总和人工流产率依次分别为１．３８、１．２６和１．２７。表明调查地区农村呈高人工流产水平。多重分类分析（ＭＣＡ）显示，调查地区农村妇女因宫内节育器失败和未采用避孕措施者发生非意愿妊娠而导致人工流产的概率最高。Ｌｏｇｉｓｔｉｃ回归分析结果表明，以采用节育措施者为参照变量，未采用节育措施者的ＯＲ值为１２８．７４。在采用节育措施者中，以绝育者为参照变量，宫内节育器使用者的ＯＲ值为３５．９６；避孕药具使用者为６６．９５。在人口学因素方面，以２０岁以下年龄组农村已婚育龄妇女为参照变量，２０～２９岁年龄组的ＯＲ值为６．６９；３０～３９岁年龄组为４．８５。以３孩及以上妇女为参照变量，一孩和二孩妇女的ＯＲ值分别为１．４３和１．７５。研究结果表明，山东省农村现有一孩和二孩的２０～３９岁年龄组的已婚育龄妇女是发生人工流产的高危人群。因此，建议该省在预防对策方面，应以该年龄组已?

Objectives: To explore the determinants of induced abortion for rural married women and the stra tegy for prevention of abortion. Design: A cross sectional survey Setting: In three counties of Shandong province Subjects: Rural married women aged 15～49 years old. Methods: The study adopted two stage and equal probability sampling methods and recruited 44 507 rural married women of reproductive age, which was a random sample from 299 natural village in Gaomi, Pingyi, and Chiping counties in Shandong province. The total sampling fraction was 10%. The interview rate was 99%. The statistical methods used were Logistic regression and multiple classification analysis(MCA). Resulte: The total induced abortion rate were 1.38, 1.26, and 1.27 respectively in Gaomi, Pingyi, and Chiping counties MCA indicated that the rural married women had the highest incidence of induced abortion, which resulted from failure of IUDs and non use of contraception. The results of Logistic regression analysis showed that OR value of the contraceptive non users was 128.74 compared with reference category of contraceptive user the OR value of IUDs was 35.96, and the OR value of users of short lasting contraceptives was 66.95 compared with reference category of users of sterilization. In the demographic factors, the OR value of users aged 20～29 years was 6.69 and their of users aged 30～39 years was 4.85, compared with reference category of users aged below 20 years old. The OR values of users with one or two children were 1.43 and 1.75 respectively, compared with reference category of users with three or more children. The results of the sampling survey showed that the rural married women aged 20～39 years with one or two children are the group of women with high risk of induced abortion in Shandong province. Conclusion: For prevention of induced abortion, the married women aged 20～39 years should be considered as the key target group in rural Shandong province. Efforts should be made to introduce more efficient types of IUDs to replace the steel ring IUDs in order to reduce unwanted pregnancies in the whole province and to strengthen management and services of family planning before pregnancy.