深圳市不同机构流产服务的现状及其评价

Situation and Evaluation of Abortion Service at Different Health Institutions in Shenzhen City

目的:了解和评价深圳市不同服务系统和不同等级医疗机构流产服务状况。方法:选择该市计划生育和卫生6家不同等级流产服务机构,采用现场观察和深入访谈等定性研究方法,了解相关设施设备、服务规范、服务记录状况以及流产服务提供过程,进行总结和评价。结果:各家机构设施设备良好,但部分机构手术室和观察室不能满足流产妇女隐私保护和舒适性需要。流产妇女基本能够知情后选择流产方法,但术前血常规和阴道分泌物检查存在一定的医患分歧。多数机构药物流产的有效性偏低(<91.7%),服务记录的内容和完整性尚有一定欠缺,医患交流不足,避孕服务缺乏积极主动。卫生机构流产妇女量经常超出其基础设施承受能力,技术人员相对不足,而计划生育机构流产妇女较少,服务资源利用不充分。结论:要加强机构管理者和技术人员流产优质服务的意识,特别要加强被服务者隐私保护和流产后计划生育服务。有必要积极探讨药物流产有效性偏低的原因,合理分流服务对象,提高计划生育机构流产服务资源利用率。

Objective ： To understand and evaluate the quality of abortion care at different health institutions in Shenzhen City. Methods： Qualitative study methodologies, i. e. , observation and in - depth interview were used. Six health institutions at three levels of public health sectors as well as family planning sectors were investigated. Results： The infrastructure of all the institutions was in good quality. However, the spaces of operation rooms and recovery rooms were insufficient at half institu- tions. All women could make an informed decision of abortion methods. The required pre - abortion examinations were provided to the majority of women who intended to have an abortion though the laboratory testing for reproductive tract infections and measurement of haemoglobin and haematocrit levels were not routinely performed at some hospitals due to refusal of clients. The service records didn＇t contain some important information at most institutions, such as post - abortion complications, women＇s death and contraceptive information. The efficacy of medical abortion was reported to be lower than accepted level （ 〈91.7% ）. It was observed that the provider - client interaction was insufficient. Post- abortion family planning service was largely neglected by service providers, although this service in family planning sector was better than that in public health sector. However, much more women were likely to seek abortion service at general hospitals than family planning centers. Some providers at general hospitals, complained that their job was overloaded. Conclusion ： It is important that institution managers and service providers should take a comprehensive view of abortion care. Particular attention should be paid on the provision of privacy and confidence and family planning for clients. It is highly needed to understand why the efficacy of medical abortion is lower than accepted level and to improve the utility of family planning institutions for abortion service.