上海市流动人口产后即时放置宫内节育器的需求及障碍分析

A Study on Need and Obstacle of Immediate Postplacental Insertion among Internal Migrant Women in Shanghai

目的:了解流动人口女性产后立即放置(IPPI)宫内节育器的需求,医务人员对IPPI的态度,探讨在平产分娩点提供IPPI服务的可能性及障碍。方法:对841例非上海户籍的孕产妇和343例医务人员进行问卷调查,并选取16例医务人员进行小组访谈。定量数据使用EpiData3.1建立数据库,SAS6.12进行统计分析。小组访谈资料采用定性研究方法分析。结果:37.0%的孕产妇愿意接受IPPI。多因素分析提示:随年龄增长,愿意接受IPPI的比例显著增加;剖宫产者较阴道分娩者更易接受IPPI。调查孕产妇不愿意接受IPPI的原因有:不了解、准备使用其他避孕方法及担心不良反应等。仅有7.3%的医务人员对IPPI持赞成态度,不赞成的理由包括:产后生殖系统尚未恢复;IUD易脱落、移位;哺乳期子宫质软,手术风险大等。结论:IPPI在外来孕产妇平产分娩点有一定的需求,可利用平产分娩点现有医疗条件,为流动人口妇女提供IPPI服务。但有必要对医务人员进行IPPI技术上和理论上的反复培训,转变医务人员的服务意识和服务态度。

Objectives：To learn about the need of immediate postplacental insertion（IPPI）among internal migrant women and health providers’attitude about IPPI and explore the possibility of providing IPPI at hospitals where provide delivery services at affordable prices for impoverished migrant women.Methods：Questionnaire surveys were carried out among 841 internal migrant women and 343 health providers,and 16 health providers were chosen to participate in group interviews.EpiData 3.1 was used for data management and SAS6.12 was performed for quantitative data analysis.Qualitative data was analyzed by qualitative methods.Results：Out of 841 internal migrant women,37.0 percent were willing to accept IPPI.Unconditional multivariate logistic regression showed that women with elder age and cesarean section were associated with increased possibility of IPPI.Main causes of declining IPPI included ignorance,willingness to use other contraceptive methods,and concerns about side effects.Only 7.3 percent of interviewed health providers agreed with IPPI.Reasons of health providers disagree with IPPI included that reproductive system has not yet resumed,IUD easy to fall off,and higher risk for surgery among lactation,etc.Conclusions：Over one third migrant women are willing to accept IPPI.Hospitals providing delivery service for impoverished migrant women are appropriate place for IPPI.Moreover,it is necessary to provide technological and theory training for health providers to change their service awareness and attitude.