流产服务提供者对药物流产认知的定性研究

Study on providers′ perceptive about medical abortion: A qualitative research

目的:调查流产服务提供者对药物流产的认知及其影响因素。方法:2009年5月对河南省、深圳市32名流产服务提供者进行个人深入访谈。结果:多数服务提供者认为药物流产缺点为不完全流产率高、出血时间长、需要多次复诊、并发症和副作用多、与流产妇女沟通过程挑战大;优点为易接受和身体损伤小。在药物流产和手术流产都适用的情况下,仅少部分服务提供者偏向推荐和采用药物流产,大部分因为考虑到手术流产的"安全、快捷"而偏向手术流产,其中不乏政策因素影响。虽然多数服务提供者反映选择何种流产方式与其个人利益无关,但医院在此环节出于盈利的考虑不能完全排除;价格等经济因素对流产妇女选择何种流产方式未见影响。结论:服务提供者基于安全性、有效性、工作负担、政策影响等方面考虑,仍认为手术流产比药物流产更适用于国内环境。建议应在服务提供者中开展针对药物流产的全面培训,利用分工合作和转诊机制解决医疗资源对药物流产的限制。

Objective： To explore abortion service providers＇ perception about medical abortion and its influencing factors. Methods： We conducted in - depth interviews among 32 abortion service providers in Shenzhen City and Henan province in May 2009. Results ： Most providers regarded high incidence of incomplete abortion, long duration of bleeding, multiple counseling, severe complications and side - effects, and challenge in communication with clients were major demerits of medical abortion, while higher acceptability and less impairment were its merits. Given that both medical abortion and surgical abortion were suitable, only minority of providers would like to recommend or choose the medical abortion. Considering about ＂safe- ty＂, ＂efficiency＂, and sometimes the effect of ＂implementation of policy＂, most respondents would select a surgical method. Majority of providers indicated that there was no relationship between the abortion method and providers personal benefits. However, the money -oriented behavior during abortion method recommendation and selection in medical facilities couldn＇t be excluded completely. Abortion clients were not influenced by the payment in choosing a medical or a surgical abortion. Con- clusion ： Concerning about safety, efficacy, workload, and policy implementation, providers tend to opine that a surgical abor- tion is more suitable than a medical abortion in China. So we suggest that comprehensive and integrated training on medical abortion should be developed among providers. Specialization and cooperation as well as referral should be promoted to remove the restriction of existing medical resources on the availability of medical abortion services .