上海市夫妇产后五年内首选避孕措施失败及停用的研究

Failure discontinuation status for the first contraceptive methods within five years after couples first delivery in Shanghai Municipality

对上海市卢湾、虹口两区 80年代末 71 0 1对初婚并已生育孩子的夫妇进行产后避孕状况的定群队列随访研究。结果显示 ,产后 5年内至少又妊娠过 1次的夫妇为40 .5 % ;妊娠过 2或 3次的夫妇分别为 5 .0 %及 0 .8% ;因带环或环移位而受孕的比例由 1次妊娠的 1 7.8%上升到 3次妊娠的 5 3 .1 %。首选避孕措施失败的主要原因 :安全期计算失误 (3 3 .4% )、环问题 (其中带环妊娠 1 7.8%、脱落 1 2 .6% )、未正确用套 (1 7.8% )及体外排精失控 (9.7% ) ,因漏用措施而妊娠者多在避孕套使用者 (65 .2 % )。寿命表法分析显示 ,夫妇产后 1 2个月时总避孕失败率 (2 6.4% )略低于新婚期 (44 .0 % ) ,但产后首选口服药或杀精剂的同期失败率却明显高于新婚期首选该两类的夫妇 ,避孕套及体外排精使用者失败率产后低于新婚期。提示产后妻子避孕实践的认真性不及丈夫。为进一步降低放环后脱落或带环妊娠 。

Objective: To investigate the failure and discontinuation status for the first contraceptive methods within 5 years after giving first birth and reasons related in Shanghai Municipallity. Design: This study was designed as a prospective cohort study. Couples married from 1987～1988 in Shanghai Luwan and Hong Kou districts were followed up. Those who have delivered their first babies were analyzed. Methods: The life table method and descriptive cross tabulation were used. Results: About 41% of couples have had at least once re conceiving and 5% and 0.8 % of them have had two or three times after first birth up to the time of follow up. The main reasons of first contraceptive failure were wrong calculation of the safety period (33.4%), IUD problems (17.8% pregnancy with IUD in situs and 12.6% IUD expulsion and misuse of condom 17.8%). The missing use was however more common in condom users (65.2%).The 12 months life table demonstrated that failure rates were lower for condom and withdrawal users compared with those methods used just after marriage. While failure rate were higher for pill or spermicides users, suggesting that wives were less active in practicing contraceptive methods after giving birth compared with husband. Conclusion: It is necessary to carry out more work with IUD and condom users after couples' first birth, and to educate couples, especially wives, practicing contraceptive methods more actively so as to reduce the contraceptive failure rates after birth.