新型宫内节育器规范化引入性试验的研究

The Introductory Trial of New Types of Intrauterine Devices.

目的:通过新型宫内节育器(IUD)的引入,提高基层计划生育服务质量,提高新技术的可接受性并鼓励更多的人更有效地使用避孕方法。方法:研究分三阶段进行,第一阶段采用定性和定量方法进行引入前需求评估;第二阶段为干预研究:宣传教育、技术培训和引入新型IUD;第三阶段采用定性方法进行干预后评估。研究现场的选择考虑了地区、社会经济和计划生育工作状况的代表性,分别在江苏省、山东省和重庆市各选择了3个县(市),然后在每个县(市)选择3个乡镇。引入的新型IUD为宫药铜300、TCu380A和γ药铜200。结果:被访的市(县)指导站能提供多种避孕方法和相关手术,如口服避孕药、皮下埋植剂、置取IUD、男/女绝育术、人工流产、男用避孕套和外用药以及一些妇科疾病和避孕药具副反应的处理。可提供的IUD种类较多,以TCu220C、药铜165和宫铜IUD为主。政策因素对避孕方法的选择有一定影响,普遍是‘一孩上环,二孩结扎’。不少妇女不知道自己使用IUD种类,相当多的妇女在放置IUD过程中未获得较规范的咨询服务。技术服务人员对性传播疾病的认识仍非常有限。多数技术人员都希望有进修和培训的机会。服务记录过于简单的问题较为突出,如放置IUD仅记录其形状如宫型、圆形或T型,这将可能影响随访和IUD的到期取出,直接影响服务的可持续性?

Objectives:To improve the quality of care of family planning in grass - roots service sites,to enhance the acceptability of new technologies and to encourage more people using contraceptives with more effectiveness. The study was carried in three stages. An assessment of the need for contraceptive introductory was carried in the first stage, and qualitative and quantitative methodologies were used in the assessment. The second stage was an intervention research. During this stage,the Information,Education and Communication (IEC) was diseminated,the technical service training was conducted, as well as three new types of IUDs were introduced. An assessment of intervention research was conducted in the third stage with qualitative methodology. The research fields were selected in consideration of the representatives of social economy, regions and family planning status. Nine counties were selected respectively in Jiangsu province, Shandong province and Chongqing municipality (each three) , then three townships were selected in each county. The new types of IUDs introduced were uterine shaped IUD containing copper 300 mm2 and indometha-cin 20mg(medicated (?) -IUD) ,TCu380A and γ shaped IUD containing copper 200 mm2 and indomethacin 25mg(medicated γ - IUD). The multiple contraceptive methods and related services, for example, oral contraceptives, implants, insertion and removal of IUDs, male and female sterilizations, abortion, condoms and spermicides, as well as the treatments of some gynaecological diseases and side - effects of contraceptives etc, were available in the county service stations visited. The multiple IUDs were also available, but TCu220c, medicated ring - 165 and uterine shaped IUD containing copper 200mm2 were mainly supplied. The contraceptive method choice was affected by family planning policy in some extent, usually women having one child used IUDs and those having two children used sterilizations. Many women do not know which type of IUD is using by herself, and many women did not receive the counselling service during the IUD insertion . The providers had limited awareness of sexual transmitted infection (STI). The majority of providers strongly hope to have the opportunity of further trainings. The service records were too simple to maintain service continuation,for example,IUD insertion records only noted the shape of IUDs,T, ring or uterine shape,the records could not find that IUD should be removed when IUD life - span will be over. Majority of program managers and service providers simply considered contraceptive introduction as a technical issue,they thought the operation procedures were well followed in accordence with requirements when new contraceptive methods would be introduced. A total of 7,772 married women chose three types of new IUDs from July 1998 to July 1999 .among them, 3,386 in medicated V-IUD, 2,301 in TCu380A and 2,085 in medicatedγ-IUD;as well as 2,455 from Jiangsu porvince, 2,359 from Shandong province and 2,959 from Chongqing municipality. The cummulative continuation rates at the end of 12 months were 97. 68 per 100 women in medicated (?) - IUD,96.03 in TCu380A and 97. 09 in medicated γ - IUD respectively. The cummulative continuation rates of medicated (?) - IUD and medicated -γ - IUD groups were significantly higher than that of TCu380A (P < 0. 05, P<0. 01). The pregnant rates of medicated (?) - IUD and medicated γ- IUD groups were significantly lower than that of TCu380A(P <0. 05) ;the removal rate due to medicated reasons in TCu380A was significantly higher than that in medicated (?) - IUD and medicated γ - IUD groups. The lostfollow - up rate at the end of 12 month is 8.02%. The introduction of three types of new IUDs made program managers and service providers have new perceptions to the quality of care of family planning services and improve the service capability in service station studied. Majority of the clients mentioned that the providers were friendly to them and expressed the satisfaction with service received. The IEC materials made providers and clients