上海市避孕节育与流产后保健管理现状评估

Evaluation of current situation of contraception and post- abortion care management in Shanghai

目的:探讨上海市提供避孕节育服务各级医疗机构的避孕节育和流产后保健(PAC)服务的管理现状。方法:选取2013年上海市具有开展节育手术和终止妊娠技术服务资质的医疗机构158所,采用定性研究与定量研究相结合的方法对机构内部分避孕节育服务提供者进行个人问卷调查,对部分机构的管理者和服务提供者进行个人深入访谈。结果:81.0%的调查机构自报能够开展PAC服务相关的健康教育、咨询,提供避孕药具和进行流产后随访,62.2%的机构会告知服务对象流产后再次妊娠的风险;全市各级医院计划生育相关技术人员配置紧张,且70.0%以上的提供者对并发症的管理、术后避孕方法的选择以及咨询技巧方面有较大的培训需求;69.0%的机构自报有独立安静的咨询室,84.5%的机构缺乏视听设备,74.3%的机构缺乏健康知识光碟,流产后服务指南和相应的登记本的配置率也较低;当前的PAC服务主要由项目资助方提供资金并进行考核,上级部门和医院缺乏相应的资金支持和考核评估。结论:全面推广PAC服务需要制定统一的技术规范和考核机制,安排定期的PAC服务培训,考虑服务提供者的工作负荷,合理配置人力和物质资源。

Objective： To explore the current situation of contraception and post- abortion care（ PAC） service management in medical institutions at all levels which provide contraception services in Shanghai. Methods： A total of 158 medical institutions which have the qualification of conducting contraceptive operations and terminating pregnancy in Shanghai in 2013 were selected,quantitative research method combined with qualitative research method were used to conduct individual questionnaire survey among contraception service providers in these institutions,in- depth interviews were conducted among managers and providers in partial medical institutions. Results： Among the investigated institutions,81. 0% of them reported that they had carried out PAC service in certain degrees,including health education,counseling,contraceptives provision and postpartum follow- up. Only 62. 2% of them informed patients of the risk of subsequent pregnancy. The personnel allocation of family planning providers in medical institutions at all levels in Shanghai was limited,and above 70. 0% of the provides needed more knowledge and training in complication management,selection of contraceptive method and consulting skills. About69. 0% of these medical institutions reported there were independent and quiet counselling rooms,but 84. 5% of them lacked audiovisual equipment,74. 3% of them lacked optical discs about health knowledge,as well as the hospital- based post- abortion service guidelines and counseling records. The current funding and assessment of PAC service were conducted by relevant program sponsors outside the hospitals instead of hospital management and local health departments. Conclusion： To promote PAC service in Shanghai,unified technical guidelines and evaluation system should be formulated and established; PAC service training should be carried out periodically. Taking providers＇ workload into account,human and material resource allocation should be optimized as well.