武汉市妇女重复人工流产影响因素的病例对照研究

Influencing factors of repeated induced abortion among the women in Wuhan: a case- control study

目的 探索武汉市育龄妇女重复人工流产的危险因素,为流产后卫生服务和生殖健康教育提供依据。方法采用病例对照研究的方法,自编问卷对武汉市某妇幼保健院2013年7~10月就诊女性进行调查,获取病例组86例（人工流产≥2次）,对照组117例（人工流产〈2次）。通过构建Logistic回归模型,对重复流产的可能影响因素进行分析。结果 妇女父母失婚（离异、丧偶或再婚）（P=0.018,OR=9.24）、妇女有过生育史（P〈0.001,OR=6.45）、妇女和配偶从未谈起避孕话题（P=0.015,OR=10.09）、紧急情况下未准备避孕药具时不采取任何措施（P=0.016,OR=7.11）、配偶很少或不听从妇女采取避孕措施要求（P=0.002,OR=4.37）等因素增加了发生重复人工流产的风险;妇女首次性生活年龄越大（P〈0.001,OR=0.72）、配偶从未喝酒（P=0.003,OR=0.08）是重复人工流产的保护因素。结论 武汉市妇女重复人工流产的发生受其父母失婚、生育史、过早开始性生活、高危行为及避孕协商不和等因素的影响。应加两性间的关系教育,包括增强双方的交流和协商以提高避孕行为自我效能、避孕的选择和执行等。

Objective To explore the risk factors of repeated induced abortion among the women of childbearing age in Wuhan, provide a basis for health service and reproductive health education after abortion. Methods A case-control study was conducted, a self- designed questionnaire was used to survey the women going to a Maternal and Child Health Care Hospital in Wuhan from July to October in 2013, 86 women in case group （induced abortion for two times or more than two times） and 117 women in control group （induced abortion less than two times） were enrolled in this study. Logistic regression model was established, the probable influencing factors of repeated in- duced abortion were analyzed. Results The risk factors of repeated induced abortion included unmarriageable statement （ dissociation, wid- owhood, and remarriage） of their parents （P = 0. 018, OR = 9. 24）, birth history （P〈0. 001, OR = 6.45 ）, never talking about contraception with their spouses （P = 0. 015, OR = 10. 09）, not taking any measures in emergency circumstances without contraceptives （P = 0. 016, OR = 7.11 ）, rarely or never adopting contraception of their spouses （ P = 0.002, OR = 4.37 ） ; the protective factors of repeated induced abortion included older age of the first sexual activity （P〈0. 001, OR = 0. 72） and no drinker of their spouses （P= 0. 003, OR = 0. 08 ） . Conclusion The occurrence of repeated induced abortion among the women in Wuhan is affected by unmarriageable statement of their par- ents, birth history, early initiation of the first sexual activity, high risk behavior, and contradictory contraception attitudes. Intersexual rela- tionship education should be enhanced, including strengthening the communication and negotiation to improve the self-efficacy of contraceptive behaviors, selection and implementation of contraception.