产后服务对象避孕节育现状与需求相关调查研究

Investigation of the status and demand of contraception for postpartum service objects

目的：了解服务对象产后避孕知识、产后访视、避孕节育状况与服务需求，为完善社区产妇健康管理及产后避孕服务模式提供科学的理论依据。方法：2013年10月1日～11月10日，对在天津医科大学总医院以及天津永久医院住院分娩的575名产后服务对象进行问卷调查，分别于产后42±7d、90±7d、180±7d进行电话随访。结果：①服务对象产后避孕相关知识总正确率为26．8％，其中有关宫内节育器（IUD）、单纯孕激素避孕法（POC）、复方口服避孕药（COC）、哺乳闭经避孕法（LAM）的正确率，分别是31．1％、18．6％、23．7％、44．9%。②服务对象产后3～7天访视率为94．0％，产后42d检查率为89．0％，其差异有统计学意义（P〈0．05）。两次访视中进行产后避孕宣教与指导的分别有50．7％和78．3％。③服务对象喜欢的避孕宣教形式为发放宣传手册资料（64．6％）、向医生护士咨询（17．4％）、热线电话（13．4％）。认为产后避孕宣教的最佳时间为产后42d健康检查（51．3％）、产后3～7d访视时（29．9％）。④服务对象母乳喂养率为86．5％，纯母乳喂养坚持到产后6个月的有40．0％。⑤服务对象性生活的恢复和开始使用避孕措施的平均时间为产后81．7±35．od、产后98．4±39．1d，其中产后未避孕及未即时避孕的有27．3％。⑥服务对象选择的避孕方法前4位是男用避用套、体外排精、IUD、安全期，分别占83．2％、1．8％、1．8％、1．6％。至产后6个月依赖LAM避孕有20．8％。结论：服务对象产后访视率较好，访视内容不完善。服务对象避孕措施的平均落实时间滞后于性生活的恢复时间。服务对象产后避孕知识匮乏，在产后访视中有关避孕的宣教和指导不足。服务提供者可以通过发放宣传手册资料、鼓励服务对象向医生护士咨询、相关科室建立产后避孕热线电话等途径开展产后避孕的宣教和指导。将产后避孕的宣教和指导的时间着重放在产后42d健康检查、产后3～7d访视时。

Objective： To known situation of contraceptive knowledge, demand of contraceptive service, and status of postpartum visit for postpartum women. And to provide scientific evidence for improving community maternal health management and service model of postpartum contraception. Method： From October 1 to November 10, 2013, 575 postpartum service objects from General Hospital of Tianjin Medical University and Permanent hospital of Tianjin had been enrolled in this study. All of the objects were followed up at postpartum 42 ± 7 day, 90 ± 7day, 180± 7 day by telephone. Result： 1. The total correct rate of the knowledge of postpartum contraception objects was 26.8 %.Correct rate of the knowledge related to IUD, POC, COC, and LAM was 31.1%, 18.6%, 23.7%, 44.9%, respectively. 2. The rate of home visit （94%） after delivery was significant higher than that （89.0M） of health check up at 42 days （P〈 0.05）. During the two kinds of postpartum visits, 50.7% and 78.3% women were given propaganda and guidance of contraception. 3. The favorite form of postpartum contraception propaganda included issuing brochures and materials （64.6%）, counseling doctors and nurses（17.4%）, counseling by hotline（13.4%）.The best time of postpartum contra eeption propaganda was at health check up 42 days after delivery（51.3%） ,and then postpartum 3-and 7 days home visit （29.9% ）.4.The rate of breastfeeding was 86.5 %, 40.0 % of service objects insisted full breastfeeding to 6 months post partum.5.The average time of restored sex life and started using contraceptive measures was 81.69±35.00 days and 98.44±39.13days. 27.3% women who restored sex life hadn＇t used any contraception or hadn＇t used contraceptive immediately. 6. The top four contraceptives of postpartum service objects used was condom （83.2%）, withdraw （1.8%）, IUD（1.8%）, safe period（1.6%）, respectively. 20.8% women relied on LAM contraception to 6 months postpartum. Conclusion： The rate of postpartum visit is better, but the content of visit isn＇t perfect. The average time of starting to use contraceptive measures lags behind the time of restored sex life. The knowledge of postpartum con traception among postpartum service objects is poor seriously, and the propaganda and guidance for postpartum contraception is insufficient during postpartum visit. Service providers can carry out propaganda and guidance for postpartum contraception by issuance of brochures and materials, encouraging service objects to counsel doctors, nurses, and hot line telephone of postpartum contraception. The time at 3-7 days of home visit and 42 days of the health check up after delivery should be paid more attention to propaganda and guidance of contraception.