上海市中心城区产后妇女避孕需求及产后避孕服务利用调查

Demands and utilization of contraceptive services in women during the first 12 months after delivery:a cross sectional survey in urban areas of Shanghai

目的调查上海市中心城区产后妇女避孕节育现况及避孕相关生殖健康服务利用情况。方法2019年8月至12月期间,采用横断面调查的方法对在上海市4个区(长宁区、静安区、普陀区、杨浦区)产后42 d健康检查门诊就诊和前往儿童保健门诊的妇女进行问卷调查。数据分析采用频率和logistic回归分析等方法。结果调查的1170名产后妇女中有420名已恢复性生活,恢复时间为分娩后(3.6±1.5)个月。按照产后时间不同进行分组,已恢复性生活的调查对象在产后1~3个月、4~6个月、7~9个月和10~12个月坚持采用避孕措施的比例分别为69.4%(43/62)、77.2%(186/241)、79.2%(57/72)和71.1%(32/45)。是否计划妊娠、再生育意愿以及产后避孕指导是影响避孕行为的主要因素。产后不同时期的妇女采用的避孕方法均以避孕套为主,长效可逆避孕方法使用率低。在产后访视和产后42 d检查时分别有43.3%(395/913)和34.6%(369/1067)的调查对象获得了具体的避孕方法指导。37.6%(420/1117)的调查对象认为产后42 d检查是避孕最佳健康宣教时机,而30.5%(341/1117)的妇女认为孕期健康教育时就应该给予指导。结论约四分之一的上海市中心城区妇女在产后未坚持采用避孕措施;宫内节育器、皮下埋植剂等长效、可逆的避孕方法使用率低。应加强产后避孕指导,强化专业队伍培训,重视避孕药具的正确选择和使用,引导妇女正确认识长效避孕方法。同时,避孕指导服务可提前至孕期开展,做到关口前移。

Objective To investigate the use of contraceptives among postpartum women in the urban areas of Shanghai and to understand women's demands and utilization of contraceptive service.Methods A cross-sectional survey was conducted using questionnaires in postpartum women in the clinics for 42-day postpartum follow-up and child health care in 4 districts in Shanghai(including Changning District,Jingan District,Putuo District and Yangpu District)from August 2019 to December 2019.Data were analyzed using frequency description and logistic regression.Results In total,1170 postpartum women were enrolled.Among them,420 women resumed sexual intercourse at an average length of(3.6±1.5)months postpartum and the proportions of consistent contraceptive use were 69.4%(43/62),77.2%(186/241),79.2%(57/72)and 71.1%(32/45),at periods of 1 to 3 months,4 to 6 months,7 to 9 months and 10 to 12 months after delivery respectively.Planned pregnancy,willingness to reproduce,and postpartum contraceptive guidance were associated with contraceptive behavior.Condom was the main approach used by postpartum women,while long-acting reversible contraceptive method was seldom used.The proportion of receiving guidance on contraception during postpartum home visits and 42-day postpartum follow-up were 43.3%(395/913)and 34.6%(369/1067)respectively.Totally,37.6%(420/1117)of the total considered that the best time for contraceptive health education was at the 42-day postpartum follow-up,while 30.5%(341/1117)of them preferred health education during pregnancy.Conclusion About one-quarter of postpartum women do not adhere to contraception in the urban areas of Shanghai.The proportion of using long-acting reversible contraceptive methods,such as intrauterine devices and subcutaneous,remains low.It is necessary to strengthen postpartum contraceptive services,to provide professional training,and strengthen guidance on the proper selection and use of contraceptive methods,especially for long-acting contraceptive methods.Meanwhile,the guidance for contraception should be advanced during pregnancy.