我国产后二年内非意愿妊娠发生现状及其影响因素

Incidence of unintended pregnancy within 2 years after delivery and its influencing factors in China

目的分析我国育龄期妇女产后2年内非意愿妊娠发生现状及其影响因素。方法在我国东、中、西部地区15个省市自治区的60家医院,采用结构式问卷调查2015年7月至2016年6月分娩的产妇,了解其产后2年内非意愿妊娠发生情况,探讨人口学特征、孕产史、母乳喂养、产后避孕启动及避孕方法等因素对产后非意愿妊娠发生风险的影响,采用描述性分析、寿命表法和Cox回归模型等方法进行统计学分析。结果共调查18045例产妇,产后1年和2年累积非意愿妊娠率分别为5.3%(95%CI为4.5%~6.1%)和13.1%(95%CI为11.3%~14.8%)。Cox回归模型分析显示,低龄、少数民族、既往有流产史、阴道分娩、哺乳时间短以及产后避孕启动时间晚者,产后2年内非意愿妊娠的发生风险增加(P均<0.01),未发现产后非意愿妊娠发生风险与地区、分娩机构有关(P均>0.05)。结论我国产后2年内非意愿妊娠发生风险较高。服务机构应促进产妇(尤其是产后非意愿妊娠高风险人群)在产后首次性生活时乃至之前使用高效避孕方法。

Objective To investigate the present situation of unintended pregnancy within two years postpartum and its influencing factors in China.Methods Participants who delivered a live birth at 60 hospitals in 15 provinces in the eastern,central and western regions of China during July 2015 to June 2016 were interviewed by using structured questionnaire.Information on occurrence of unintended pregnancy within 2 years after delivery,postpartum contraceptive use,sexual resumption,breastfeeding,and women′s socio-demographic characteristics,and so on,were collected.Life-table analysis,cluster log-rank tests and a 2-level Cox regression model were used for data analysis.Results A total of 18045 postpartum women were investigated.The cumulative 1-and 2-year unintended pregnancy rates after delivery were 5.3%(95%CI:4.5%-6.1%)and 13.1%(95%CI:11.3%-14.8%),respectively.Cox regression model analysis showed that the risk of unintended pregnancy within 2 years postpartum were increased in younger women,ethnic minorities,women with abortion history,and those who had a vaginal delivery with short lactation time and late postpartum contraceptive initiation(all P<0.01).The risk of postpartum unintended pregnancy was not associated with geographic regions and hospitals where women gave a birth(all P>0.05).Conclusions In China,the risk of unintended pregnancy within 2 years after delivery is relatively high.Service institutions and service providers should improve the quality of postpartum family planning services,promote the use of high effect contraceptive methods,and educate women to use a method at the time of their sexual resumption or even before.