青少年长效可逆避孕方法认知和应用及其影响因素分析

Awareness and usage of long-acting reversible contraception in adolescents

目的 研究青少年长效可逆避孕方法(long acting reversible contraception, LARC)的认知和应用情况及其影响因素,探索如何提高青少年LARC的使用率。方法 回顾性分析2019年1—12月在宁波市妇女儿童医院计划生育门诊行人工流产的1 565例<25岁青少年的临床资料,包括LARC调查问卷、流产后关爱(post-abortion care, PAC)咨询指导后落实的避孕方法以及术后1、3、6、12个月随访情况。以放置LARC组为研究组,放置短效可逆避孕方法为对照组,两组从婚姻、年龄、生育史、流产史、文化程度、经济状况、籍贯、居住地、高危因素共9个方面比较LARC的放置率,并采用logistic多因素回归分析相关影响因素。结果 青少年流产呈现低龄化、未婚未育比例高、重复流产率及高危流产率高、流动人口多、经济状况差及受教育程度低的特点。调查问卷显示,大部分青少年根本不了解LARC或者对其存在认知误区,PAC服务后LARC放置率由流产前的0.26%增加到9.65%。多因素分析显示,婚姻、年龄、生育史、流产史、流产高危因素是青少年选择LARC的影响因素。结论 开展PAC服务后LARC落实率虽然有了明显提高,但未婚未育、年龄<20岁、流产次数少、无流产高危因素的青少年LARC使用率仍较低,需加强对青少年以及医务工作者的培训,利用互联网技术提高宣教效果。

Objective To understand the awareness and usage of long acting reversible contraception(LARC)in adolescents,and to discuss its influencing factors,in order to increase the usage rate of LARC in adolescents.Methods A retrospective analysis was performed on the clinical data of 1 565 adolescents under the age of 25 who underwent abortions in the Family Planning Clinic of Ningbo Women and Children’s Hospital from January 2019 to December 2019.The data included LARC questionnaire information,contraception methods taken after post-abortion care(PAC) consultation and follow-up information at 1,3,6 and 12months after the induced abortion.Subjects were divided into observation group(LARC group) and control group(SARC group,those who received short acting reversible contraception).The utilization rate of LARC was compared between the two groups and the influencing factors related to the use of LARC were analyzed using multivariate logistic regression model.Results The induced abortion rate tended to go higher among younger adolescents,especially those unmarried,childless,with low income and poor-educated.Repeated abortion rate and high-risk abortion rate were not uncommon among adolescents.The questionnaire survey showed the great majority of adolescents either were naive about LARC or had some misunderstandings about it.After PAC consultation,the LARC utilization rate increased from 0.26 % to 9.65%.Multivariate analysis showed that marriage,age,history of childbirth and abortion,high risks of abortion were major influencing factors for adolescent LARC usage.Conclusions The overall LARC utilization rate among adolescents is still low even though it increases a lot after PAC consultation.Adolescents of younger age,unmarried or childless,with fewer abortion or free of high risk factors of abortion are less likely to use LARC.Therefore,it is necessary to strengthen the LARC training in adolescents and medical providers.Internet based health education should be fully improved.