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社区儿童保健整合产后避孕服务的需求及可行性分析

Needs and feasibility of integrating community children's health care and postpartum contraceptive service

  • 摘要:
    目的 分析利用儿童系统保健时机开展产后避孕服务的可行性, 为妇女和儿童保健服务的整合提供依据和建议。
    方法 通过对1 946名产后妇女进行问卷调查, 分析妇女产后避孕现状和在儿童保健服务时获取产后避孕服务的需求;选取区级和社区基层妇幼保健管理者、妇幼领域专科医生、社区医生共计26名, 开展个人访谈和焦点小组访谈, 从卫生系统角度分析在儿童保健服务时提供产后避孕服务的内部优势和劣势、外部机遇和挑战。
    结果 调查时有1 438名(73.90%)产后妇女已恢复性生活, 妇女产后首次性行为避孕率为89.50%(1 287/1 438), 产后2年内非意愿妊娠发生率为3.89%(56/1 438);产后12个月及以上的妇女在每次性生活中规范使用避孕措施的占比低于80.00%;有91.73%(1 785/1 946)的妇女希望在利用儿童保健服务的同时获得产后避孕的相关信息。大部分受访者认为妇女儿童保健服务的整合是推进全生命周期妇幼保健服务的必然趋势, 坚实的社区基层卫生建设和全科医生队伍是上海整合妇幼保健服务具备的基本要素;但服务对象利用社区卫生服务的可能性、儿童保健卫生人力紧缺以及妇幼保健服务信息不互通是整合服务的实践阻力。当前, 相关生育保障政策的出台及信息化互通平台的建设都有利于整合服务的实施;但妇幼保健人员的激励机制长期得不到改善会给整合服务的实施带来挑战。
    结论 在我国现有卫生资源条件下, 利用儿童系统保健服务时机提供产后避孕服务是可以尝试的, 但具体的整合服务模式还需进一步探索。

     

    Abstract:
    Objective To evaluate the feasibility of providing postpartum contraceptive service at the timing of children's health care visit, so as to provide evidence and recommendation for integrating maternal and child health(MCH) service.
    Methods A total of 1 946 postpartum women were recruited for questionnaire survey to analyse their contraception used and needs of receiving postpartum contraceptive services along with children's health care. Meanwhile, in-depth interview and focus group interview were used to collect information regarding strengths and weaknesses of the internal environment, and opportunities and challenge of external conditions for integrating postpartum contraceptive service and children's health care from 26 MCH care providers, managers, and professionals.
    Results A total of 1 438 (73.90%) participants resumed their sexual activity. 89.50%(1 287/1 438) used contraception at the first intercourse postpartum. 3.89%(56/1 438) got unintended pregnancy within 2 years postpartum. The proportion of correct use of contraception 12 months after delivery and beyond was below 80.00%. 91.73%(1 785/1 946) expressed their wishes to receive contraceptive information along with children's health care. Most interviewee thought that the integrated MCH service was inevitable for promoting life-course based MCH services. The capacity of community health service and the teamwork of general practitioners were essential elements of integrated MCH services in Shanghai. However, the probability of community health service utilization, shortage of children's health care workforce and unconnected information system between MCH health care might be the barriers for service integration. Maternity security policy implementation and information communication platform establishment would be the opportunities for service integration, but lack of incentive mechanism for MCH care service providers might be challenge for the implementation of service integration.
    Conclusion Promoting integration of postpartum contraceptive service and child health care is feasible under the current health resource condition, but practical service model needs to be further explored.

     

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