摘要
目的 了解广州市流动人口已婚育龄妇女生殖保健的状况并对其影响因素进行研究,为提高流动人口生殖健康水平提出合理化的建议和措施。
方法 对2003处9月～2004年10月在广州市计划生育指导所定期查孕、查环的流动人口已婚育龄妇女,采用分层随机抽样的方法抽取1054人作为研究对象。调查内容主要包括:流动人口已婚妇女的一般人口学特征、生殖保健的相关知识和行为、生殖道感染自我报道症状、孕产期保健状况以及对卫生保健的需求等。采用SPSS10.0软件对资料进行分析。
结果
1.人口学特征 本次调查流动人口已婚育龄妇女平均年龄为29.01±4.45岁,文化程度以初中为主,她们在广州职业以工厂打工为主,经济收入普遍较低,来源地主要为湖南、河南和四川等省份。
2.生殖保健相关知识 在被调查的流动人口已婚育龄妇女中有66.6%的人曾经接受过各种生殖保健相关知识的教育。将避孕措施的种类、性传播疾病、艾滋病传播途径方面的知识综合在一起作为生殖保健的相关知识并给予赋分,总分为25分,平均得分为16.12±4.27分。多因素Logistic回归分析影响生殖保健相关知识的因素包括:是否接受过生殖保健相关知识教育、妇女及其丈夫的文化程度、职业和家庭月总收入。
3.生殖保健相关行为 在被调查的流动已婚育龄妇女中,总避孕现用率和流产率分别为91.8%、40.9%。其中有34.9%的人在人流术后出现各种妇科疾病等并发症,并且流动妇女中许多人存在许多不良的卫生行为习惯,如采用盆浴、经期性生活等。
4.生殖道感染自我报道症状 在被调查的流动人口妇女中,52.8%的人在最近一年中有过一种或一种以上生殖道自我报道的症状,其中外阴搔痒、白带异常、生殖器溃疡、非月经期腰背酸痛、尿频尿痛症状的发生率分别为15.8%、38.0%、2.8%、31.9%、6.8%。影响生殖道感染自我报道症状发生的因素包括流产、妇科病/性病、洗澡方式、便后擦纸方向和月经期性生活。
5.初次怀孕的围产期保健 流动人口已婚育龄妇女初次怀孕的活产率为
Objective To understand the status of reproductive care(RC) among floating married women(FMW) at reproductive age and study some influential factors of RC in Guangzhou, and to provide some reasonable suggestions and measures for enhancing the level of reproductive health among FMW .Methods Stratified random sampling was employed to select FMW who were checked pregnancy. IUD in Guangzhou family planning and guidance unit from September in 2003 to October in 2004. The main content of questionnaire include demographical information, knowledge and behavior of RC, self-reported symptoms of RTIs, prenatal care and demands of RC. All data were analyzed by SPSS 10.0. Results1.Demographical information: The mean age of the FMW was 29.01 ±4.45 years old. and their education were mostly junior high school. Most of them worked in the factory and earned a little. They came from Hunan, Henan, Sichuan province in China. 2. RC related knowledge: Findings showed 66.6% of the FMW had received RC knowledge. Take the knowledge of contraception, STDs, transmission routes of AIDS as RC knowledge, the mean score was 16.12 ± 4.27 among the total score which was 25. Logistic regression showed the influential factors of the total score were whether they had received RC education, their education, their husband education, occupation, income.3.RC related behavior: The rate of contraception was 91.8% of the FMW, most of them selected IUD, condom, female sterilization. The abortion rate was 40.9%, 34.9% of them had gynecologic syndrome. Most of them had ill behavior, such as tubbing, sexual intercourse during menses etc.4.Self-reported symptom of RTIs: 52.8% of FMW reported they had one or more self-reported symptom of RTIs in the last year, the rate of pudendum itch, leucorrhoea
abnormity, ulcer in pudendum, ache in waist or back, urine too much or ache duringemiction were 15.8%, 38.0%, 2.8%, 31.9%, 6.8% respectively. Logistic regressionshowed the influential factors of the self-reported symptom of RTIs were abortion,gynecologic diseases/STDs, tubbing, clean backwards after stool, sexual intercourseduring menses.S.Prenatal care: The rate of birth living-child was 81.0% in the first pregnancyamong the FMW, 56.8% of them had received antenatal check. Most of themdelivered at home (52.4%) and in hospital (41.8%).6. Health care sevices: Among the all FMW. the rate of regular gynecologic checkwas 24.1% in the last year. 44.1% of them were checked gynecologic disease and therate of medical insurance, receiving RC knowledge in Guangzhou, satisfied withgovernment were 10.3%, 65.2%, 77.2% respectively.Conclusionsl.The study showed FMW"s knowledge of RC was not very high and they hadincomplete and incorrect knowledge about RC.2.In order to debase the rate ofRTis. detection earlier, diagnoses earlier, cure earlierby checking regularly is indispensable, thus the FMW's self-care and demands of RCcould be promoted.3.Based on community, in order to improve female's reproductive health, it isnecessary to innovate the managing mode of FMW , to found and perfect the newmode which is the same education, supervising and service as local, to supply somefavourable policy for FMW and enhance men's concern about female's reproductivehealth.
引文
[1] 朱向东.国家统计局人口和社会科技统计司.中国人口统计年鉴 2001:286
[2] 徐缓.中国流动人口的艾滋病预防和控制.中国艾滋病性病防治,2001,7(6):376-377
[3] 广州流动人口超500万,手续全和享受免费计生服务.http://news.sohu.com/20041006/n222352945.shtml
[4] 叶旭军,施卫星,李鲁.城市外来农民工的健康状况与政策建议.中华医院管理杂志,2004,20(9):562-566
[5] 苏长梅,石淑华,叶鸣,刘筱娴,彭大元,张静,时俊新,王绍海,胡美荣.武汉市流动人口中已婚妇女生殖保健需求及服务对策研究.中国计划生育学杂志,2001,4:226-228
[6] 何爱娥.加强流动人口生殖健康服务的管理.人口与计划生育,2003(3):27-28
[7] 沈汝棡,刘凯波,肖珣,何芳,聂妍,丁辉,潘迎,刘刚.流动人口孕产妇保健及分娩调查.中国公共卫生,2004,20(1):46-47
[8] 《人口与计划生育法》释义
[9] 奉贤区人口与计划生育委员会.http://202.101.8.25/fxjsw/born.asp
[10] 高尔生,杨娟.论生殖健康.生殖和避孕,1996,16(6):403-407
[11] 武俊青,陶建国,高尔生.上海流动人口中育龄妇女避孕知识主避孕状况调查.生殖医学杂志,2001,10(3):154-163
[12] 武俊青,陶建国,高尔生.流动人口紧急避孕知识状况分析.中国计划生育杂志,2002,5:269-271
[13] 吴玉琴,曹庆丽,封锦平,于海莲,龚宝华,胡素芳.城市流动人口中青少年对生殖健康的需求调查.中国健康教育,2003,19(2):102-104
[14] 张建端,石淑华,刘筱娴,时俊新,苏长梅,叶鸣,彭大元.流动人口已婚妇女生殖健康认知状况的调查.中国公共卫生,2001,17(1):964-966
[15] 周敏,王临虹,赵更力.已婚妇女妇科常见病患病情况与相关知识、卫生行为和保健需求的关系.中国健康教育,2002,18(3):154-158
[16] 乐杰 主编.妇产科学.第四版,北京:人民卫生出版社,1997:378-392
[17] 肖燕军,张友方.北京市人工流产妇女婚育与避孕状况调查分析.中国计划生育杂志,2000,8(6):252
[18] 时俊新,石淑华,张静,王绍海,胡美荣,苏长梅,叶鸣,彭大元.武汉市已婚女性流 动人口人工流产状况调查分析.中国妇幼保健,2000,15:707-709
[19] 田爱平,律淑芬,瞿丽.成都市流动人口生殖健康需求服务现状调查.中国计划生育杂志,1999(5):211
[20] Parfitt. T. Russia moves to curb abortion rates. The Lancet, 2003, 362(9388): 968
[21] 赵艳霞,杜玉开.人工流产现状及对在妊娠母婴的影响.国外医学(社会医学分册),2003,20(2):56-60
[22] Zhou W, Nielsen GL, Larsen H, Olsen J. Induced abortion and placenta complications in the subsequent pregnancy. Acta Obstet Gynecol Scand, 2001, 80(12): 1115-1120
[23] Henriet L, Kaminski M. Impact of induced abortions on subsequent pregnancy outcome: the 1995 French national perinatal survey. BJOG, 2001, 108(10): 1036-1042
[24] Berer, M. Making Abortion a Woman's Worldwide. Reproductive Health Matters, 2002, 10(19): 1-8
[25] 郭素芳,张文坤,Oratai Rauajin.妇女生殖道感染的控制.国外医学妇幼保健分层,2001,12(1):3-5
[26] 王燕,安琳,张学斌,王绍贤.北京地区604名流动人口育龄妇女生殖健康状况的研究.生殖与避孕,1999,19(2):108-113
[27] 张红杰,曾光.妇女生殖道感染及其危害.中国计划生育杂志,2001(6):372-374
[28] Bhatti LI, Fikree FF. Health-seeking behavior of Karachi women with reproductive tract infections. Social science & Medicine, 2002, 54(1): 105-117
[29] 卫生部官员谈如何防范艾滋、远离毒品、避免性乱.http://cn.news.yahoo.com/GB/channel12/3/30/2889/2894
[30] 连玉峰,杨卫国,黄彪.珠海市1993～2002年传染病流行病学分析.中国公共卫生,2004,20(6):695-697
[31] 刘传新,苏生利,傅继华,康殿民.山东省HIV感染者中流动人口感染现况调查.中国性病艾滋病防治,2002,8(1):28-30
[32] 刘兆炜,马骁,熊婉梅,李钋,王国庆.农村流动人口与HIV/AIDS传播的关系.预防医学情报,2002,18(3):216-218
[33] 齐玉玲,唐维红.育龄妇女生殖健康状况与需求.人口与计划生育,2000(1):43-45
[34] 陈沁,曾芳玲,王平.广州市777名流动人口妇女孕产期保健状况及影响因素调查分析.广州医药,2004,35(5):59-61
[35] 谢学勤,詹绍康,谢玲玉,上海市闵行区流动人口中的孕产妇保健状况.中国初级卫生保健,1997,11(1):32.
[36] 姜海萍,刘植鸿.深圳市流动人口孕产妇死亡、儿童死亡5年观察.中国公共卫生,1997,13(9):550.
[37] 朱丽萍,周冰华,秦敏,许厚琴,秦张艳,王寅.上海市1979-1998年孕产妇死亡情况分析.中国妇幼保健,2000(15):426-429
[38] 杨金凤.对城市流动人口卫生服务的思考.卫生经济研究,2001,9:32
[39] 全国孕产妇死亡监测协作组.全国孕产妇死亡监测结果分析.中华妇产科杂志,1999(11):645-648
[40] Sadana R. Definition and measurement of reproductive health. Bulletin of the World Health Organization, 2002, 80(5): 407-409
[41] 余铮,朱丽萍.上海市产前检查和住院分娩费用调查.中国妇幼保健,2001,16:491-492
[42] 肖贤武.外来流动人口社区卫生保健需求初探.卫生软科学,2001,15(2):39-41
[43] 袁方.安全生产形式依然严峻—访国家安全生产监督管理局局长王显政.南风窗,2002,(8下) :30
[44] 王伟,蔡建平.三资企业外来工职业危害问题与对策.职业与健康,2001,17(5):12-13
[45] Cain JM. Women in the workplace. Clinical obstetrics and gynecology, 1997, 40(3): 687-694
[46] Nurminen T. Shift work and reproductive health. Scandinavian journal of work, environment & health, 1998, 24 (3): 28-34
[47] 黄爱群.轮班对女性生殖健康影响的流行病学研究进展.国外医学(卫生学分册),2003,30(1):1-4
[48] Loewenson RH. Women's occupational health in globalization and development. Am J Ind Med, 1999, 36(1): 34-42
[49] Cobas JA, Balcazar H, Benin MB, Keith VM, Chong Y. Acculturation and low-birth weight infants among Latino women: a reanalysis of HHANES data with structural equation models. Am J Public Health, 1996, 86(3): 394～396.
[50] Jenkins CN, Le T, McPhee SJ, Stewart S, Ha NT. Health care access and preventive care among Vietnamese immigrants: do traditional beliefs and practices pose barriers? Soc Sci Med, 1996, 43(7): 1049～1056.
[51] Lubben, Marianne, Mayhew, Susannah H, Collins, Charles, Green, Andrew. Reproductive health and health sector reform in developing countries: establishing a framework for dialogue. Bulletin of the World Health Organization, 2002, 80(8): 667-673
[52] Flores G, Vega LR. Barriers to Health Care Access for Latino Children: A Review. Fam Med, 1998, 30(3): 196～205.
[53] 陈灿山.生殖健康及其主要影响因素.中国妇幼保健,2000,15(1):55-57
[54] 任建伟,高丽素.初孕妇流产术近期并发症分析.海峡预防医学杂志,2000,6(5):62
[55] 贺佳,贺宪民,高尔生,楼超华.生殖健康综合评价模型的研究.中国公共卫生,2002,18(1):115-117
[56] 刘自远,刘成福.加权关联度分析综合评价我国生殖健康之研究.现代预防医学,2003,30(2):169-171
[57] 郑立新,朱嘉明,田佩玲,陈勇,宋玉洁,陈咏诗.广州流动人口未婚青年女工生殖健康高危因素分析.南方人口,2000,15(2):33-38
[58] 郑真真.对我国育龄妇女生殖健康状况的分析—个体指标的应用实例.人口研究,2000,24(6):8-21
[59] YUZHOU. THE FALL OF "THE OTHER HALF OF THE SKY" ?CHINESE IMMIGRANT WOMEN IN THE NEW YORK AREA. Women's Studies International Forum, 2000, 23(4): 445-459
[60] Westerway SC, Keogh J, Heard R, Morris J. Incidence of fetal macrosomia and birth complications in Chinese immigrant women. Aust N Z J Obstet Gynaecol, 2003, 43(1): 46-49
[61] 刘莹,李惠军,冯庆才,戚其伟,常云飞,王远萍.流动人口与常住人口人工流产情况对比调查.中国计划生育杂志,2000(6):264-266
[62] 薛晓华.少数民族地区育龄妇女对生殖健康知识的理解和需求—青海省大通县育龄妇女生殖健康调查分析.南京人口管理学院学报,2000,16(3):34-37
[63] 高秋艳.育龄妇女生殖健康知识及健康教育.人口研究,2000,24(6):46-50
[64] 陆焯平,朱作金.流动人口AIDS知识与态度现状调查.中国艾滋病性病,2004,10(2):99-101
[65] 中英艾滋病性病合作项目.艾滋病性病预防干预最佳实践文集[R].2002,6
[66] 中国疾病预防控制中心艾滋病性病预防控制中心.世界银行贷款卫生九项目艾滋病性病预防与控制项目交流材料.2002
[67] 计国平,吴尊友,尹惠萍,刘美荣,宁学文.已婿育龄妇女生殖健康KAP定性研究报告.中国农村卫生事业管理,1999,19(11):58-60.
[68] Odutolu O, Adedimeji A, Odutolu O, Baruwa O, Olatidoye F. Economic empowerment and reproductive behaviour of young women in Osun state, Nigeria. Afr J Reprod Health, 2003, 7(3): 92-100
[69] Shlay JC, Mayhugh B, Foster M, Maravi ME, Baron AE, Douglas JM Jr. Initiating contraception in sexually transmitted disease clinic setting: a randomized trial. Am J obstet Gynecol, 2003, 189(2): 473-481
[70] Chakraborty N, Islam MA, Chowdhury RI, Bari W, Akhter HH. Determinants of the use of maternal health services in rural Bangladesh. Health Promot Int, 2003, 18(4): 327-337
[71] Iglesias E, Robertson E, Johansson SE, Engfeldt P, Sundquist J. Women, international migration and self-reported health. A population-based study of women of reproductive age. Social Science & Medicine, 2003, 56(1): 111-124
[72] 杨德华,程锦泉,彭绩,刘军安,夏挺松,张丹,卢祖洵.深圳市流动人口健康保障现状及政策分析.医学与社会,2002,15(6):8-10
[73] Dunn JR, Dyck I. Social determinants of health in Canada' s immigrant population: results from the National Population Health Survey. Social Science & Medicine, 2000, 51(11): 1573-1593
[74] 贺佳,贺宪民,高尔生,楼超华.生殖健康与社会、经济关联的研究.中国公共卫生,2002,18(7):867-868
[75] Moodley J, Akinsooto VS. Unsafe abortions in a developing country: has liberalisation of laws on abortions made a difference? Afr J Repord Health, 2003, 7(2): 34-38
[76] Tountas Y, Dimitrakaki C, Antoniou A, Boulamatsis D, Creatsas G. Attitudes and behavior towards contraception among Greek women during reproductive age: a country-wide survey. Eur J Obstet Gynecol Reprod Biol, 2004, 116(2): 190-195
[77] van Bogaert LJ. 'Failed' contraception in a rural South African population. S Afr Med J, 2003, 93(11): 858-861
[78] Diaz S, Hardy E, Alvarado G, Ezcurra E. Acceptability of emergency contraception in Brazil, Chile, and Mexico: 1-Perceptions of emergency oral contraceptives. Cad Saude Publica, 2003, 19(5): 1507-1517
[79] Ezumah NN. Gender issues in the prevention and control of STIs and HIV/AIDS: lessons from Awka and Agulu, Anambra State, Nigeria. Afr J Reprod Health, 2003, 7(2): 89-99
[80] Zurayk H, Khattab H, Younis N, Kamal O, el-Helw M. Comparing women's reports with medical diagnoses of reproductive morbidity conditions in rural Egypt. Studies in Family Planning, 1995, 26(1): 14-21
[81] GUO Sufang, WANG Linhong, YAN Renying. Health service needs of women with reproductive tract infections in selected areas in China. Chinese Medical Journal, 2002, 115 (8): 1253-1256
[82] 张丽杰,耿玉田,安慧艳,高淑云,张玲,岑阳,曾光.北京市丰台区流动已婚育龄妇女生殖道感染、相关知识及求医为调查.中华流行病学杂志,2003,24(8):678-680
[83] 程振莲,刘素梅.人工流产对妇女生殖健康的影响.齐鲁护理杂志,1999,5(2):32-33
[84] Wang Y, An L, Zhang XB, Wang SX. Cross-sectional study on their reproductive health status of 604 female floating residents in Beijing. Reproduction and contraception, 1999, 10(1): 49-57
[85] 闻增玉,武俊青,钟细华,李文英,黄伟栋,刘宁,杨瑛,陈锡宽,周小萍,高尔生.上海市徐汇区已婚育龄妇女生殖道感染与卫生行为的研究.生殖与避孕,2003,23(6):340-344
[86] 段平,王歌欣,王晓莉.105个项目县妇女产前保健现况分析.中国公共卫生,2002,18(2):185-187
[87] 曾声尤.依法加强孕产妇管理是降低两个死亡率的关键.中国妇幼保健杂志,2000,15(1):9-10.
[88] 刘昌英.荆州市16年孕产妇死亡分析.中国妇幼保健杂志,2000,15(2):102-104.
[89] 路平,郑全庆,田玉,李燕琴,阎春芳.西部5省孕产妇保健服务状况的调查研究.中国妇幼保健,2000(15):648-650
[90] 王燕,赵新胜,王晓莉,付小萍,李明德,张瑞兰,张瑞生.影响农村地区产妇住院分娩的因素研究—对河北省丰宁县673例妇女的调查.中国农村卫生事业管理,2001,21(9):60-63