国家免费提供宫内节育器使用现状分析

发布时间：2018-06-24 07:16

本文选题：避孕措施 + 免费　；参考：《吉林大学》2013年硕士论文

【摘要】：放置宫内节育器（IUD，Intrauterine Device）是我国育龄妇女采取的主要避孕措施，中国育龄妇女占全球育龄妇女人数的26.9%，使用IUD人数占全球使用IUD育龄妇女人数的75.7%。2011年底，我国2.46亿采取避孕措施的已婚育龄妇女中，正在使用宫内节育器的达1.32亿人。面对如此庞大的IUD使用人群，了解并掌握其中免费IUD的使用状况，是十分必要的。目的：国家向育龄群众提供免费IUD历时40多年，是党和政府最早实行的覆盖面广泛的一项惠民工程，也是“十二五”时期基本公共服务的重点内容之一。免费IUD公共服务，是计划生育基本国策的制度安排，服务对象是健康的育龄妇女，措施落实需要借助技术人员专业操作才能达成，服务对象的需求、服务提供者的能力是该项公共服务的基本要素，服务供给能力和服务提供水平则直接影响到这项基本公共服务效能的发挥。全国免费IUD使用管理情况调查，目的在于摸清底数，适时、及时地掌握免费IUD使用状况，了解服务提供能力，了解免费IUD的需求和供给的适应性以及免费IUD作为避孕节育措施的相关影响因素，通过分析获得的数据和趋势，了解群众实际需求，梳理、分析存在的系统性问题，讨论并提出有利于可持续发展的对策和建议，为完善免费IUD需求和供给之间的适应性、促进免费IUD使用管理规范化建设、提高免费IUD公共服务的提供能力、更有成效地对免费IUD公共服务科学决策、实施和评价，促进和提高宏观管理水平和循证决策能力，提供参考依据。方法：免费IUD使用管理情况调查于2012年2月~10月在全国31个省（区、市）、5个原计划单列市、新疆生产建设兵团范围进行，所有承担免费IUD放置技术的省、市、县、乡级计划生育技术服务机构和医疗单位均参加了调查。调查方法有发放问卷自填、面对面访谈式问答、观察法、查阅资料法等。调查内容为2009年1月1日至2011年12月31日之间，国家免费IUD的使用情况、使用效果、产品质量状况、影响使用的因素等。调查全过程进行了严格的质量控制，统一方案、统一问卷、统一编码、统一培训，各级机构分别独立完成调查表并直接上报，每份问卷均做了完整性、正确性审核，采用Epidata3.1双人双录，差错率控制在万分之一以内，应用SPSS13.0进行分析，对结果进行了一般描述分析。结果：在免费IUD技术服务中，基层计划生育技术服务机构仍在继续发挥着主要作用；免费IUD使用率，全国总体呈下降趋势，免费IUD的使用率与区域经济水平总体上呈负相关，免费IUD公共服务提供与育龄妇女的需求之间有不适应之处；免费IUD品种的供需方面，尚有34.3%的技术服务机构在临床应用中对免费IUD产品不认可，免费IUD品种结构调整的运行机制需完善；免费IUD使用和供给的种类趋于合理，实际使用免费IUD的种类数为3～5种，全国平均为3.96种，免费IUD使用普及率和使用量构成比位居前4位的是T型环、元宫环、含铜宫腔型环、花式环；全国免费IUD三年累积使用效果分别是：脱落比0.0177、带器妊娠比0.0118、因症取出比0.025、续用比0.7913，带器妊娠情况相对好转并成为当前影响使用效果的主要因素，脱落率和因症取出率明显降低，续用率有较大幅度的升高，避孕有效率有所提高；各类免费IUD使用效果仍不同程度存在需要进一步改进的方面；IUD技术服务能力有长足提高，但免费IUD技术服务水平还需继续提升，全国免费IUD技术服务机构对免费IUD的知晓率为42.4%，各层级机构及两类机构免费IUD知晓率和用量构成比呈正相关；各类免费IUD的知晓率和使用普及率呈正相关；技术服务机构能熟练掌握放置技术的免费IUD种类数小于实际使用免费IUD种类数，技术服务机构放置IUD操作技能与实际业务不匹配，略低于实际要求；技术服务机构放置技术操作技能与实际匹配的有T型环，元宫环，含铜宫腔型环，其他4类免费IUD的操作技能均不足，需要加强培训；全国技术服务机构中，有16.5%的机构能在灭菌有效期内用完免费IUD；22.6%的机构对于超过灭菌有效期的免费IUD进行消毒后再用，至少32.2%的机构存在一定的浪费现象，技术服务机构对免费IUD的使用管理需加强，免费IUD的技术服务有待更加规范；免费IUD放置使用时遇到的问题和困难，主要源自个体差异、产品结构不满意和服务提供不足；影响免费IUD使用的首要因素是服务提供不足。结论：免费IUD放置技术服务主要由县、乡两级落实，97.6%的IUD放置手术在县乡两级技术服务机构实施。城市化快速进程中，，需制定衔接城乡免费IUD共服务体系的具体措施，将IUD纳入中央财政保障的完全免费提供的基本公共服务体系，是IUD公共服务全覆盖和均等化有关问题的根本解决途径。免费IUD使用数量逐年下降；2009年~2011年全国平均使用率为86.8%，各地免费IUD使用率情况有所不同，最高的厦门市为97.4%，最低的海南省为29.7%。为提高财政资金使用绩效，应完善免费IUD的计划管理运行机制，使免费IUD数量供需的均衡性和匹配性更加科学合理。免费IUD使用和供应的品种趋于合理，全国62.9%的免费IUD技术服务机构选择使用3～5种免费IUD，免费IUD用量构成比和使用普及率位居前4位的均为元宫环、T型环、花式环、含铜宫腔型环；但免费IUD品种结构的更新换代滞后，应适时和及时调整免费IUD产品的品种结构。免费IUD放置使用时遇到的问题和困难，主要源自个体差异、产品结构不满意和服务提供不足；影响免费IUD使用的首要因素是服务提供不足。免费IUD技术服务能力尚需提升，技术服务机构对免费IUD知晓率为42.4%，实际使用3.96种免费IUD,熟练掌握3.85种免费IUD的放置技术，技术服务技能与优质服务的要求略有差距。技术服务机构应加强免费IUD使用管理的制度化和规范化。
[Abstract]:IUD (Intrauterine Device) is the main contraceptive measure for women of child-bearing age in China. Women of child-bearing age in China account for 26.9% of the number of women of childbearing age in the world. The number of IUD in the number of women of childbearing age using IUD in the world is at the end of the year. Among the 246 million married women of childbearing age in our country, the intrauterine Festival is being used. There are 132 million people in the feeder. It is very necessary to understand and master the use of free IUD in the face of such a large IUD user.
Objective:
The state provided free IUD for more than 40 years to the people of childbearing age. It is one of the most important projects of the party and the government to carry out the broad coverage of the public service. It is also one of the key contents of the basic public service in the "12th Five-Year" period. The free IUD public service is the system arrangement of the basic national policy of family planning, the target of service is the healthy women of childbearing age, and the measures are carried out. The needs of the technical personnel, the needs of the service objects, the ability of the service providers are the basic elements of the public service. The service supply ability and the level of service supply directly affect the performance of the basic public service. The national free IUD makes a survey on the management situation, the purpose is to find out the bottom number, and to find out the proper number of the public service. Timely grasp the use of free IUD, understand the ability to provide services, understand the requirements and the adaptability of free IUD and the related factors of free IUD as contraceptive measures. Through the analysis of the data and trends obtained, we can understand the actual needs of the masses, comb, analyze the systematic problems, discuss and put forward the benefits. The countermeasures and suggestions for sustainable development, in order to improve the adaptability of free IUD demand and supply, promote the standardized construction of free IUD management, improve the ability to provide free IUD public service, make more effective decisions on free IUD public service, implement and evaluate, promote and improve the level of macro management and evidence-based decision-making ability. Reference basis.
Method:
The free IUD management survey was conducted in 31 provinces (districts, cities), 5 original listed cities and the Xinjiang production and Construction Corps in ~10 month of February 2012. All the provinces with free IUD placement technology, city, county, township level family planning technical service institutions and medical units all participated in the investigation. Interviewing, observing, and consulting information. The content of the survey is from January 1, 2009 to December 31, 2011, the use of free IUD, the use effect, the quality of the product, the factors affecting the use, etc.. The whole process of investigation is strictly controlled by quality, unified plan, unified questionnaire, unified coding, unified training, training at all levels. The organization completed the questionnaire independently and reported it directly. Each questionnaire did the integrity, the correctness review, the Epidata3.1 double record, the error rate within 1/10000, the SPSS13.0 analysis, and the general description of the results.
Result:
In the free IUD technology service, the basic family planning technology service institutions are still playing the main role; the free IUD utilization rate, the overall decline trend in the whole country, the free IUD use rate and the regional economic level are negatively related, the free IUD public service is incompatible with the needs of women of childbearing age; free IUD In the supply and demand of the varieties, 34.3% of the technical service agencies do not approve of the free IUD products in clinical application, the operating mechanism of the free IUD variety structure adjustment needs to be perfected; the free IUD use and supply types tend to be reasonable, the number of free IUD types is 3~5, the national average is 3.96, the free IUD use rate and make the free use of free IUD The amount composition ratio is the top 4 in the T ring, the yuan palace ring, the cupric uterine cavity ring, and the flower type ring. The cumulative use effect of free IUD in the country is: the ratio of exfoliative ratio 0.0177, the ratio of pregnancy to pregnancy 0.0118, the ratio of the disease extraction ratio 0.025, the continued use ratio 0.7913, the relative improvement of the belt pregnancy and the main factor affecting the current effect, the exfoliative rate. The rate of removal of the disease was significantly reduced, the rate of continued use was raised, the efficiency of contraception increased, and the effect of free IUD was still improved in different degrees. The ability of IUD technology service was greatly improved, but the level of free IUD technical service needs to be further improved, and the free IUD technical service organization in China was to be improved. The awareness rate of free IUD was 42.4%. The rate of free IUD awareness was positively correlated with the rate of free IUD awareness and the ratio of free IUD. The free IUD species number of technical service institutions was less than the number of free IUD, and the technical service institutions placed I. The UD operation skills do not match the actual business, slightly lower than the actual requirements; the technical service institutions have the T ring, the yuan palace ring, the copper uterine cavity ring, the other 4 kinds of free IUD operating skills, and the need to strengthen the training; among the national technical service institutions, 16.5% of the institutions can be in the sterilization period. Use the free IUD for free; 22.6% of the institutions to disinfect the free IUD that exceed the period of sterilization, at least 32.2% of the institutions have a certain waste, the management of the technical service institutions on the use of free IUD needs to be strengthened, and the technical service for free IUD needs to be more standardized; the problems and difficulties encountered in the free IUD placement are the main source. From the individual differences, the product structure is not satisfied and the service supply is insufficient; the primary factor affecting the free IUD usage is insufficient service provision.
Conclusion:
Free IUD placement technology services are mainly implemented by county, township level two, and 97.6% of the IUD placement operation in county and township level two technical service institutions. In the rapid urbanization process, the concrete measures to connect the free IUD common service system in urban and rural areas should be formulated, and IUD is incorporated into the basic public service system provided by the central financial security free fee free service. It is a IUD public suit. The fundamental solution to the problems of full coverage and equalization.
The number of free IUD use is declining year by year; the national average utilization rate of ~2011 in 2009 is 86.8%. The use rate of free IUD in different places is different, the highest in Xiamen is 97.4%. The lowest Hainan province is to improve the performance of financial funds, and the plan management mechanism of free IUD should be perfected so as to balance the supply and demand of free IUD and the balance of the free IUD quantity and supply. The matching is more scientific and reasonable.
Free IUD use and supply of varieties tend to be reasonable, 62.9% of the national free IUD technical service institutions choose to use 3~5 kinds of free IUD, free IUD dosage form ratio and the use of the top 4 are the top 4 are yuan palace ring, T ring, flower type ring, copper bearing ring type ring; but free IUD product structure renewal and replacement lag, should be timely and timely adjustment Whole free IUD product variety structure.
The problems and difficulties encountered in the use of free IUD are mainly from individual differences, product dissatisfaction and lack of service delivery, and the primary factor affecting the use of free IUD is the shortage of service.
The free IUD technology service capacity needs to be promoted. The rate of awareness of free IUD is 42.4%, and 3.96 kinds of free IUD are actually used. 3.85 kinds of free IUD placement techniques are mastered, and the technical service skills are slightly different from the requirements of high quality services.
Technical service institutions should strengthen the institutionalization and standardization of free IUD usage management.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R169.4

【参考文献】