Analysis of starting adoption of contraceptive method only after induced abortion among women after first birth and its determinants in Shanghai municipality

Abstract

Objectives:To describe the status and reasons of adoption of contraceptive method only after induced abortion in some couples after their first birth and explore its social and behavioral determinants Method:A prospective cohort study of couples up to 5～6 year after their marriage registration in two defined districts in Shanghai Results:About 9.3% (663/7 101)of the couples did not adopt any contraceptive method until after the induced abortion following their first birth, i.e. among those who had at least one induced abortion after their first delivery, about 26.2% of re conceiving women (663/2 527) wsa totally exposed to the risk of pregnancy. The main reason was that about 1/3 of them (223/663) originally intended to have postabortion IUD insertion. Actually, 56.4% of them had IUD inserted. Logistic regression model revealed that women who thought induced abortion would not damage their health, or couple’s, especially husband’s, contraceptive knowledge score low at the revisit. Younger women, or women whose health status were not very well during puerperium, or those who resumed their sexual life within 2 months after delivery, would be the risky couples who had not adopted any contraceptive method, until after the induced abortion. Conclusion:This cohort study indicates that there is an urgent need for Family Planning Personnel to advise couples to use contraceptive method, as soon as they have resumed their sexual life after birth. Family Planning Personnel should also keep a scientific point of view with the immediate post abortion insertion of IUDs in order to further lowering the rate of induced abortion.

對上海市兩社區 71 0 1對于 1 987～ 1 988年初婚并于婚后 5～ 6年時已有孩子的夫婦進行 8年的前瞻性隊列調查。結果顯示 ,其中 9.3 % (6 6 3對 )的夫婦是于人工流產(人流 )術后開始選用避孕措施 (在本次調查的 2 52 7例產后至少有一次人流者中占2 6 .2 % )。在 6 3 3例產后完全暴露于妊娠危險狀況的夫婦中 ,1 / 3的妻子因感避孕麻煩而原就準備于人流術后放環避孕。 51 .3 %的夫婦認為產后夫婦性生活少、哺乳期或未轉經、月經量少不會受孕等而未于產后及時避孕。近 80 %未及時避孕的妻子于恢復性生活后 1年內受孕。56 .4 %未及時避孕的妻子均于人流術后放置環 ,其中 1 / 2的妻子認為于該時放環最有效。在產后非人流術后開始避孕的妻子中僅 8.1 %首選放環 ,從有效性出發首選放環的僅占 1 / 3。擬合雙反應 L ogistic回歸模型顯示夫婦人口統計學 (妻子婚齡、宗教信仰、夫婦月收入 ) ,生育意愿 (婚后推遲生育時期 ) ,心理學因素 (產后妻子健康狀況 ) ,妻子對人流的態度 ,夫婦的避孕知識 (特別丈夫在二訪時 ) ,性生活狀況等多種因素均顯著影響到夫婦產后是否及時避孕。結果顯示 :(1 )要加強對夫婦 ,特別是妻子 ,產后一旦恢復性生活及時避孕的教育 ;(2 )對有關人流后放環和人流術本身對婦女健康潛在危險性等開