Influencing Factors Analysis And Comprehensive Evaluation On The Quality Of Post-Abortion Family Planning Services Of Three Cities Of China

ObjectivesGeneral objectivesTo explore the influential factors of the post-abortion family planning services and comprehensively evaluate the quality of post-abortion family planning service of three cities, to raise suggestions for the further development and providing high quality post abortion family planning services.Detailed objectives1. From the factor ananlysis of the four major categories evaluation indicators of international abortion projects, rate of the repeat induced abortions, implementing of the contraception, knowledge level of the sexual and reproductive health and women’s satisfaction, combined with the build of women post-abortion contraceptive behavior influencing factors confirmatory factor analysis SEM, from the purposes of improving the quality of post-abortion family planning services(to prevent the occurrence of unwanted pregnancy, reduce the rate of abortion and repeat abortion), departure to explore the influential factors of post-abortion family planning service quality, and propose appropriate countermeasures.2. Based on the quality post-abortion family planning services framework of WHO, integrated scoring, the spider diagram modeling, and cluster analysis were used to evaluate the quality of post-abortion family planning services in29hospitals in Beijing, Shanghai, Zhengzhou, to abortionthe strengths and weaknesses of the post abortion family planning services, and verify the applicability of several comprehensive evaluation methods in the assessment of the quality post-abortion family planning services, to provide a reference for the quality assessment of the post-abortion family planning services.Methods:1. The source of the data:The present study is a re-analysis and re-excavation of a former study. The data of the present study is from the EU-China FP6Projdet:The Study of Post-abortion Family Planning Services of China. Details of the data are as follows:29hospitals were selected from the three cities, Beijing, Shanghai and Zhengzhou, by using stratified randomization method.3132abortion women were investigated form the29hospitals. The inclusion criteria of abortion women were (1) to seek abortion services in the selected hospitasl;(2) age<25years old;(3) early pregnancy;(4) could be followed up after six months, anti-clinic or telephone follow-up;(5) willing to participate in this survey. The exclusion criteria were: women do not want to participate in the research and those who could not adhere to the follow-up.2. Research methodsBoth classic statistical analysis methods and modern statistical methods were used the influential factors analysis of the quality post-abortion family planning services. The classic statistical analysis methods used were including the descriptive analysis, chi-square test, Logistic regression and the multiple-linear regression. The modern statistical method used was SEM, the most prominent method in the new generation of three statistical progresses.Based on the quality post-abortion family planning services framework of WHO. integrated scoring, the spider diagram modeling, and cluster analysis were used to evaluate the quality of post-abortion family planning services. Microsoft Office software was used for the construction of the spider diagram.Results1. Influential factors analysis of the quality post-abortion family planning services1.1The factor ananlysis of the four major categories evaluation indicators of international abortion projects1.1.1Repeat abortion(1) Causes of pregnancy among abortion womenWithout contraception and contraception failure were the two main reasons for the3132abortion women. The two main reasons for abortion women did not taken contraceptives were "did not prepare any contraceptive measures"(43.3%) and "being afriaid of troubles"(34.6%). Most the contraception failure were happended during using short-acting contraceptives (condom:39.2%, emergency contraceptive pill:20.1%, and oral contraceptive pill:12.4%) and traditional contraceptives (rhythm:29.7%, withdrawl:20.1%), while contraception failure were rarely happened during using long-acting contraceptives such as IUDs(1.5%).(2) Influencing factors of repeated abortionMultivariate logistic regression shows that, knowledge score and time of sexual life were the influencing variables for repeated abortion. Compared to women socored <60, women scored≥60more less likely to have have repated abortion(OR95%CI:0.694(0.498-0.969); Compared to women had sex life<1year, women had sex life≥1year more likely to have repated abortion (OR95%CI:29.44(15.327-56.548)).1.1.2Knowledge score of sexual and reproductive healthMultivariate Logistic regression showed that, age and place of birth were the influential factors of the knowledge score. Compared with women<22, women≥22more likely to achive higher scores(OR95%CI:1.625(1.164-2.270)); Compare with women born in rural areas, women born in town (OR95%CI:1.800(1.241-2.611)) and urban areas more likely to achive higher scores.1.1.3Contraceptives(1) Distribution of the abortion contraception used by abortion womenCondom and withdrawl are the two main contraceptives used by women under going abortion, the proportion used were77.5%11.6%before abortion and78.2%and7.7%after abortion respectively.(2) Abortion women’s considerations when chosing contraptivesThe effectiveness (74.6%) and safety (70.0%) of the contraceptives were the top two aspects that women undergoing abortion were concerned, while the cost the contraceptives (10.5%) were the least fouced aspect.(3) Influencing factors of the cotraception during the first intercourse after abortion. Mulit-variable logisteic regression showed that, marital status, whether the man is concerned about contraception, the age gap between men and women and the sexual life time were realted to the contraceptives during the first intercourse taken after abortion. Compared to the male partner does not care about contraception, abortion women with male partner of caring about contraception more likely to take contraceptives during the first intercourse after abortion(OR95%CI:1.413(1.102-1.812)); compared to women had sex life<1year, wome had sex life≥1year more likely to take contraceptives during the first intercourse after abortion(OR95%CI:1.382(1.076-1.774)); compared with married women, unmarried women less likely to take contraceptives during the first intercourse after abortion (OR95%CI:0.66(0.498-0.875)); comepared with the age gap between men and women<2years, women of with the age gap between men and women≥2years less likely to take contraceptives during the first intercourse after abortion (OR95%CI:0.749(0.593-0.946)).(4) Influencing factors of the use of various contraceptivesThe multivariate logistic regression analysis results of the influencing factors of the use of condoms, oral contraceptives, IUDs, emergency contraception, traditional/modern contraceptive measures. and the use of short-acting/long-acting contraceptive measures were summarized in the Summary Table ST-1. Notes:1. Only the statistically significant variables were summarized in the above summary table.2. No statistically signficnat variable was found in the univariate analysis of the oral contraceptive. Therefore, oral contracptive was not included in the above table.3. Assignment of the independent variables: Age:1=<22years (ref),2=≥22years of age; Age of the male partner:1=<24years old (ref),2=≥24years old; Time of sex life:1=<1year (ref)2=≥1year;The argument of the rest independent variables:0=No (ref),1=Yes4. Dependent variable assignment Condoms (0=not used;1=used); Intrauterine device (0=not used;1=used); Emergency contraception (0=not used;1=used) Traditional/modern contraceptive measures (0-traditional;1=modern); Short-acting/long-acting contraceptive measures (0=short-acting;1=long-term 1.2The contraction of women post-abortion contraceptive behavior influencing factors confirmatoryfactor analysis SEMThe SEM was construted by using AMOS17.0, see Fiugre SF-1. All path coefficients of the SEM were standardized path coefficients. Model fitting results were χ2=841.782(P<0.05), GFI=0.969, AGFI=0.949, PGFI=0.596. Althoght the P value is less than0.05, the fitting indicators GFI, AGFI, and PGFI were ideal, thus the defauted model fits the sampling data. The outcome of SEM analysis showed that the four latent variables, knowledge on sex and reproductive, individual facters, social economic status and social support were all have affects on the contraceptive behaviors of women after abortion through direct and/or indirect ways.Fiugure SF-1Women Post-abortion Contraceptive Behavior Influencing Factors Confirmatoryfactor Analysis SEM2. Comprehensive evulation of the service quality Integrated score results showed that the quality of family planning services in the three cities in China after abortion is relatively good in interpersonal relationships (82.17points) and continuity through likage of services (82.66points), followed by the choice of methods (62.85points), the timing (57.67points) and the technical competence (57.26points), while information and consulting were the weakest aspect (48.46points). The scores achived by Shanghai, Beijing, Zhengzhou were72.33.61.84and57.32respectively.The spider diagram evaluation results showed, in six elements of the WHO quality post-abortion family planning services framework, the service quality of the three cities were in good agreement.The result of cluster analysis showed that, total29hospitals were clustered into3groups by their service quality, and there were9,12and8in each group respectively.Conclusions1. Conculusions of the part of influential factors analysisThe purposes of exploring the influential factors of post-abortion family planning service quality, is to improving the quality of post-abortion family planning services. And then, reduce the rate of abortion and repeated abortion. Unwanted pregnancy is the source of abortion and reapeated abortion. Thus, to address the issue of abortion and repeated abortion should be started from the causes of unwanted pregnancy. Therefore, improving the quality of post-abortion family planning services, to address the issues of abortion and repeat abortion, could be addressed by so loving the following thress problems:optimizing the contracptives service network, changing womens’myth attitude "did not want to use contraceptives", and solving the problem of abortion failure.Increasing the abortion women’s accessibility to the contraceptives is a breakthrough point of contraceptives service network optimization. Changing the attitude of not want to use contraptives, not only need further raising of the knowledge level of abortion women, but should give more attention to the outside environmental factors such as male partenrs’support. Diminishing the use of traditional contraceptives such as rhythm and withdrawl, increasing the currect and consistant use of short-acting modern contraceptives, and rasing the use of long-acting modern contraceptives were the main ways of solving the problem of contraception failure.The outcome of the women post-abortion contraceptive behavior influencing factors confirmatoryfactor analysis SEM showed that, the behaviors of contraception of women after abortion were impacted by many combimed aspects. Therefore, to change the cotracption behavior of women after abortion, not rely solely on one single factor. But to coordinate and integrate a variety of measures, to improve the quality of post-abortion family planning services, to prevent the occurance of unwanted pregnancies, thereby achieving the purpose of reducing the rate of abortion and repeated abortion.2. Conculusions of the part of quality assessmentFrom the six elements of quality post-abortion family planning services framework of WHO, the quality of family planning services in the three cities in China after abortion is relatively good in interpersonal relationships and continuity through likage of services, followed by the choice of methods, the timing and the technical competence, while information and consulting was the weakest aspect. The service qualities of the three cities were in good agreement.The results consistency of the two comprehensive evaluation method, comprehensive scoring method and cluster analysis, not only verified the reliability and stability of the quality of evaluation results in the present study, but also indicated that the two methods is applicable in using to evaluate the services quality of post-abortion family planning.