| Background"Women should be ensured with reliable, safe abortion and post abortion care within the full extent permitted by law" This is not only a question of how a country defines what is legal and what is not, but also of guaranteeing women access, to the fullest extent permitted by law, to good quality and responsive abortion and post-abortion care."reported in "2005 World Health Report Overview". The health of induced abortion women is widely concerned all over the world, and various projects have been developed to protect the health of induced abortion women in many countries.Induced abortion has many complications especially in the groups of repeated induced abortion, among them the secondary infertility has been more and more concerned by the public. The induced abortion women in China have the characters of low age, unmarried, nullipara, increased ratio among floating population, increased repeated induced abortion. The main reasons of induced sex behavior without contraception, fail of contraception and other medical reasons. In China, the reason varies with areas, age groups and time period.In the late 1980s, international society developed the idea of post abortion service (PAS) and it has been proved to be an effective method to reduce the ratio of repeated induced abortion by some researches. But in China, PAS is not connected to Family Planning. Neither the treatment of induced abortion complication nor the post induced abortion service was included in Family Planning and abortion service.Many researches have indicated that the outpatient clinic room for Family Planning is the best place to conduct the Family Planning service for post induced abortion. Recent researches have provided good ideas approaches to provide supports for the post induced abortion service especially for Family Planning service. Furthermore, the network of Family Planning in China is an excellent platform to develop support for post induced abortion service. But the problems such as how to conduct specific post induced abortion service in primary hospitals, how to fully use the existing resources still need to be solved.Our study analyzed the causes of induced abortion and the demand of Family Planning service for post induced abortion through data collected in a secondary hospital in Shanghai. Based on the analysis, we explored and put forward the essential contents and approaches for Family Planning service for post induced abortion.ObjectivesObjection:To analyze the reasons and factors of induced abortion in an outpatient induced abortion room in a certain hospital in BaoShan area. Specific objectives:To analyze the reasons of induced abortion of patients from a secondary hospital in Shanghai; to analyze the reasons of repeated induced abortion of patients from a secondary hospital in Shanghai; to analyze the demand of post induced abortion service of patients from a secondary hospital in Shanghai; to explore the contents and approaches to develop post induced abortion service in hospitals.Methods1. Use the combination of quantitative—epidemiological questionnaire survey and qualitative approaches—individual in depth interview.2. Quantitative questionnaire survey:self-report questionnaire to induced abortion women in a secondary hospital3. Individual in depth interview:Use both face to face interview and telephone interview. Interviewees were four Family Planning service providers including women and children Family Planning manager, doctors of women abortion apartment, circulating nurse. The interview was tape-recorded, and key points are summarized through the analysis.Results1.543 volunteers was recruited for this study and 502 qualified questionnaires, was received.4 interviews with health providers were carried out.2. Demographic characteristic of sample:Most of the participants (53.6% of total) aged from 20 to 30 years old,269(53.6%). Most of them were unemployed, high middle school or lower education, migrants, married. The rate of repeated induced abortion was 64.1%3. Main reasons of pregnancy: Contraceptive failure accounted for the most (52.8%) reason for induced abortion. There were 101 women (58.7%) had sex behavior without contraception which led to the pregnancy. Among 265 women who failed in applying contraceptive methods,87 women were failed in condom using,36 women got pregnancy using the natural family planning method. Age, census register, marriage status, induced abortion history, sex action and male factors were showed statistical significant in relationship with the cause of contraception failure.4. The rate of repeated induced abortion was 64.1% (322 of 502). The rate of repeated induced abortion among unmarried repeated was 45.69% and among married women, it was 69.69%. The shortest time from the last induced abortion was 47 days; the shortest time between the last induced abortion and the 1st sex behavior after abortion was 4 days. Among women who had repeated induced abortion,267(94.7%) women had rest after last induced abortion. Age, job, marriage status, census regsister, number of sex partner, male attitude to using contraceptive methods were shown to be related with repeated induced abortion.5. The current content of post abortion education mainly focused on the care after abortion, without emphasis and introduction on contraceptive methods.32.6% of women preferred they could receive contraceptive introduction when they were informed pregnant.6. Through qualitative interview, it was showed Family Planning service after induced abortion is an effective method to reduce repeated induced abortion. The education on the male partner was also an important on reducing repeated induced abortion. Contraceptive advocacy and education should be emphasized on people after their induced abortion, accompanied with following up after induced abortion. The largest obstacle was the lack of consultation by professional health staff.Conclusion and Suggestion:1. Hospital was found to be the best place to develop the post induced abortion care. 2. The education should be developed for reproductive age women to improve their utilization for contraceptive service. Health professionals should be trained to be qualified to provide the post abortion service. The service process should be more optimized to improve work efficacy.3. The content of education of post abortion could focus on the appropriate selection of contraceptive method and the appropriate contraceptive application. The introduced contraceptive method should be simple and easy to persist. As community has good resource for family planning service, women should be given enough information to receive service in community.4. Contraceptive education could develop when visiting outpatient doctor, registration and after induced abortion.5. Education on the male partner is important. The content of education could cover the harm of induced abortion, appropriate selection and application of contraceptive method.6. Teaching and education should base on the condition of the certain hospital, including advertised layout, face to face consultation and pamphlet. |
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