【作者】 唐杰；

【导师】 杜玉开； 王家骥；

【作者基本信息】 华中科技大学 ， 儿少卫生与妇幼保健学， 2012， 博士

【摘要】 研究目的了解我国未婚流动女性生殖健康知识、态度、行为,以及她们的生殖健康服务需求的现状；分析并比较我国不同地区未婚流动女性婚前性行为发生的影响因素；探索提高未婚流动女性生殖健康水平的策略,评价干预效果；为政府相关部门制定有关政策提供科学依据。研究方法1.未婚流动女性生殖健康KAP现状、服务需求与利用调查：采用定量与定性相结合的流行病学调查方法。定量调查方法通过自行设计调查问卷,简单随机抽样,共调查深圳市宝安区两家工厂、广州市一家工厂的未婚流动女性5156人,调查内容包括未婚流动女性的生殖健康知识、态度、行为、服务需求等；定性调查通过访谈方式进行。2.不同流出地区未婚流动人口生殖健康状况的比较研究：分析比较我国中、西部流出未婚流动女性的生殖健康知识、态度、行为、服务需求现状、及婚前性行为发生的影响因素。3.基于社区卫生服务的未婚流动女性生殖健康的综合干预研究：以深圳市某工厂社区卫生服务站为基础,开展生殖健康干预研究,干预组和对照组分别有该工厂两个厂区的未婚女性402人和449人。干预活动的形式包括发放宣传资料、组织讲座、同伴教育、提供咨询和避孕服务。干预持续6个月,总随访率为85.9%。干预后,以问卷调查对干预效果进行评价,对干预全面总结评价该干预模式推广的可行性。所得定量资料采用Epidata3.0建立数据库,使用Excel 2003、SPSS 15.0等软件进行统计处理和分析。所运用的统计分析方法有描述性统计分析、单因素分析、Logistic回归分析；定性资料采用归类分析、案例评价等分析方法。研究结果1.未婚流动女性生殖健康知识缺乏。仅15.9%的未婚流动女性知道“月经正常的妇女的易孕期”；38.4%知道怀孕后最早最特征的症状；多数避孕方法的知晓率低于40%；40.3%的未婚流动女性不知道或者没有意识到人工流产对于身心健康的影响；多数未婚流动女性听说过艾滋病、常见的性病,但对艾滋病、性病的症状、传播途径、及危害缺乏全面的、科学的认识。2.未婚流动女性对婚前性行为的态度较以往研究开放。31.9%的未婚流动女性支持婚前性行为,14.2%的对象支持未婚先孕,未婚流动女性的性观念仍处于较传统的状态,与以往研究相比较,她们的相关态度呈开放趋势。3.未婚流动女性婚前性行为、人工流产率较高。未婚流动女性自报婚前性行为发生率为16.9%,在有婚前性行为的女性中,26.4%的对象自报有人工流产的经历。4.未婚流动女性对生殖健康保健服务需求较大。85.3%的未婚流动女性认为有必要向他们提供生殖健康知识、咨询、避孕服务,其中58.4%的对象有获得正确性知识的需求,32.9%的对象希望获得避孕咨询服务,32.2%希望获得妇科检查服务等。5.我国中西部未婚流出女性生殖健康知识、态度、及婚前性行为不同,差异有显著性统计学意义。影响未婚流动女性婚前性行为的因素为：有无男友、年龄、外出务工时间、当地或居住地是否有避孕服务、住宿类型、避孕知识得分、性病／艾滋病知识、学历、是否与男友有性与生殖健康话题交谈、婚前性行为态度,但中部、西部未婚流出女性婚前性行为发生的影响因素不同。6.基于社区卫生服务开展未婚流动女性的生殖健康保健服务,具有一定的可行性和有效性,但同时存在一些局限性。可行性体现在：①社区卫生服务机构有良好的群众基础,容易实现生殖保健的友好服务；②社区卫生服务机构提供的保健服务可及性较好；③社区卫生服务机构的医务人员容易与未婚人群建立信任的关系,有利于保健服务的开展；④社区卫生服务机构的服务费用低廉；⑤经过近半年的干预发现,干预组研究对象生殖健康知识显著提高,性相关态度和行为有所改变。局限性体现在：①以健康教育和咨询为主开展的性与生殖健康保健服务,需要政府部门的支持和投入,其力度有限；②缺乏开展性与生殖保健服务的专业人员；③社区卫生是以需求为导向的,不同类型的社区,社区服务内容倾向不同。④性与生殖保健的短期干预被证明是有效的,但其长期效果尚不能确定。结论及建议1、未婚流动女性生殖健康现状不容乐观,应引起社会各界的关注。政府应将未婚流动人口的性与生殖健康问题纳入到城市卫生服务的提供和管理体系中,并逐渐完善该体系,加大对未婚流动人口性与生殖健康的投入。2、未婚流动女性的生殖健康知识贫乏,知识来源方式单一,提倡“学校-家庭-社会”的教育体系可提高她们的知识水平。让未婚流动人群接受更多的来自于学校的性与生殖健康教育,家庭和社会教育相结合对性教育起辅助和加强的作用。3、社会多部门联合促进未婚流动人口的性与生殖健康。计划生育部门和卫生部门是生殖保健服务的主要提供部门,但服务信息可及性差、并且流动人口具有对性与生殖健康服务需求不断变化,可接受性差,管理难度大的特点。因此,需要社会各界的共同协作以促进未婚流动女性的性与生殖健康。4、大力推行友好服务。建立广泛的友好信息与服务,可以提高未婚人群性与生殖健康的可及性。很多未婚人群由于“不好意思”而错失接受生殖健康服务,在选择服务时,她们也会考虑医疗技术、保护隐私、服务价格、工作人员的服务态度、就诊环境、候诊时间、便利性等。这些都反映了他们对“友好服务”的渴望。5、结合实际,进一步探索提高未婚人群生殖健康的干预措施。研究的创新点1、首次探讨了我国中西部未婚人群的生殖健康现状,及影响因素的差异。2、率先尝试了在社区卫生服务机构中开展未婚流动人口生殖健康综合干预研究。更多还原

【Abstract】 Objective:To understand the status of reproductive health knowledge, attitudes, behaviors, and demand for reproductive health services among unmarried migrant female in China, to analysis and compare the influencing factors of the occurrence of premarital sex, to find intervention strategies to improve the reproductive health level of unmarried migrant female and to assess its’intervention effects, so to provide scientific evidences for developing policies for the relevant government departments.Methods:Ⅰ. Survey on reproductive health KAP and demand for reproductive health service among unmarried migrant female:both of quantitative and qualitative methods were used. A total sample of 5156 unmarried migrant female workers from three factories, with one in Guangzhou and two in Shenzhen, were obtained by simple random sampling. A self-designed questionnaire was conducted to measure the subjects’reproductive health knowledge, attitudes, behaviors, demands for reproductive health services etc. Additionally, the interview was conducted as qualitative method.Ⅱ. A comparative study on reproductive health status among unmarried migrant female from different regions of China:to analysis the different status of reproductive health knowledge, attitudes, behaviors and the demand for health services between the unmarried female from the central region and the western region of China, to find the influencing factors of the occurrence of premarital sex and to compare the factors stratified by regions.Ⅲ. A community-based comprehensive intervention pilot to improve the reproductive health of unmarried migrant female:a big factory located on Shenzhen which separate into two parts was selected as the research sites, of 402 and 449 unmarried migrant females were obtained as intervention and control group from the two parts, respectively. The intervention included distributing promotional materials, organizing lectures and peer-education, offering counseling and contraceptive services, and so on. The intervention activities lasted 6 months, the total follow-up rate was up to 85.9%. Questionnaire surveys were carried out before and after intervention to evaluate the effect of the intervention project, and summarizing the process of the intervention project to assess the feasibility of the intervention model.Results:Ⅰ. Unmarried migrant female lacks of reproductive health knowledge. There were only 15.9% of the participants knew "the easiest pregnant period of a normal menstruation women ", only 38.4% knew that the characteristic symptoms of the early pregnancy; less than 40% can tell four or more contraceptive methods,40.3% of unmarried women did not know or did not realize the impact of abortion. Most unmarried migrant female had heard of AIDS, common sexually transmitted diseases, however, they lacked of comprehensive understanding of symptoms and transmission of AIDS and STD.Ⅱ. The attitude towards premarital sex among unmarried migrant female were more open than that in the previous studies. There were 31.9% and 14.2%of the subjects held a favorable attitude towards premarital sex, and premarital pregnancy, respectively. The attitude towards premarital sex among unmarried migrant female were still traditional, however, compare with the previous study, their relative attitudes were more open.Ⅲ. The premarital sex rate and abortion rate were high among unmarried female. The self-reported premarital sex rate was 16.9%, and the self-reported abortion rate was 26.4% among the unmarried migrant female who had reported premarital sex. Ⅳ. The need and demand for reproductive health care services in unmarried migrant female was unmet. There were 85.3% subjects thought it is necessary to provide reproductive health knowledge, counseling, and contraceptive service to them, including 58.4% of the subjects demand for correct information on reproductive health,32.9% of them need contraceptive counseling, and 32,2% of the subjects demand for gynecological examination services.Ⅴ. Significant difference on reproductive health knowledge, attitudes, and prevalence rate of premarital sex existed between central and western regional of China. The influencing factors of premarital sex included whether or not have boyfriend, age, how long they had left their home, the availability of contraceptives on the place where they live now, type of living conditions, knowledge scores on contraceptive and AIDS/STD, education level, communicate sexual and reproductive health topic with boyfriend, attitude to premarital sex. Additionally, the factors of premarital sex among unmarried migrant female from the central were different from that among unmarried migrant female from the western part of China central.Ⅵ. It is feasible and effective to carry out reproductive health service among unmarried migrant female based on community health service, however, there were still some limitations. The feasibility was reflected in the following aspects:First, as community health services have a good mass base, youth friendly services of reproductive health are easy to implement. Second, the accessibility of reproductive health services provided by community health service is good. Third, the medical staffs of the community health service organization are easy to establish a trust relationship with the unmarried population, which is conducive to carry out health care service. Fourth, it is low cost to see a doctor at community health service center. Fifth, after the intervention which lasted 6 months, we found that the reproductive health knowledge was improved significantly among the subjects in the intervention groups, more subjects in the intervention group disapproval of premarital sex, and the premarital sex prevalence rate decreased. The limitations reflected in the following aspects:First, government supports and investment are needed to carry out sexual and reproductive health service in the form of health education and counseling; however, the government may not invest enough money to build reproductive health system for unmarried migrant population in a short period. Second, it lacks of a group of medical staffs to carry out reproductive health service special for unmarried migrant population. Third, community health is a demand-oriented organization, so the community services orientation are different among different types of communities. Fourth, the short-term effect of sexual and reproductive health interventions were proven to be effective, however, further studies are needed to explore whether the long-term effective exist or not.Conclusions and suggestions:Ⅰ. The reproductive health status of unmarried female migrants is on no way of optimistic, which should be focused by all sectors of the community. Take the sexual and reproductive health of unmarried migrant population into the urban health service and management system, and increase investments to perfect the system gradually.Ⅱ. Unmarried female migrants lack of productive health knowledge, and they only have simple way of obtaining those knowledge, thus, advocating the’School-Family-Society’model of education is imperative. It may be helpful to make the unmarried migrant population learn more sexual and reproductive health from school, family and social education play auxiliary role in sexual education, which can strengthen the effects of sexual education from school.Ⅲ. Multi-sectoral collaboration is needed to promote sexual and reproductive health level. Family planning departments and health departments are the main provider of the reproductive health service, however, among the unmarried population, the accessibility and acceptability of the sexual health service are poor, their need for sexual health services are changed from time to time, and it is difficult to manage the unmarried migrant population. Therefore, it is necessary that all the social sectors should work together to promote sexual and reproductive health level of unmarried migrant population. Ⅳ. Youth or adolescent friendly service is advocated. The accessibility of reproductive health service are improved among unmarried migrant population through establish a broad-friendly information and service. Because of’embarrassment’, many unmarried persons missed the chance of access to sexual and reproductive health service. The unmarried migrant population will consider the medical technology, privacy protection, price, service attitude, the medical environment, waiting time, convenience and so on when they choose sexual and reproductive health services, all of which reflect that they are eager for youth friendly service.Ⅴ. To improve the reproductive health level of the unmarried migrant, further study is needed which should be carried out by combining practice.Innovations:Ⅰ. It is the first time to clarify the different status and influencing factors of the reproductive health between the unmarried population from the central and the western of China.Ⅱ. Taking the leading in trying to carry out reproductive health interventions among unmarried females based on community health service.更多还原