【作者】 胡平成；

【导师】 孙振球；

【作者基本信息】 中南大学 ， 社会医学与卫生事业管理， 2013， 博士

【摘要】 目的：了解未婚人工流产女性的基本情况,并分析其生殖健康知识、态度和行为现状,探讨未婚人工流产女性生殖健康知识、对“婚前性行为”态度和避孕措施采取频率的影响因素,以采取有效措施提高未婚人工流产女性生殖健康知识水平、自我保护意识和有效避孕技能,从而减少未婚女性人工流产发生率,为我省计划生育和妇幼保健工作的开展提供科学依据。方法：采用分层随机抽样的方法,对2010年11月-2012月6月在长沙市部分一级医院、二级医院和三级医院计划生育门诊确诊妊娠并要求终止妊娠的2650名未婚女性进行面对面匿名访谈调查,将获取的信息通过EpiData录入数据库,对定性和等级指标进行数量化处理和统一编码后用SPSS17.0和MLwiN软件进行统计分析,统计方法包括统计描述、单因素分析(方差分析、χ2检验、非参数检验),多因素分析(聚类分析、两水平方差成分模型、单水平Logistic回归分析、两水平Logistic回归模型)。结果：①未婚人工流产女性的平均年龄为(23.93±2.92)岁,城镇和农村人口之比为2.29：1,51.8%的女性是外来人口,65.2%文化程度在大专及以上,职业以公司职员(39.9%)、公务员(10.8%)和学生(10.1%)为主,月收入1701-2500元者占40.6%,家庭状况较好者占36.3%,首次工作年龄为“18-25岁”的女性占57.5%,64%更换过工作,72.8%的女性首次性交年龄在20-24岁,79.8%的女性发生首次性行为的原因是出于爱情。②未婚人工流产女性生殖健康知识平均得分为(22.26±7.03)分,大部分女性能掌握基本的生殖健康知识,但对排卵期和易孕期的计算、金指标以外的早孕反应、新型避孕方法、软下疳等性传播疾病了解较少,未婚人工流产女性获得生殖健康知识的来源主要是书本、报纸、杂志(80.6%)和广播、电影、电视(59.2%),她们最想了解的生殖健康知识分别是性生理卫生知识(82.9%)、避孕知识(63.1%)和优生优育知识(61.9%)；66.4%的未婚人工流产女性对婚前性行为持支持或无所谓态度,80.3%的女性认为人工流产危害大,主要是影响女性身体健康(98.0%)、心理健康(61.2%)和日常生活(44.5%),86.8%的女性愿意在今后的性生活中采取有效措施防止意外怀孕；93.6%的未婚人工流产女性都采取过避孕措施,但仅有9.2%能坚持避孕,主要避孕措施是避孕套(66.8%)和体外排精(16.0%)；③28.2%的女性做过二次及以上人工流产,对本次人工流产的原因进行调查,42.9%的女性是无计划性生活,24.9%的女性避孕失败,29.4%的女性是接触到有害环境或胚胎发育不良,经Spearman相关分析和非参数检验表明,多次人工流产与生殖健康知识、避孕措施采取频率均存在相关关系(P<0.05)；④两水平方差成分模型显示,文化程度、职业、月收入、父母婚姻状况、首次性交年龄、首次性交原因、父母教育、学校社区宣传和男友交流等9个因素对未婚人工流产女性生殖健康知识得分有影(P<0.05),单水平Logistic回归分析显示,年龄、户口所在地、籍贯、在本市常住时间、文化程度、职业、月收入、家庭经济状况、兄弟姐妹数、父母婚姻状况、学校社区宣传、男友交流以及生殖健康知识得分等13个因素对未婚人工流产女性“婚前性行为”的态度有影响(α入=0.05,α出=0.10),两水平logistic回归模型显示,年龄、户口所在地、籍贯、在本市(县)常住时间、文化程度、职业、月收入、家庭经济状况、家里兄弟姐妹数、父母婚姻状况、首次工作年龄、更换工作次数、父母教育、学校社区宣传、男友交流、生殖健康知识得分、对婚前性行为态度、采取避孕措施的意愿等18个因素对未婚人工流产女性避孕措施采取频率有影响(P<0.05)结论：①未婚人工流产女性年龄较小,以城镇户口为主,大部分是外来人口,文化程度普遍较高,主要是公司职员和学生,大部分女性更换过工作,首次性交的原因主要是爱情。②大部分未婚人工流产女性对生殖健康知识有一定了解,但了解不深,其获得生殖健康知识的主要来源是书籍和媒体；大部分女性对婚前性行为持支持或无所谓态度,绝大部分女性都愿意在今后的性生活中采取有效措施来防止意外怀孕；多数未婚人工流产女性都采取过避孕措施,但只有小部分能坚持,主要是采用避孕套和体外射精。③大部分女性人工流产的原因是无计划性生活或避孕失败,并且多次人工流产与女性生殖健康知识、避孕措施采取频率均存在相关关系；④文化程度、职业、月收入、父母教育、学校社区宣传、男友同伴交流等多个因素对未婚人工流产女性生殖健康知识、态度、行为有影响,在今后的妇幼保健工作中,要以文化程度较低、月收入较低、工作不稳定的外来务工人员和学生作为重点人群,建立以家庭-学校-社区为一体的“健康教育三角”,采取灵活多样的形式,开展生殖健康知识、态度、行为教育,为未婚女性提供更多、更有效的婚前生殖健康服务。更多还原

【Abstract】 Objective:This research studies the basic situation of unmarried female who takes induced abortion and analyzes the reproductive health knowledge, attitude and behavior status and explores the influence factors of the reproductive health knowledge,attitude to premarital sexual behavior,and Frequency of contraceptive measures of unmarried female who takes induced abortion,so as to take effective measures to improve the reproductive health knowledge’s level, the self-protect consciousness and the effective birth control skills of unmarried female who takes induced abortion. So that reducing the incidence of unmarried women abortion, and providing scientific basis for promoting the work of family-planning, material and child hygiene in our province.Method:By using stratified random sampling method, this research investigates2650unmarried female who were diagnosed of pregnancy by outpatient department of family planning but were asked terminated gestation and comes from part of level Ⅰ hospital, level Ⅱ hospital and level Ⅲ hospital in changsha city from July2010to June2012. Import all the information of research into Epidata statistical software to build a database. Then use the statistical software SPSS17.0and MLwiN to make an analysis of the qualitative and quantification level indexes which should be quantified and unified coding. The Statistical methods include statistical description, one-way analysis (ANOVA and Chi-square test, Nonparametric test), multi-way analysis (Clustering analysis, two level variance component model, single-level Logistic regression analysis, two-level Logistic regression model)Result:①Unmarried female who take induced abortion have an average age of age (23.93±23.93), the ratio of urban and rural population of2.29:1, of whom51.8%female are migrants and65.2%female have the culture level of college or above. These respondents are main composed of company employees (39.9%), and civil service (10.8%) and students (10.1%), and of whom40.6%monthly income reaches1201-1201yuan and36.3%have better family situation,and57.5%female who were the age of18～25for the first time of working,64%changed jobs. The proportion for women who have first sexual intercourse in20to24years old accounted for72.8%, and the major reason (79.8%)of having sex for the first time is out of love.②The average score about reproductive health knowledge was (22.26+7.03) points among unmarried female who take induced abortion, and most of whom can master the basic knowledge of reproductive health, but litter know about the calculation of ovulation period and likely pregnancy period, other index about morning sickness but the gold standard, new Contraceptive Methods, chancroid and other sexually transmitted diseases. The main access to reproductive health knowledge are books, newspapers and magazines (80.6%) and radio, movies, television (59.2%) for unmarried female who take induced abortion, and what they want to understand about the reproductive health knowledge is physiological health knowledge (82.9%),contraceptive knowledge(63.1%),eugenic knowledge (61.9%).66.4%of unmarried female who take induced abortion hold support or indifferent attitude on premarital sex,80.3%of female recognize it’s harmful to abortion,and86.8%of these female are willing to take effective measures to prevent the accidental pregnancy in the future sexual life.93.6%of unmarried female who take induced abortion have taken contraceptive measures, but only9.2%insisting on contraception, and major contraception is a condom (66.8%), Onanism (16.0%).②28.2%of women have done two or more induced abortion. Investigating the reason for the abortion, it shows that42.9%of women were unplanned sex,24.9%of the female contraceptive failure,29.4%of women are exposed to harmful environment or embryo dysplasia. Spearman correlation analysis and Nonparametric test show that the multiple abortions is correlated to reproductive health knowledge and the frequency of contraceptive measures (P<0.05);④Multiple levels of model research shows that culture degree, occupation, monthly income, parents’ education, school, community publicity, boyfriend peer exchanges, and other factors have effect on the knowledge of reproductive health for unmarried female who take induced abortion, the attitude to premarital sex, contraception frequency and the number of induced abortion (P<0.05). Single-level Logistic regression analysis showed that13factors including age, residence, native place, time to live in this city, educational level, occupation, Monthly Income, families’ economic conditions, number of siblings, marital status of parents, Publicity among school and community, communication with boy-friend and score of reproductive health knowledge,affect attitude to pre-marital sex of Unmarried female who take induced abortion (αλ=0.05,α出=0.10). Two-level Logistic regression model shows that18factors including age, residence, native place, time to live in this city, educational level, occupation, monthly income, families’ economic conditions, number of siblings, marital status of parents,age for the first time work, number of changing jobs, parents’ education, Publicity among school and community, communication with boy-friend and score of reproductive health knowledge, attitude toward "pre-marital sex, willingness to take contraceptive measures, have effect on frequency of contraceptive measures of Unmarried female who take induced abortion (P<0.05).Conclusion:①The age of unmarried female who take induced abortion is young. They mainly come form urban city and mostly are migrants, and generally have high cultural level, mainly are the company’s staff and students, most changed work. The major reason is love for sexual intercourse in the first time of female.②Most of the unmarried female who take induced abortion have certain understanding to the knowledge of reproductive health but only litter, for whom the main access to the knowledge of reproductive health is book or media; Most women holds support or indifferent attitude on premarital sex, and the large majority of women are willing to take effective measures to prevent the accidental pregnancy in the future sexual life; Most unmarried female who take induced abortion have taken contraceptive measures mainly by condom and Onanism, but only a fraction can insist.③The main reason of most abortion are unplanned sex or contraceptive failure, and the multiple abortions is correlated to reproductive health knowledge and the frequency of contraceptive measures.④Culture degree, occupation, monthly income, parents’ education, school, community publicity, boyfriend peer exchanges, and other factors have effect on the knowledge of reproductive health, attitude and behavior for unmarried female who take induced abortion. Focusing on the key crowd choosing community, establishing the "triangle of health education based on home-school-community, we should adopt flexible and varied forms to carry out the reproductive health knowledge, attitude and behavior education in the future work of maternal and child health care, which will to provide more and more effective reproductive health service before marriage for unmarried female.更多还原