發(fā)布時(shí)間：2018-06-24 07:16

  本文選題：避孕措施 + 免費(fèi)�。� 參考：《吉林大學(xué)》2013年碩士論文

【摘要】：放置宮內(nèi)節(jié)育器（IUD，Intrauterine Device）是我國育齡婦女采取的主要避孕措施，中國育齡婦女占全球育齡婦女人數(shù)的26.9%，使用IUD人數(shù)占全球使用IUD育齡婦女人數(shù)的75.7%。2011年底，我國2.46億采取避孕措施的已婚育齡婦女中，正在使用宮內(nèi)節(jié)育器的達(dá)1.32億人。面對(duì)如此龐大的IUD使用人群，了解并掌握其中免費(fèi)IUD的使用狀況，是十分必要的。 目的： 國家向育齡群眾提供免費(fèi)IUD歷時(shí)40多年，是黨和政府最早實(shí)行的覆蓋面廣泛的一項(xiàng)惠民工程，也是“十二五”時(shí)期基本公共服務(wù)的重點(diǎn)內(nèi)容之一。免費(fèi)IUD公共服務(wù)，是計(jì)劃生育基本國策的制度安排，服務(wù)對(duì)象是健康的育齡婦女，措施落實(shí)需要借助技術(shù)人員專業(yè)操作才能達(dá)成，服務(wù)對(duì)象的需求、服務(wù)提供者的能力是該項(xiàng)公共服務(wù)的基本要素，服務(wù)供給能力和服務(wù)提供水平則直接影響到這項(xiàng)基本公共服務(wù)效能的發(fā)揮。全國免費(fèi)IUD使用管理情況調(diào)查，目的在于摸清底數(shù)，適時(shí)、及時(shí)地掌握免費(fèi)IUD使用狀況，了解服務(wù)提供能力，了解免費(fèi)IUD的需求和供給的適應(yīng)性以及免費(fèi)IUD作為避孕節(jié)育措施的相關(guān)影響因素，通過分析獲得的數(shù)據(jù)和趨勢(shì)，了解群眾實(shí)際需求，梳理、分析存在的系統(tǒng)性問題，討論并提出有利于可持續(xù)發(fā)展的對(duì)策和建議，為完善免費(fèi)IUD需求和供給之間的適應(yīng)性、促進(jìn)免費(fèi)IUD使用管理規(guī)范化建設(shè)、提高免費(fèi)IUD公共服務(wù)的提供能力、更有成效地對(duì)免費(fèi)IUD公共服務(wù)科學(xué)決策、實(shí)施和評(píng)價(jià)，促進(jìn)和提高宏觀管理水平和循證決策能力，提供參考依據(jù)。 方法： 免費(fèi)IUD使用管理情況調(diào)查于2012年2月~10月在全國31個(gè)�。▍^(qū)、市）、5個(gè)原計(jì)劃單列市、新疆生產(chǎn)建設(shè)兵團(tuán)范圍進(jìn)行，所有承擔(dān)免費(fèi)IUD放置技術(shù)的省、市、縣、鄉(xiāng)級(jí)計(jì)劃生育技術(shù)服務(wù)機(jī)構(gòu)和醫(yī)療單位均參加了調(diào)查。調(diào)查方法有發(fā)放問卷自填、面對(duì)面訪談式問答、觀察法、查閱資料法等。調(diào)查內(nèi)容為2009年1月1日至2011年12月31日之間，國家免費(fèi)IUD的使用情況、使用效果、產(chǎn)品質(zhì)量狀況、影響使用的因素等。調(diào)查全過程進(jìn)行了嚴(yán)格的質(zhì)量控制，統(tǒng)一方案、統(tǒng)一問卷、統(tǒng)一編碼、統(tǒng)一培訓(xùn)，各級(jí)機(jī)構(gòu)分別獨(dú)立完成調(diào)查表并直接上報(bào)，每份問卷均做了完整性、正確性審核，采用Epidata3.1雙人雙錄，差錯(cuò)率控制在萬分之一以內(nèi)，應(yīng)用SPSS13.0進(jìn)行分析，對(duì)結(jié)果進(jìn)行了一般描述分析。 結(jié)果： 在免費(fèi)IUD技術(shù)服務(wù)中，基層計(jì)劃生育技術(shù)服務(wù)機(jī)構(gòu)仍在繼續(xù)發(fā)揮著主要作用；免費(fèi)IUD使用率，全國總體呈下降趨勢(shì)，免費(fèi)IUD的使用率與區(qū)域經(jīng)濟(jì)水平總體上呈負(fù)相關(guān)，免費(fèi)IUD公共服務(wù)提供與育齡婦女的需求之間有不適應(yīng)之處；免費(fèi)IUD品種的供需方面，尚有34.3%的技術(shù)服務(wù)機(jī)構(gòu)在臨床應(yīng)用中對(duì)免費(fèi)IUD產(chǎn)品不認(rèn)可，免費(fèi)IUD品種結(jié)構(gòu)調(diào)整的運(yùn)行機(jī)制需完善；免費(fèi)IUD使用和供給的種類趨于合理，實(shí)際使用免費(fèi)IUD的種類數(shù)為3～5種，全國平均為3.96種，免費(fèi)IUD使用普及率和使用量構(gòu)成比位居前4位的是T型環(huán)、元宮環(huán)、含銅宮腔型環(huán)、花式環(huán)；全國免費(fèi)IUD三年累積使用效果分別是：脫落比0.0177、帶器妊娠比0.0118、因癥取出比0.025、續(xù)用比0.7913，帶器妊娠情況相對(duì)好轉(zhuǎn)并成為當(dāng)前影響使用效果的主要因素，脫落率和因癥取出率明顯降低，續(xù)用率有較大幅度的升高，避孕有效率有所提高；各類免費(fèi)IUD使用效果仍不同程度存在需要進(jìn)一步改進(jìn)的方面；IUD技術(shù)服務(wù)能力有長(zhǎng)足提高，但免費(fèi)IUD技術(shù)服務(wù)水平還需繼續(xù)提升，全國免費(fèi)IUD技術(shù)服務(wù)機(jī)構(gòu)對(duì)免費(fèi)IUD的知曉率為42.4%，各層級(jí)機(jī)構(gòu)及兩類機(jī)構(gòu)免費(fèi)IUD知曉率和用量構(gòu)成比呈正相關(guān)；各類免費(fèi)IUD的知曉率和使用普及率呈正相關(guān)；技術(shù)服務(wù)機(jī)構(gòu)能熟練掌握放置技術(shù)的免費(fèi)IUD種類數(shù)小于實(shí)際使用免費(fèi)IUD種類數(shù)，技術(shù)服務(wù)機(jī)構(gòu)放置IUD操作技能與實(shí)際業(yè)務(wù)不匹配，略低于實(shí)際要求；技術(shù)服務(wù)機(jī)構(gòu)放置技術(shù)操作技能與實(shí)際匹配的有T型環(huán)，元宮環(huán)，含銅宮腔型環(huán)，其他4類免費(fèi)IUD的操作技能均不足，需要加強(qiáng)培訓(xùn)；全國技術(shù)服務(wù)機(jī)構(gòu)中，有16.5%的機(jī)構(gòu)能在滅菌有效期內(nèi)用完免費(fèi)IUD；22.6%的機(jī)構(gòu)對(duì)于超過滅菌有效期的免費(fèi)IUD進(jìn)行消毒后再用，至少32.2%的機(jī)構(gòu)存在一定的浪費(fèi)現(xiàn)象，技術(shù)服務(wù)機(jī)構(gòu)對(duì)免費(fèi)IUD的使用管理需加強(qiáng)，免費(fèi)IUD的技術(shù)服務(wù)有待更加規(guī)范；免費(fèi)IUD放置使用時(shí)遇到的問題和困難，主要源自個(gè)體差異、產(chǎn)品結(jié)構(gòu)不滿意和服務(wù)提供不足；影響免費(fèi)IUD使用的首要因素是服務(wù)提供不足。 結(jié)論： 免費(fèi)IUD放置技術(shù)服務(wù)主要由縣、鄉(xiāng)兩級(jí)落實(shí)，97.6%的IUD放置手術(shù)在縣鄉(xiāng)兩級(jí)技術(shù)服務(wù)機(jī)構(gòu)實(shí)施。城市化快速進(jìn)程中，，需制定銜接城鄉(xiāng)免費(fèi)IUD共服務(wù)體系的具體措施，將IUD納入中央財(cái)政保障的完全免費(fèi)提供的基本公共服務(wù)體系，是IUD公共服務(wù)全覆蓋和均等化有關(guān)問題的根本解決途徑。 免費(fèi)IUD使用數(shù)量逐年下降；2009年~2011年全國平均使用率為86.8%，各地免費(fèi)IUD使用率情況有所不同，最高的廈門市為97.4%，最低的海南省為29.7%。為提高財(cái)政資金使用績(jī)效，應(yīng)完善免費(fèi)IUD的計(jì)劃管理運(yùn)行機(jī)制，使免費(fèi)IUD數(shù)量供需的均衡性和匹配性更加科學(xué)合理。 免費(fèi)IUD使用和供應(yīng)的品種趨于合理，全國62.9%的免費(fèi)IUD技術(shù)服務(wù)機(jī)構(gòu)選擇使用3～5種免費(fèi)IUD，免費(fèi)IUD用量構(gòu)成比和使用普及率位居前4位的均為元宮環(huán)、T型環(huán)、花式環(huán)、含銅宮腔型環(huán)；但免費(fèi)IUD品種結(jié)構(gòu)的更新?lián)Q代滯后，應(yīng)適時(shí)和及時(shí)調(diào)整免費(fèi)IUD產(chǎn)品的品種結(jié)構(gòu)。 免費(fèi)IUD放置使用時(shí)遇到的問題和困難，主要源自個(gè)體差異、產(chǎn)品結(jié)構(gòu)不滿意和服務(wù)提供不足；影響免費(fèi)IUD使用的首要因素是服務(wù)提供不足。 免費(fèi)IUD技術(shù)服務(wù)能力尚需提升，技術(shù)服務(wù)機(jī)構(gòu)對(duì)免費(fèi)IUD知曉率為42.4%，實(shí)際使用3.96種免費(fèi)IUD,熟練掌握3.85種免費(fèi)IUD的放置技術(shù)，技術(shù)服務(wù)技能與優(yōu)質(zhì)服務(wù)的要求略有差距。 技術(shù)服務(wù)機(jī)構(gòu)應(yīng)加強(qiáng)免費(fèi)IUD使用管理的制度化和規(guī)范化。
[Abstract]:IUD (Intrauterine Device) is the main contraceptive measure for women of child-bearing age in China. Women of child-bearing age in China account for 26.9% of the number of women of childbearing age in the world. The number of IUD in the number of women of childbearing age using IUD in the world is at the end of the year. Among the 246 million married women of childbearing age in our country, the intrauterine Festival is being used. There are 132 million people in the feeder. It is very necessary to understand and master the use of free IUD in the face of such a large IUD user.
Objective:
The state provided free IUD for more than 40 years to the people of childbearing age. It is one of the most important projects of the party and the government to carry out the broad coverage of the public service. It is also one of the key contents of the basic public service in the "12th Five-Year" period. The free IUD public service is the system arrangement of the basic national policy of family planning, the target of service is the healthy women of childbearing age, and the measures are carried out. The needs of the technical personnel, the needs of the service objects, the ability of the service providers are the basic elements of the public service. The service supply ability and the level of service supply directly affect the performance of the basic public service. The national free IUD makes a survey on the management situation, the purpose is to find out the bottom number, and to find out the proper number of the public service. Timely grasp the use of free IUD, understand the ability to provide services, understand the requirements and the adaptability of free IUD and the related factors of free IUD as contraceptive measures. Through the analysis of the data and trends obtained, we can understand the actual needs of the masses, comb, analyze the systematic problems, discuss and put forward the benefits. The countermeasures and suggestions for sustainable development, in order to improve the adaptability of free IUD demand and supply, promote the standardized construction of free IUD management, improve the ability to provide free IUD public service, make more effective decisions on free IUD public service, implement and evaluate, promote and improve the level of macro management and evidence-based decision-making ability. Reference basis.
Method:
The free IUD management survey was conducted in 31 provinces (districts, cities), 5 original listed cities and the Xinjiang production and Construction Corps in ~10 month of February 2012. All the provinces with free IUD placement technology, city, county, township level family planning technical service institutions and medical units all participated in the investigation. Interviewing, observing, and consulting information. The content of the survey is from January 1, 2009 to December 31, 2011, the use of free IUD, the use effect, the quality of the product, the factors affecting the use, etc.. The whole process of investigation is strictly controlled by quality, unified plan, unified questionnaire, unified coding, unified training, training at all levels. The organization completed the questionnaire independently and reported it directly. Each questionnaire did the integrity, the correctness review, the Epidata3.1 double record, the error rate within 1/10000, the SPSS13.0 analysis, and the general description of the results.
Result:
In the free IUD technology service, the basic family planning technology service institutions are still playing the main role; the free IUD utilization rate, the overall decline trend in the whole country, the free IUD use rate and the regional economic level are negatively related, the free IUD public service is incompatible with the needs of women of childbearing age; free IUD In the supply and demand of the varieties, 34.3% of the technical service agencies do not approve of the free IUD products in clinical application, the operating mechanism of the free IUD variety structure adjustment needs to be perfected; the free IUD use and supply types tend to be reasonable, the number of free IUD types is 3~5, the national average is 3.96, the free IUD use rate and make the free use of free IUD The amount composition ratio is the top 4 in the T ring, the yuan palace ring, the cupric uterine cavity ring, and the flower type ring. The cumulative use effect of free IUD in the country is: the ratio of exfoliative ratio 0.0177, the ratio of pregnancy to pregnancy 0.0118, the ratio of the disease extraction ratio 0.025, the continued use ratio 0.7913, the relative improvement of the belt pregnancy and the main factor affecting the current effect, the exfoliative rate. The rate of removal of the disease was significantly reduced, the rate of continued use was raised, the efficiency of contraception increased, and the effect of free IUD was still improved in different degrees. The ability of IUD technology service was greatly improved, but the level of free IUD technical service needs to be further improved, and the free IUD technical service organization in China was to be improved. The awareness rate of free IUD was 42.4%. The rate of free IUD awareness was positively correlated with the rate of free IUD awareness and the ratio of free IUD. The free IUD species number of technical service institutions was less than the number of free IUD, and the technical service institutions placed I. The UD operation skills do not match the actual business, slightly lower than the actual requirements; the technical service institutions have the T ring, the yuan palace ring, the copper uterine cavity ring, the other 4 kinds of free IUD operating skills, and the need to strengthen the training; among the national technical service institutions, 16.5% of the institutions can be in the sterilization period. Use the free IUD for free; 22.6% of the institutions to disinfect the free IUD that exceed the period of sterilization, at least 32.2% of the institutions have a certain waste, the management of the technical service institutions on the use of free IUD needs to be strengthened, and the technical service for free IUD needs to be more standardized; the problems and difficulties encountered in the free IUD placement are the main source. From the individual differences, the product structure is not satisfied and the service supply is insufficient; the primary factor affecting the free IUD usage is insufficient service provision.
Conclusion:
Free IUD placement technology services are mainly implemented by county, township level two, and 97.6% of the IUD placement operation in county and township level two technical service institutions. In the rapid urbanization process, the concrete measures to connect the free IUD common service system in urban and rural areas should be formulated, and IUD is incorporated into the basic public service system provided by the central financial security free fee free service. It is a IUD public suit. The fundamental solution to the problems of full coverage and equalization.
The number of free IUD use is declining year by year; the national average utilization rate of ~2011 in 2009 is 86.8%. The use rate of free IUD in different places is different, the highest in Xiamen is 97.4%. The lowest Hainan province is to improve the performance of financial funds, and the plan management mechanism of free IUD should be perfected so as to balance the supply and demand of free IUD and the balance of the free IUD quantity and supply. The matching is more scientific and reasonable.
Free IUD use and supply of varieties tend to be reasonable, 62.9% of the national free IUD technical service institutions choose to use 3~5 kinds of free IUD, free IUD dosage form ratio and the use of the top 4 are the top 4 are yuan palace ring, T ring, flower type ring, copper bearing ring type ring; but free IUD product structure renewal and replacement lag, should be timely and timely adjustment Whole free IUD product variety structure.
The problems and difficulties encountered in the use of free IUD are mainly from individual differences, product dissatisfaction and lack of service delivery, and the primary factor affecting the use of free IUD is the shortage of service.
The free IUD technology service capacity needs to be promoted. The rate of awareness of free IUD is 42.4%, and 3.96 kinds of free IUD are actually used. 3.85 kinds of free IUD placement techniques are mastered, and the technical service skills are slightly different from the requirements of high quality services.
Technical service institutions should strengthen the institutionalization and standardization of free IUD usage management.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R169.4

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 徐小佶;關(guān)于政府服務(wù)質(zhì)量管理若干問題的思考[J];福建行政學(xué)院福建經(jīng)濟(jì)管理干部學(xué)院學(xué)報(bào);2001年02期

2 古偉文,梁貴尚;宮內(nèi)節(jié)育器安全性研究新進(jìn)展[J];國外醫(yī)學(xué)(計(jì)劃生育分冊(cè));1993年04期

3 諸葛汶;國外宮內(nèi)節(jié)育器并發(fā)癥現(xiàn)狀[J];國外醫(yī)學(xué)(計(jì)劃生育分冊(cè));1999年04期

4 李亮,李瑛;宮內(nèi)節(jié)育器副作用和并發(fā)癥的研究進(jìn)展[J];國外醫(yī)學(xué)(計(jì)劃生育分冊(cè));2003年02期

5 吳尚純;;宮內(nèi)節(jié)育器的應(yīng)用進(jìn)展[J];國際生殖健康/計(jì)劃生育雜志;2009年02期

6 馬昊;曾小溪;;我國基本公共服務(wù)均等化的評(píng)價(jià)指標(biāo)體系構(gòu)建——基于東中西部代表省份的實(shí)證研究[J];江漢論壇;2011年11期

7 尉建霞;韓麗暉;;含銅宮內(nèi)節(jié)育器的遠(yuǎn)期安全性研究[J];中國計(jì)劃生育學(xué)雜志;2007年02期

8 ;12萬例宮內(nèi)節(jié)育器避孕效果調(diào)查報(bào)告[J];中國計(jì)劃生育學(xué)雜志;2007年03期

9 張開寧;吳尚純;彭林;李俊杰;鄧睿;周潔;熊源發(fā);程怡民;;中國9省農(nóng)村育齡婦女IUD使用及失敗現(xiàn)狀的流行病學(xué)研究[J];中國計(jì)劃生育學(xué)雜志;2007年11期

10 姜潤(rùn)生;張開寧;吳尚純;李俊杰;;知情選擇中提供IUD種類與效果關(guān)系的分析[J];中國計(jì)劃生育學(xué)雜志;2007年12期

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