Sable M R, Libbus M K, Chiu J E
School of Social Work, University of Missouri-Columbia, USA.
Fam Plann Perspect. 2000 May-Jun;32(3):124-31.
If the national health objective of reducing unintended pregnancy is to be met, a better understanding is needed of barriers to women's acquisition and use of contraceptives.
A sample of 311 Missouri women who were seeking pregnancy tests in public health department clinics in 1997 and who said their potential pregnancy was unintended were asked about potential barriers to family planning. Factors affecting contraceptive use among these women were examined by frequency of use, insurance status, education and race.
In general, the women mostly disagreed that particular factors were potential barriers to contraceptive use. For only one item--worry over the potential side effects of the hormonal injectable contraceptive--did a majority agree or strongly agree that it was a barrier to method use in the previous six months. Women who used a contraceptive infrequently were more likely than frequent users to identify 33 factors in nine areas as being potential barriers to contraceptive use. These ranged from factors involving access to services and condom-specific issues to cost-related concerns, social norms, pregnancy denial, embarrassment over discussing or obtaining birth control, worry about side effects and experience with forced sex, among others. Perceived barriers differed somewhat by insurance status in the areas of access, embarrassment, side effects and forced sex. For example, women with no insurance coverage reported a higher level of agreement that transportation problems had hindered their access to a clinic than did women with private insurance. Level of education affected agreement only in the area of side effects, with more-educated women expressing greater concern about side effects than less-educated women. The respondent's race affected agreement in six areas: access, social norms, pregnancy denial, embarrassment, forced sex and other miscellaneous concerns, such as condom use and relationship issues.
Better education and improved access to and delivery of services might address several factors affecting contraceptive use that are associated with unintended pregnancy. Some barriers, however, such as those related to self-efficacy, self-esteem and fatalistic attitudes about pregnancy, would be much harder for family planning providers to resolve.
若要实现降低意外怀孕这一国家卫生目标，就需要更好地了解阻碍女性获取和使用避孕药具的因素。
选取了311名密苏里州女性作为样本，她们于1997年在公共卫生部门诊所进行妊娠检测，且表示自己此次潜在怀孕是意外怀孕，研究人员询问了她们在计划生育方面可能存在的障碍。通过使用频率、保险状况、教育程度和种族对这些女性中影响避孕药具使用的因素进行了研究。
总体而言，女性大多不同意特定因素是避孕药具使用的潜在障碍。在前六个月中，只有一项——担心激素注射避孕药的潜在副作用——大多数人同意或强烈同意它是使用该方法的障碍。与频繁使用者相比，不经常使用避孕药具的女性更有可能将九个领域中的33个因素视为避孕药具使用的潜在障碍。这些因素包括从涉及服务获取和避孕套特定问题的因素到与成本相关的担忧、社会规范、否认怀孕、讨论或获取节育措施时的尴尬、对副作用的担忧以及强迫性行为经历等。在获取服务、尴尬、副作用和强迫性行为等方面，不同保险状况的女性所感知到的障碍略有不同。例如，没有保险的女性比有私人保险的女性更认同交通问题阻碍了她们前往诊所。教育程度仅在副作用方面影响认同程度，受教育程度较高的女性比受教育程度较低的女性更担心副作用。受访者的种族在六个领域影响认同程度：获取服务、社会规范、否认怀孕、尴尬、强迫性行为以及其他杂项问题，如避孕套使用和关系问题。
更好的教育以及改善服务的获取和提供可能会解决一些影响避孕药具使用且与意外怀孕相关的因素。然而，一些障碍，比如那些与自我效能感、自尊以及对怀孕的宿命论态度相关的障碍，计划生育服务提供者要解决起来会困难得多。
