Espey Eve, Ogburn Tony, Espey David, Etsitty Virgil
Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, USA.
Perspect Sex Reprod Health. 2003 Jul-Aug;35(4):169-73. doi: 10.1363/psrh.35.169.03.
The IUD once accounted for about half of contraceptive use among Navajo women but is now little used in this population, which has a high rate of unintended pregnancy. Identifying barriers to use--including those stemming from providers' IUD-related knowledge, attitudes and practices--could help expand use of the method.
In 2000, 107 Navajo Area Indian Health Service providers who offer contraceptive services completed a mailed survey. Responses of women's health providers and other types of providers were compared, using the Cochran-Mantel-Haenszel method.
Overall, 69-78% of providers had good factual knowledge about the IUD and felt adequately prepared to insert a device or counsel women about it; considerably larger proportions of women's health providers than of others felt able to counsel about and insert IUDs. Sixty-five percent of providers (88% of women's health providers and 50% of others) currently inserted IUDs, and only 8% (none of them women's health providers) never recommended the method. The main reasons providers cited for not recommending the IUD were concerns about its safety and about side effects (mentioned by 69% and 44%, respectively); these concerns did not differ by provider type.
Provider education and training should focus on insertion techniques and on the safety of available IUDs. Training should be targeted not only to women's health providers, but to family practice physicians, nurse practitioners and other providers who offer family planning counseling and services.
宫内节育器（IUD）曾在纳瓦霍族女性的避孕方式中占比约一半，但目前在该人群中很少使用，而该人群意外怀孕率很高。识别使用障碍——包括那些源于提供者与宫内节育器相关的知识、态度和做法的障碍——可能有助于扩大该方法的使用。
2000年，107名提供避孕服务的纳瓦霍地区印第安卫生服务提供者完成了一项邮寄调查。使用 Cochr an-Mantel-Haenszel方法比较了女性健康提供者和其他类型提供者的回答。
总体而言，69%-78%的提供者对宫内节育器有良好的事实性知识，并认为自己有足够的准备来插入宫内节育器或为女性提供相关咨询；女性健康提供者中认为自己能够提供宫内节育器咨询和插入服务的比例比其他提供者高得多。65%的提供者（女性健康提供者中的88%和其他提供者中的50%）目前会插入宫内节育器，只有8%（女性健康提供者中无人如此）从不推荐该方法。提供者不推荐宫内节育器的主要原因是担心其安全性和副作用（分别有69%和44%提到）；这些担忧在不同类型的提供者中并无差异。
提供者教育和培训应侧重于插入技术以及现有宫内节育器的安全性。培训不仅应针对女性健康提供者，还应针对提供计划生育咨询和服务的家庭医生、执业护士及其他提供者。
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