Xiang Yuan-Xi, Xiong Ju-Yang, Tian Miao-Miao, Yuan Fang, Feng Zhan-Chun
School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
Center for Policy and Health Management, Chinese Academy of Medical Sciences, Beijing, 10020, China.
J Huazhong Univ Sci Technolog Med Sci. 2014 Dec;34(6):869-874. doi: 10.1007/s11596-014-1366-1. Epub 2014 Dec 6.
Postpartum visits (PPVs) are still underutilized in rural China, and identification of factors that influence PPV use is important in ensuring the utilization of maternal health services and for wellbeing of women. A cross-section study was undertaken to collect related data from 347 rural women interviewed six weeks or more after delivery, and an ANOVA was performed to find whether there were significant differences in the number of PPVs among different rural areas in China. According to Andersen's socio-behavioral model of health service use, factors were divided into equitable and inequitable ones. Chi-squared test, univariate and multiple analyses were used to determine the equity of PPV use by identifying factors that were most strongly associated with the use of a PPV. The results showed that 20.2% of the respondents (n=70) did not receive any PPVs, and 62.5% (n=173) of those who had PPVs (n=277) did not receive standard PPVs (referring to at least 3 visits). There was no significant difference among different rural areas in terms of the number of PPVs (F=1.514, P=0.211). Multiple regression analyses revealed that enabling factors such as compensation for delivery expense [OR (95% CI)=2.825 (1.331, 5.995)], village type [OR (95% CI)=1.802 (1.021, 3.182)] and service quality [OR (95% CI)=1.847 (1.074, 3.176)] were strongly associated with PPV use. Both enabling factors such as home visits [OR (95% CI)=1.855 (1.085, 3.174)], service quality [OR (95% CI)=1.993 (1.155, 3.439)] and need factors such as low birth weight [OR (95% CI)=4.424 (1.482, 13.203)] were significantly associated with standard PPV use. Our results suggested that the equitable access to PPVs has been considerably improved in rural areas in China. The associations between inequitable factors and PPV use warrant further exploration, and policies aimed at improving quality and patterns of service supply are needed in order to ensure a full equitable access to maternal health services.
产后访视（PPV）在中国农村地区的利用率仍然较低，识别影响产后访视利用的因素对于确保孕产妇保健服务的利用以及妇女的健康福祉至关重要。开展了一项横断面研究，从347名产后六周或更长时间接受访谈的农村妇女中收集相关数据，并进行了方差分析，以确定中国不同农村地区产后访视次数是否存在显著差异。根据安德森的卫生服务利用社会行为模型，将因素分为公平因素和不公平因素。采用卡方检验、单因素和多因素分析，通过识别与产后访视使用最密切相关的因素来确定产后访视利用的公平性。结果显示，20.2%的受访者（n = 70）未接受任何产后访视，在接受产后访视的人群（n = 277）中，62.5%（n = 173）未接受标准产后访视（指至少3次访视）。不同农村地区在产后访视次数方面没有显著差异（F = 1.514，P = 0.211）。多因素回归分析显示，分娩费用补偿[比值比（95%可信区间）= 2.825（1.331，5.995）]、村庄类型[比值比（95%可信区间）= 1.802（1.021，3.182）]和服务质量[比值比（95%可信区间）= 1.847（1.074，3.176）]等促成因素与产后访视的使用密切相关。家访[比值比（95%可信区间）= 1.855（1.085，3.174）]、服务质量[比值比（95%可信区间）= 1.993（1.155，3.439）]等促成因素以及低出生体重[比值比（95%可信区间）= 4.424（1.482，13.203）]等需求因素均与标准产后访视的使用显著相关。我们的结果表明，中国农村地区在公平获得产后访视方面有了相当大的改善。不公平因素与产后访视使用之间的关联值得进一步探索，需要制定旨在改善服务提供质量和模式的政策，以确保全面公平地获得孕产妇保健服务。
