Casey Sara E, Tshipamba Martin
RAISE Initiative, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, 60 Haven Ave, New York, NY 10032 USA.
SAF-PAC Project, CARE, 65, Av.de la corniche, Quartier les Volcans, Goma, Nord Kivu Democratic Republic of the Congo.
Confl Health. 2017 Mar 8;11:2. doi: 10.1186/s13031-017-0104-2. eCollection 2017.
Humanitarian assistance standards mandate specific attention to address the sexual and reproductive health (SRH) needs of conflict-affected populations. Despite these internationally recognised standards, access to SRH services is still often compromised in conflict settings. CARE in collaboration with the RAISE Initiative strengthened the Ministry of Health (MOH) to provide contraceptive services in Maniema province, Democratic Republic of the Congo. This study evaluated the effectiveness of this support for MOH health facility provision of contraception.
Cross-sectional surveys in 2008 ( = 607) and 2010 ( = 575) of women of reproductive age using a two-stage cluster sampling design were conducted in Kasongo health zone. Facility assessments were conducted to assess the capacity of supported government health facilities to provide contraceptive services in 2007 and 2010. Data on the numbers of clients who started a contraceptive method were also collected monthly from supported facilities for 2008-2014.
Current use of any modern contraceptive method doubled from 3.1 to 5.9% (adjusted OR 2.03 [95%CI 1.3-3.2]). Current use of long-acting and permanent methods (LAPM) increased from 0 to 1.7% ( < .001), an increase that was no longer significant after adjustment. All current users except a few condom users reported a health facility as the source of the method. The 2010 facility assessments found that most supported facilities had the capacity to provide short-acting and long-acting methods. Service statistics indicated that the percentage of clients who accepted a long-acting method at supported facilities increased from 8% in 2008 to 83% in 2014 ( < .001).
This study demonstrated that contraceptive prevalence doubled between 2008 and 2010; service statistics indicate that utilization of long-acting methods continued to increase to a majority of new clients after 2010. Strengthening the health system to provide contraceptive services enabled individuals to exercise their right to prevent unintended pregnancies. These results suggest that demand for contraception, including long-acting methods, is present even in humanitarian settings, and that women will use them when they are available and of reasonable quality. It is critical that the humanitarian community ensure that such services are available to women affected by crises.
人道主义援助标准要求特别关注满足受冲突影响人群的性与生殖健康需求。尽管有这些国际公认的标准，但在冲突环境中，获得性与生殖健康服务的机会仍常常受到损害。救助儿童会与“增强生殖健康行动倡议”合作，加强了刚果民主共和国马涅马省卫生部提供避孕服务的能力。本研究评估了这种对卫生部在医疗机构提供避孕服务的支持的有效性。
2008年（n = 607）和2010年（n = 575）在卡松戈卫生区对育龄妇女进行了横断面调查，采用两阶段整群抽样设计。2007年和2010年对受支持的政府医疗机构提供避孕服务的能力进行了机构评估。2008 - 2014年还每月从受支持的机构收集开始采用避孕方法的服务对象数量的数据。
目前使用任何现代避孕方法的比例从3.1%翻倍至5.9%（调整后的比值比为2.03 [95%置信区间1.3 - 3.2]）。长效和永久避孕方法的当前使用率从0增至1.7%（P <.001），调整后该增幅不再显著。除少数使用避孕套者外，所有当前使用者均报告避孕方法来自医疗机构。2010年的机构评估发现，大多数受支持的机构有能力提供短效和长效避孕方法。服务统计数据表明，在受支持的机构中，接受长效避孕方法的服务对象比例从2008年的8%增至2014年的83%（P <.001）。
本研究表明，2008年至2010年间避孕普及率翻倍；服务统计数据表明，2010年后长效避孕方法在大多数新服务对象中的使用率持续上升。加强卫生系统以提供避孕服务使个人能够行使预防意外怀孕的权利。这些结果表明，即使在人道主义环境中，对避孕（包括长效避孕方法）的需求也存在，并且当这些服务可得且质量合理时，妇女会使用它们。至关重要的是，人道主义界要确保受危机影响的妇女能够获得此类服务。
