Han Leo, Saavedra-Avendano Biani, Lambert William, Fu Rongwei, Rodriguez Maria I, Edelman Alison, Darney Blair
Department of Obstetrics and Gynecology, Oregon Health & Science University, 3181 Sam Jackson Road, L 466, Portland, OR, 97239, USA.
National Institute of Public Health, Center for Health Systems Research, Cuernavaca, Mexico.
Matern Child Health J. 2017 Nov;21(11):2132-2139. doi: 10.1007/s10995-017-2328-6.
Objectives A package of interventions to introduce emergency contraception (EC) to Mexico was implemented, resulting in the addition of EC to the national family planning guidelines in 2004. We describe EC knowledge and use among women in Mexico over time. Methods We used the 2006, 2009, and 2014 of waves of a nationally representative demographic survey (ENADID). We assessed EC knowledge and usage in women ages 15-29 who are not using permanent methods and tested whether EC knowledge and use is changing over time after controlling for socio-demographic characteristics using logistic regression. Results Our sample included n = 99,223 (population N = 40,234,355) women ages 15-29. Overall, knowledge of EC increased over time: 62% in 2006 to 79% in 2009 to 83% in 2014 (p < 0.001). Among young women who have used contraception (n = 42,883; N = 16,816,701), the proportion that reported EC use increased from 3 to 11% to 29% (p < 0.001). Compared to non-users, women who had ever used EC were more likely to be using no method of contraception (44 vs. 35%) or barrier method (22 vs. 17%). Demographic factors including lower wealth, lower education, indigenous status and rural living are significantly associated with less EC knowledge and use. Stratified multivariate analysis found that demographic disadvantages magnify lower EC use among rural residents compared to non-rural residents. Conclusions for Practice Knowledge and use of EC are growing rapidly in Mexico, but disparities persist in demographically disadvantaged women, particularly those living in rural areas. Women who use EC appear to be at higher risk of unintended pregnancy based on current contraceptive use.
目标 实施了一套将紧急避孕（EC）引入墨西哥的干预措施，结果在2004年紧急避孕被纳入国家计划生育指南。我们描述了墨西哥女性对紧急避孕的知识掌握情况及使用情况随时间的变化。方法 我们使用了具有全国代表性的人口调查（ENADID）2006年、2009年和2014年的数据。我们评估了15 - 29岁未采用永久性避孕方法的女性对紧急避孕的知识掌握情况和使用情况，并通过逻辑回归在控制社会人口学特征后检验紧急避孕知识和使用情况是否随时间变化。结果 我们的样本包括n = 99,223名（总体N = 40,234,355）15 - 29岁的女性。总体而言，紧急避孕知识随时间增加：从2006年的62%增至2009年的79%，再到2014年的83%（p < 0.001）。在使用过避孕措施的年轻女性中（n = 42,883；N = 16,816,701），报告使用紧急避孕的比例从3%增至11%，再到29%（p < 0.001）。与未使用者相比，曾使用过紧急避孕的女性更有可能未采取任何避孕措施（44%对35%）或使用屏障避孕法（22%对17%）。包括财富水平较低、教育程度较低、原住民身份和农村居住等人口学因素与较少的紧急避孕知识和使用显著相关。分层多变量分析发现，与非农村居民相比，人口学劣势使农村居民的紧急避孕使用率更低。实践结论 在墨西哥，紧急避孕的知识和使用正在迅速增长，但在人口学上处于劣势的女性中，尤其是农村地区的女性，差距仍然存在。根据目前的避孕使用情况，使用紧急避孕的女性意外怀孕风险似乎更高。
