Ackerson Kelly, Zielinski Ruth
Western Michigan University, Bronson School of Nursing, 1903 West Michigan Avenue, Kalamazoo, MI 49008-5345, United States.
University of Michigan, School of Nursing, 400 North Ingalls Building, Ann Arbor, MI 48109-5482, United States.
Midwifery. 2017 Nov;54:35-60. doi: 10.1016/j.midw.2017.07.021. Epub 2017 Aug 1.
far too many women continue to die from pregnancy and childbirth related causes. While rates have decreased in the past two decades, some areas of the world such as sub-Saharan Africa continue to have very high maternal mortality rates. One intervention that has been demonstrated to decrease maternal mortality is use of family planning and modern contraception, yet rates of use in sub-Saharan countries with the highest rates of maternal death remain very low.
to review available research and summarize the factors that inhibit or promote family planning and contraceptive use among refugee women and women from surrounding areas living in Sub-Saharan Africa.
a review of the literature.
Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), OVID, power search, and PubMed databases.
studies included were: (1) published in English from 2007 to present; (2) primary research; and (3) focused on family planning and contraceptive use among refugee women and women in surrounding areas. Findings were discussed within the framework of the Interaction Model of Client Health Behavior.
twelve studies met the inclusion criteria. Utilization of modern contraceptive methods was low. Women were socially influenced to avoid the use of contraceptives by husbands and others in the community. Reasons were a lack of trust in western medicine and the desire to have large families. Low socioeconomic status and proximity of family planning clinics were barriers to access. Women believed that health care providers were unqualified, many described being treated with disrespect in the health clinics. Knowledge and understanding of contraceptives was low; while most women knew different methods were available, there were many misconceptions. Believing that certain contraceptives cause death, infertility and side effects, contributed to fear of use. This lack of knowledge and fear, even with the desire to space and limit births, affected motivation to use contraception.
developing new approaches to educating women, men (husbands), community leaders as well as healthcare providers is needed to address the multi-factorial issues that contribute to underuse of family planning services, thus contraceptive use.
while lack of access to family planning is a barrier to use, interventions that improve access must be affordable and include education regarding contraceptive methods, preferably from those within the community. However, education and access is not sufficient unless the issue of disrespect by healthcare providers is addressed. Respectful and culturally sensitive care for all women, regardless of socio-economic status or country of origin, must be provided by midwives and other women health providers.
仍有太多女性死于与妊娠和分娩相关的原因。尽管在过去二十年中死亡率有所下降，但世界上一些地区，如撒哈拉以南非洲，孕产妇死亡率仍然很高。已证明能降低孕产妇死亡率的一项干预措施是使用计划生育和现代避孕方法，但在孕产妇死亡率最高的撒哈拉以南国家，其使用率仍然很低。
回顾现有研究，总结影响撒哈拉以南非洲地区难民妇女及周边地区妇女使用计划生育和避孕措施的促进因素和阻碍因素。
文献综述。
考克兰图书馆、护理学与健康照护领域累积索引数据库（CINAHL）、OVID、强力检索以及医学期刊数据库。
纳入的研究需符合以下条件：（1）2007年至今以英文发表；（2）原始研究；（3）聚焦于难民妇女及周边地区妇女的计划生育和避孕措施使用情况。研究结果在客户健康行为互动模型的框架内进行讨论。
12项研究符合纳入标准。现代避孕方法的使用率较低。女性在社会层面受到丈夫及社区其他成员的影响而避免使用避孕措施。原因包括对西医缺乏信任以及希望生育大家庭。社会经济地位低和计划生育诊所距离远是获取避孕服务的障碍。女性认为医疗服务提供者不合格，许多人描述在诊所受到不尊重的对待。对避孕措施的知识和了解程度较低；虽然大多数女性知道有不同的避孕方法，但存在许多误解。认为某些避孕措施会导致死亡、不孕和副作用，这加剧了对使用避孕措施的恐惧。这种知识的缺乏和恐惧，即使有生育间隔和限制生育的愿望，也影响了使用避孕措施的积极性。
需要开发新的方法来教育女性、男性（丈夫）、社区领袖以及医疗服务提供者，以解决导致计划生育服务利用不足进而影响避孕措施使用的多因素问题。
虽然无法获得计划生育服务是使用避孕措施的障碍，但改善获取途径的干预措施必须是可负担得起的，并且包括关于避孕方法的教育，最好由社区内部人员提供。然而，除非解决医疗服务提供者不尊重患者的问题，否则教育和获取途径是不够的。助产士和其他女性健康服务提供者必须为所有女性提供尊重且具有文化敏感性的护理，无论其社会经济地位或原籍国如何。
