NHC Key Lab. of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), Fudan University, Shanghai, 200237, China.
Minhang Maternal and Child Health Care Hospital, Shanghai, 201102, China.
Reprod Health. 2019 Jan 31;16(1):10. doi: 10.1186/s12978-019-0678-9.
Unintended pregnancy and induced abortion among young (unmarried or nulliparous) women have become serious social and health issues in China, which are thought to partly result from low use of long-acting reversible contraception, such as intrauterine devices (IUDs). Considering that providers may play an especially important role in increasing use of this particular method, we investigated Chinese health care providers' attitudes and practices regarding IUDs use for nulliparous women, and further examine the potential factors and reasons contributing to their attitudes and practices.
We recruited health care providers at two Chinese national academic conferences and surveyed them about knowledge of IUDs, willingness to recommend IUDs to nulliparous women, and their related practices. Modified Poisson regression was used to examine the potential factors related to their attitudes and practices.
Approximately a half of respondents reported unwillingness to recommend IUDs to nulliparous women. Providers with more misperceptions about the safety and contraindications were more likely to be unwilling to recommend IUDs to nulliparous women. Moreover, 71.0% of respondents rarely or never recommended or provided IUDs to nulliparous women. Providers' unwillingness to recommend IUDs to nulliparous women was associated with their infrequent practices (aPR=1.43; 95% CI: 1.04, 1.96). In addition to concerns about the side effects or complications, traditional sexual concept against premarital sex was often cited as a reason by Chinese health providers for their negative attitudes towards IUDs use for nulliparous women, a large proportion of whom are unmarried.
Our findings suggest that negative attitudes and infrequent practices regarding IUDs use for nulliparous women are common in Chinese health care providers. Moreover, misperceptions about IUDs, as well as traditional sexual concept, contribute to Chinese health care providers' negative attitudes towards IUDs use for nulliparous women, and may further reduce their provision. Educational interventions are needed to improve providers' accurate knowledge of IUDs and fill the gap between traditional sexual concept and young women's needs of contraceptive services.
在中国，未婚或未育的年轻女性（未育或初产妇）中意外怀孕和人工流产已成为严重的社会和健康问题，这部分归因于长效可逆避孕措施（如宫内节育器[IUD]）的使用率较低。考虑到提供者可能在增加该特定方法的使用率方面发挥特别重要的作用，我们调查了中国卫生保健提供者对初产妇使用宫内节育器的态度和做法，并进一步研究了促成他们的态度和做法的潜在因素和原因。
我们在两次中国国家级学术会议上招募了卫生保健提供者，并对他们进行了关于宫内节育器知识、向初产妇推荐宫内节育器的意愿以及相关实践的调查。采用修正泊松回归来检验与他们的态度和做法相关的潜在因素。
约有一半的受访者表示不愿意向初产妇推荐宫内节育器。对宫内节育器的安全性和禁忌证有更多误解的提供者更有可能不愿意向初产妇推荐宫内节育器。此外，71.0%的受访者很少或从不向初产妇推荐或提供宫内节育器。提供者不愿意向初产妇推荐宫内节育器与他们不频繁的实践有关（aPR=1.43；95%CI：1.04，1.96）。除了对副作用或并发症的担忧外，中国卫生保健提供者经常将传统的性观念（反对婚前性行为）作为对初产妇使用宫内节育器持负面态度的原因之一，因为其中很大一部分是未婚。
我们的研究结果表明，中国卫生保健提供者普遍对初产妇使用宫内节育器持消极态度且实践频率较低。此外，对宫内节育器的误解以及传统的性观念，导致中国卫生保健提供者对初产妇使用宫内节育器持负面态度，这可能进一步减少他们的提供。需要开展教育干预措施，以提高提供者对宫内节育器的准确认识，并弥合传统性观念与年轻女性对避孕服务需求之间的差距。
