Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan.
Partnership for Maternal, Newborn and Child Health, Geneva, Switzerland.
PLoS One. 2019 Jul 25;14(7):e0218187. doi: 10.1371/journal.pone.0218187. eCollection 2019.
In the Philippines, one in four pregnancies are unintended and 610 000 unsafe abortions are performed each year. This study explored the association between missed opportunities to provide family planning counseling, quality of counseling and its impact on utilization of effective contraception in the Philippines.
One-hundred-one nationally representative health facilities were randomly selected from five levels of the health system. Sexually-active women 18-49 years old, wanting to delay or limit childbearing, attending primary care clinics between April 24 and August 8, 2017 were included. Data on contraceptive use, counseling and availability were collected using interviews and facility assessments. Effective contraceptive methods were defined as those with rates of unintended pregnancy of less than 10 per 100 women in first year of typical use.
849 women were recruited of whom 51.1% currently used effective contraceptive methods, 20.6% were former effective method users and 28.3% had never used an effective method. Of 1664 cumulative clinic visits reported by women in the previous year, 72.6% had a missed opportunity to receive family planning counseling at any visit regardless of level of facility, with 83.7% having a missed counseling opportunity on the day of the interview. Most women (55.9%) reported health concerns about modern contraception, with 2.9% receiving counseling addressing their concerns. Only 0.6% of former users and 2.1% never-users said they would consider starting a modern contraceptive in the future. Short and long acting reversible contraceptive methods were available in 93% and 68% of facilities respectively.
Missed opportunities to provide family planning counseling are widespread in the Philippines. Delivery of effective contraceptive methods requires that wider legal, policy, social, cultural, and structural barriers are addressed, coupled with systems approaches for improving availability and quality of counseling at all primary health care contacts.
在菲律宾，四分之一的妊娠是意外妊娠，每年有 61 万不安全的堕胎。本研究探讨了提供计划生育咨询的机会错失、咨询质量及其对菲律宾有效避孕措施使用的影响之间的关联。
从五个卫生系统级别中随机选择了 101 家具有代表性的卫生机构。纳入 2017 年 4 月 24 日至 8 月 8 日期间在初级保健诊所就诊、年龄在 18-49 岁、希望延迟或限制生育的有性行为的妇女。使用访谈和设施评估收集避孕措施使用、咨询和可用性方面的数据。有效的避孕方法定义为在典型使用的第一年，妊娠率低于 10/100 名妇女的方法。
共招募了 849 名妇女，其中 51.1%目前使用有效的避孕方法，20.6%为前有效方法使用者，28.3%从未使用过有效方法。在妇女报告的前一年的 1664 次累计就诊中，无论设施级别如何，72.6%的就诊都有机会接受计划生育咨询，但 83.7%的就诊在访谈当天错过了咨询机会。大多数妇女（55.9%）对现代避孕药具表示关注健康问题，其中 2.9%的妇女接受了咨询以解决她们的问题。只有 0.6%的前使用者和 2.1%的从未使用者表示他们将来会考虑开始使用现代避孕药具。短期和长效可逆避孕方法在 93%和 68%的设施中均可获得。
在菲律宾，提供计划生育咨询的机会普遍错失。提供有效的避孕措施需要解决更广泛的法律、政策、社会、文化和结构障碍，并采取系统方法，在所有初级保健接触点提高咨询的可及性和质量。
