Stud Fam Plann. 2022 Jun;53(2):281-299. doi: 10.1111/sifp.12192. Epub 2022 Apr 5.
Family planning (FP) has been a development priority since the mid-1990s, yet barriers to access persist globally, including women being turned away from facilities without a method. This study aimed to assess the extent of, and reasons for, FP turnaway in three districts of Malawi. In 2019, data collectors screened women exiting 30 health facilities and surveyed those who had been denied a method. Follow-up surveys were conducted via telephone with turned away clients at six and 12 weeks postvisit. Of the 2,246 women who were screened, 562 were new or restarting users. Of these, 15% (83/562) reported having been turned away from the health facility without an FP method. Women cited 14 different reasons for turnaway; the top three were unavailability of method (34%), unavailability of a provider (17%), or a requirement to return on the scheduled FP day (15%). The multiple reasons cited for leaving the health facility without an FP method indicate that reducing turnaway will not be achieved easily. The top reasons for turnaway are related to health systems or management issues within health facilities. Facilities need additional support for staffing, training on long-acting and permanent methods, and a consistent supply of methods.
计划生育（FP）自 20 世纪 90 年代中期以来一直是一项发展重点，但全球仍存在获得 FP 的障碍，包括妇女因没有方法而被医疗机构拒之门外。本研究旨在评估马拉维三个地区 FP 被拒的程度和原因。2019 年，数据收集员对 30 家卫生机构的女性进行了筛查，并对那些被拒绝提供方法的女性进行了调查。通过电话对被拒绝的客户在就诊后 6 周和 12 周进行了随访调查。在接受筛查的 2246 名女性中，有 562 名是新用户或重新开始使用的用户。其中，15%（83/562）报告说她们在没有 FP 方法的情况下被医疗机构拒之门外。女性列举了 14 个不同的被拒原因；排名前三的是方法不可用（34%）、提供者不可用（17%）或需要在计划的 FP 日返回（15%）。导致离开医疗机构而没有获得 FP 方法的多种原因表明，减少 FP 被拒并不容易。被拒的主要原因与医疗机构内的卫生系统或管理问题有关。医疗机构需要额外的人员支持、长效和永久性方法的培训以及持续的方法供应。
