巴西的堕胎后避孕:在COVID-19大流行期间,参考服务的经验
Carolina Braga Trabach1, Nelio Neves Veiga-Junior2, Priscilla Brenda Fonseca Dantas1
1Department of Obstetrics and Gynecology, School of Medicine, University of Campinas (UNICAMP), Rua Alexander Fleming, 101,- Cidade Universitária, Campinas, SP, 13083-881, Brazil.
International journal for equity in health
|October 9, 2025
概括
在COVID-19大流行期间,堕胎后宫内器械 (IUD) 的使用增加,特别是在弱势群体中. 这突显了可获得的长效可逆避孕 (LARC) 的重要性,以减少意外怀孕和不安全的堕胎.
科学领域:
- 生殖健康 生殖健康
- 公共卫生 公共卫生
- 流行病学 流行病学
背景情况:
- 巴西的性和生殖健康 (SRH) 服务在COVID-19大流行期间面临运营挑战,只有55%的堕胎服务运行.
- 获得SRH服务的限制可能会增加意外怀孕,不安全的堕胎和孕产妇死亡率.
- 堕胎后避孕 (PAC),特别是长效可逆方法 (LARC),如子宫内避孕器 (IUD),在住院期间对于立即和有效的避孕至关重要.
研究的目的:
- 评估堕胎后的避孕方法,重点关注LARC,在自发堕胎和合法终止妊娠后入院期间.
- 通过堕胎监测网络,识别与堕胎后避孕药的使用相关的因素.
主要方法:
- 在2017年7月至2022年11月期间,对接受自发堕胎或合法终止妊娠的妇女进行了一项横截面研究.
- 数据包括临床,社会人口统计特征,脆弱群体状态和住院期间 (流行病前与流行病前).
- 统计分析包括Cochran-Armitage趋势测试和调整后勤回归来确定与IUD插入相关的因素.
主要成果:
- 在675名住院妇女中,45.2%在住院期间启动了PAC,注射剂 (48.5%),口服避孕药 (34.8%) 和IUD (13.4%) 是常见的方法.
- 观察到一个显著的趋势,即在出院前增加IUD的使用 (p < 0.01),特别是在大流行期间.
- 与更高的宫内节育器插入频率独立相关的因素包括有3+的脆弱性因素 (p=0.01),大流行期间住院治疗 (p < 0.01),以及更高的先前堕胎数量 (p=0.02).
结论:
- 降低高效LARC的障碍对于减少意外怀孕至关重要.
- 在疫情期间,在弱势群体中增加了流产后宫内节育器的使用,这凸显了流行病学监测的价值.
- 实施有效的SRH政策对于减少不安全堕胎和产妇死亡率至关重要.
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