Cross-national differences in the use of contraception and abortion services between England, Wales, and Scotland.
Cross-national differences in the use of contraception and abortion services between England, Wales, and Scotland.
复制标题
英格兰、威尔士和苏格兰之间使用避孕和堕胎服务的跨国差异。
DOI：
10.1136/bmjsrh-2022-201635
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发表时间：
2023
影响因子：
3.3
通讯作者：
Kuang B
中科院分区：
文献类型：
--
作者：
Kuang B
英格兰和威尔士的总体生育水平（2021年总生育率分别为1.62和1.49）明显高于苏格兰（1.31），但很少有研究调查堕胎或避孕作为生育率的直接决定因素的作用，留下了一个关键的知识空白。这主要是由于缺乏持续收集的可比数据，因为历来收集此类数据的调查（即综合调查、一般住户/生活方式调查）已经停止。从2009年到2020年收集的关于堕胎率的现有行政数据显示，苏格兰的堕胎率一直低于英格兰和威尔士-每年每1000名妇女约有8次堕胎-这意味着堕胎的使用不能解释苏格兰持续较低的生育率水平。因此，我们的分析集中在避孕，是第一个确定和量化的程度，在英国的跨国差异，在避孕药具的使用，以及方法组合。使用的避孕方法的组合是很重要的，因为方法在预防怀孕1的有效性不同，从而可能影响生育率。我们分析了全国性态度和生活方式调查（NATSAL-1至-3，1990年，2000年和2010年）的数据。最近的中期调查（NATSALCOVID-19调查1和2）没有以同样的方式询问避孕问题，由于样本量较小，不允许进行跨国分析。2我们使用NATSAL提供的权重，汇总了三项现有调查中年龄在16-49岁之间有过异性性行为的受访者（n= 35 245）的数据。受访者被出示了一份避孕方法的清单，并被问到：“在过去的一年里，你和伴侣使用过哪些避孕方法？”我们定义长效
Dear Editor, Overall levels of childbearing are significantly higher in England and Wales (total fertility rate of 1.62 and 1.49, respectively, in 2021) than in Scotland (1.31), but few studies have investigated the role of abortion or contraception as proximate determinants of fertility, leaving a key gap in knowledge. This is largely due to a paucity of continuously collected comparable data, since surveys that have historically collected such data (ie, the Omnibus Survey, General Household/Lifestyle Survey) have been discontinued. Existing administrative data on abortion rates collected from 2009 to 2020 show that abortion rates are consistently lower in Scotland than in England and Wales—by approximately eight abortions per 1000 women per year—meaning use of abortion cannot account for the persistently lower fertility levels in Scotland. Our analysis thus focuses on contraception and is the first to identify and quantify the extent of cross-national differences in Britain in contraceptive use, as well as method mix. The mix of contraceptive methods used is important because methods vary in their effectiveness at preventing pregnancy 1 and may thus influence fertility.We analysed data from the National Surveys of Sexual Attitudes and Lifestyles (NATSAL-1 to-3, 1990, 2000 and 2010). The more recent interim surveys (NATSALCOVID-19 surveys 1 and 2) did not ask about contraception in the same way and do not permit cross national analysis due to smaller sample sizes. 2 We pooled data from the three available surveys for respondents aged 16–49 years who had ever had heterosexual intercourse (n= 35 245), using weights provided by NATSAL. Respondents were presented with a list of contraceptive methods and asked,‘Which have you used at all with a partner in the past year?’. We defined long-acting