Geographic access to family planning facilities and the risk of unintended and teenage pregnancy
Geographic access to family planning facilities and the risk of unintended and teenage pregnancy
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DOI：
10.1007/s10995-006-0151-6
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发表时间：
2007-03-01
影响因子：
2.3
通讯作者：
Marth, Nancy
中科院分区：
文献类型：
--
作者：
Goodman, David C.;Klerman, Lorraine V.;Marth, Nancy
目的：这项研究检验了以下假设，即更多地利用计划生育设施与意外怀孕和少女怀孕率较低有关。研究方法：国家怀孕风险评估监测系统（PRAMS）和四个州的出生率档案分别用于定位意外生育和青少年生育。地理可用性是衡量队列旅行时间到最近的计划生育设施，在ZIP地区的计划生育设施的存在，以及初级保健医生和妇产科医生的供应。结果如下：83%的PRAMS队列和80%的青少年生活在15分钟或更短的设施，几乎没有人生活超过30分钟。调整后的比值比没有显示出统计学显著的趋势，意外怀孕的风险更高，旅行时间更长。同样，意外怀孕和在产妇居住的ZIP地区内存在计划生育设施或提供能够提供计划生育服务的医生之间也没有联系。随着远离计划生育地点和ZIP居住区没有设施，少女怀孕的粗比率和调整后的相对比率都显著降低。在调整后的模型中，妇产科医生和初级保健医生的供应与减少青少年怀孕没有显着相关。结论：这项研究发现，计划生育设施的地理可用性与意外怀孕的风险之间没有关系。计划生育服务的地理分布范围越广，少女怀孕的风险就越高，尽管这些结果可能会受到计划生育需求越大的地区的设施的混淆。
Objectives: This study tested the hypotheses that greater geographic access to family planning facilities is associated with lower rates of unintended and teenage pregnancies. Methods: State Pregnancy Risk Assessment Monitoring System (PRAMS) and natality files in four states were used to locate unintended and teenage births, respectively. Geographic availability was measured by cohort travel time to the nearest family planning facility, the presence of a family planning facility in a ZIP area, and the supply of primary care physicians and obstetric-gynecologists. Results: 83% of the PRAMS cohort and 80% of teenagers lived within 15 min or less of a facility and virtually none lived more than 30 min. Adjusted odds ratios did not demonstrate a statistically significant trend to a higher risk of unintended pregnancies with longer travel time. Similarly there was no association with unintended pregnancy and the presence of a family planning facility within the ZIP area of maternal residence, or with the supply of physicians capable of providing family planning services. Both crude and adjusted relative rates of teenage pregnancies were significantly lower with further distance from family planning sites and with the absence of a facility in the ZIP area of residence. In adjusted models, the supply of obstetricians-gynecologists and primary care physicians was not significantly associated with decreased teen pregnancies. Conclusions: This study found no relationship between greater geographic availability of family planning facilities and a risk of unintended pregnancies. Greater geographic availability of family planning services was associated with a higher risk of teenage pregnancy, although these results may be confounded by facilities locating in areas with greater family planning needs.