Limits to modern contraceptive use among young women in developing countries: a systematic review of qualitative research.
Limits to modern contraceptive use among young women in developing countries: a systematic review of qualitative research.
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DOI：
10.1186/1742-4755-6-3
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发表时间：
2009-02-19
影响因子：
3.4
通讯作者：
Hart GJ
中科院分区：
文献类型：
--
作者：
Williamson LM;Parkes A;Wight D;Petticrew M;Hart GJ
改善发展中国家年轻女性的生殖健康需要获得安全有效的生育控制方法，但大多数依赖传统而非现代避孕药具，例如避孕套或口服/注射激素方法。我们对定性研究进行了系统回顾，以探讨发展中国家年轻女性使用现代避孕药具的局限性。专注于定性研究可以评估定量分析中经常遗漏的复杂过程。对 Medline、Embase 和 POPLINE® 等 23 个数据库进行了文献检索。 1970 年至 2006 年有关 11 至 24 岁年龄组的文献也被纳入其中。研究受到严格评价，并使用元民族志来综合数据。在符合纳入标准的 12 项研究中，有 7 项符合质量标准并纳入综合报告（6 项来自撒哈拉以南非洲；1 项来自东南亚）。样本规模为 16 至 149 名年轻女性（年龄范围为 13 至 19 岁）。其中四项研究是基于城市的，一项是农村的，一项是半农村的，一项是混合的（主要是农村的）。由于缺乏知识、获取障碍以及对副作用的担忧，尤其是对不孕不育的恐惧，激素方法的使用受到限制。虽然安全套通常比激素方法更容易获得，有时也更有吸引力，但安全套的使用受到疾病和滥交以及男性控制力增强的限制。因此，年轻女性常常依赖传统方法或堕胎。尽管审查仅限于五个国家，而且所有发展中国家所有年轻女性的情况并不相同，但总体主题在不同环境和背景下是共同的，支持改善生殖健康的干预措施的潜在可转移性。增加现代避孕方法的使用需要在社区范围内采取多方面的干预措施，并综合提供信息、生活技能、支持和获得青年友好型服务的机会。干预措施应旨在消除对现代避孕方法的负面看法，尽管存在挑战，但应利用安全套在避孕和预防性传播感染方面的双重作用。
Improving the reproductive health of young women in developing countries requires access to safe and effective methods of fertility control, but most rely on traditional rather than modern contraceptives such as condoms or oral/injectable hormonal methods. We conducted a systematic review of qualitative research to examine the limits to modern contraceptive use identified by young women in developing countries. Focusing on qualitative research allows the assessment of complex processes often missed in quantitative analyses. Literature searches of 23 databases, including Medline, Embase and POPLINE®, were conducted. Literature from 1970–2006 concerning the 11–24 years age group was included. Studies were critically appraised and meta-ethnography was used to synthesise the data. Of the 12 studies which met the inclusion criteria, seven met the quality criteria and are included in the synthesis (six from sub-Saharan Africa; one from South-East Asia). Sample sizes ranged from 16 to 149 young women (age range 13–19 years). Four of the studies were urban based, one was rural, one semi-rural, and one mixed (predominantly rural). Use of hormonal methods was limited by lack of knowledge, obstacles to access and concern over side effects, especially fear of infertility. Although often more accessible, and sometimes more attractive than hormonal methods, condom use was limited by association with disease and promiscuity, together with greater male control. As a result young women often relied on traditional methods or abortion. Although the review was limited to five countries and conditions are not homogenous for all young women in all developing countries, the overarching themes were common across different settings and contexts, supporting the potential transferability of interventions to improve reproductive health. Increasing modern contraceptive method use requires community-wide, multifaceted interventions and the combined provision of information, life skills, support and access to youth-friendly services. Interventions should aim to counter negative perceptions of modern contraceptive methods and the dual role of condoms for contraception and STI prevention should be exploited, despite the challenges involved.