【摘要】 目的 研究旨在探讨上海市长宁区孕产保健服务的公平性现状，并分析其影响因素。方法 采用方便抽样的方法，2022年3～4月对长宁区内10个社区卫生服务中心儿童保健及计划免疫门诊接受保健服务的1～1.5岁儿童母亲进行问卷调查。对于计数资料用频数和百分比表示，公平性相关因素分析选用卡方分析、二元logistic回归分析以及多元logistic回归分析，公平性计算指标选用率差、率比、集中指数表示。结果 共调查研究对象696例，平均年龄为(33.35±4.76)岁。不同户籍妇女仅在早孕建册(χ~2=11.026,P=0.001)、产后访视(χ~2=4.989,P=0.026)的服务利用差异存在统计学意义。有无职业的妇女在增补叶酸(χ~2=6.247,P=0.012)、早孕建册(χ~2=12.989,P=0.002)、产后42d体检(χ~2=4.446,P=0.035)和产后避孕(χ~2=4.061,P=0.044)四项利用的差异有统计学意义。不同家庭月收入的妇女在孕前检查(χ~2=8.977,P=0.030)和产后访视(χ~2=16.114,P=0.001)两项服务公平性较差，差异有统计学意义。有无生育保险的妇女在早孕建册(χ~2=10.576,P=0.001)和产后42d体检(χ~2=8.166,P=0.004)两项服务公平性差异有统计学意义。多因素分析结果显示，有无职业(OR=2.616,95%CI:1.142～5.990)和有无生育保险(OR=4.490,95%CI:1.992～10.120)影响早孕建册服务利用情况，家庭月收入(OR=0.278,95%CI:0.124～0.625)影响产后访视服务利用情况，同时家庭月收入情况(10 000～19 999元:OR=0.286,95%CI:0.090～0.907;≥30 000元:OR=0.180,95%CI:0.041～0.801)还影响产后42d检查情况。结论上海中心城区孕产保健服务利用公平性总体较好，不过仍有可提升空间。应加强社区动员，做好孕产保健服务内容的宣传，同时扩大生育保险覆盖率，以提高孕产保健服务利用的公平性，推进孕产妇女有均等机会获得孕产保健服务。更多还原

【Abstract】 Objective To understand the equity and influencing factors of maternal health service utilization in Changning District,Shanghai. Methods A convenience sampling method was used to conduct a questionnaire survey among mothers of children aged 1 to 1. 5 years old who received health services from the child health care clinics and EPI clinics of 10 community health service centers in Changning District,Shanghai from March to April 2022. Count data was expressed by frequency and percentage. Chi-square analysis,binomial logistic regression analysis,and multivariate logistic regression analysis were used to analyze fairness-related factors. Rate difference,rate ratio and concentration index were used to represent fairness. Results A total of 696 subjects were investigated,with an average age of( 33. 35 ± 4. 76) years. There were statistically significant differences in service utilization among women with different household registrations only in early pregnancy registration( χ~2= 11. 026,P = 0. 001) and postpartum visits( χ~2= 4. 989,P = 0. 026). Women with a career showed differently in folic acid supplement( χ~2= 6. 247,P = 0. 012),early pregnancy registration( χ~2= 12. 989,P =0. 002),physical examination in 42 days postpartum( χ~2= 4. 446,P = 0. 035) and postpartum contraception( χ~2= 4. 061,P= 0. 044),and the differences were statistically significant. Women with different monthly family income had a statistically significant difference in pre-pregnancy examination( χ~2= 8. 977,P = 0. 030) and postpartum visit( χ~2= 16. 114,P =0. 001). There was a statistically significant difference between women with maternity insurance or not in the early pregnancy registration( χ~2= 10. 576,P = 0. 001) and physical examination in 42 days postpartum( χ~2= 8. 166,P = 0. 004). The results of the multivariate analysis showed that occupation( OR = 2. 616,95% CI: 1. 142-5. 990) and maternity insurance( OR = 4. 490,95% CI: 1. 992 ～ 10. 120) affected the utilization of service in early pregnancy registration. The monthly household income( OR = 0. 278,95% CI: 0. 124-0. 625) affected the utilization of services in postpartum visit. At the same time,the monthly household income( 10 000-19 999: OR = 0. 286,95% CI: 0. 090-0. 907; ≥30 000: OR = 0. 180,95%CI: 0. 041-0. 801) also affected the utilization of service in physical examination in 42 days postpartum. Conclusion The equity of maternal health care service utilization overall is good in central area in Shanghai,but there is still room for improvement. It is necessary to strengthen community mobilization,propagandize maternal health services,and expand the coverage of maternity insurance to improve the equity of maternal health service utilization and provide equal access to maternity health services.更多还原