Совершенствование системы охраны здоровья женщин в Российской Федерации by World Bank Russia

РОССИЙСКАЯ ФЕДЕРАЦИЯ

СОВЕРШЕНСТВОВАНИЕ СИСТЕМЫ ОХРАНЫ ЗДОРОВЬЯ ЖЕНЩИН В РОССИЙСКОЙ ФЕДЕРАЦИИ Результаты пилотного проекта

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CWA: Improving women's health services in the Russian Federation: results of a pilot project / Patricia Stephenson...[et al]. p.

cm. - (World Bank technical paper; no.404. Social challenges of transition series)

Includes bibliographic references and index.

ISBN 0-8213-4197-9 1. Maternal

health services-Russia(Federation)-Statistics.

2. Women's health services-Russia

(Federation)-Statistics 3. Pregnant women-Health and hygiene-Russia (Federation)-Statistics. 4. Russia (Federation)-Statistics,Medical.

1.Stephenson, Patricia,1954-.ll. Series. Ill. Series: World Bank technical paper; 404. IV. Series: World Bank technical paper. Social Challenges of transition series.

RG964. R8147 1998 362.1 '982'00947-dc2l

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MaTept4aAOB Ans AN1HOR CTepl4nW3aLA4w4. KpoMe Toro, Heo6xoALMo OpFaHU3oBaTb CWCTeMy nOArOTOBK1 U nepenOArOTOBKu MeAU4ULHCKoro nepcoHajia c L4enbIo nOBblWeHU1I YPOBH1 UX 3HaHNA U CO3AaH145 AonOj1HuTe6JbHbIX CTmMynOB K pa6oTe. BceMLpHoMy 6aHKy U MHHMCTePCTBY 3ApaBooxpaHeHHA cAeAyeT paCCMOTpeTb B03MO)KHOCTL4 qaCTHoro ceKTopa no 4)WHaHCWpOBaHI4o U4pacw1peH&1K0 ceT&4 OKa3aHWl ycjiyr no oxpaHe penpOAYKTMBHoro 3AOPOBbSi. M14CHCTePCTBO 3ApaBooxpaHeHW9 U opraHbl 3ApaBOoxpaHeHM9 Ha MeCTax AOf)KHbl cnoco6CTBOBaTb TOMy, 4To6bl BOnpOCbi nniaH&lpoBaHMFI CeMbW CTani HeOTheM,neMbiM KOMnOHeHTOM npeHaTanbH0A U nOCTHaTanbHOrU noMou14, a TaKwKe ycjiyr no a6opTaM U ML4H&4-a6opTaM. CneAyeT cepbe3Ho paccMOTpeTb B03MO)KHOCTb BBeAeHNA pernameHTaLuu no noaogy Toro, qTo6bi a6opTbl B nepBOM Tp&4MeCTpe 6epeMeHHocTu npOM3BOAHRHCb TOJ1bKO BaKYYMHbIM cnoco6oM, KOTOpblU 3aMeH1i1n 6bI BO BCeX cnyL.aRx BbICKa6Jl14BaH&4e. nOBblweHHoe BHMmaH1e Heo6XoA1Mo yAent4Tb npo6JleMaM KOHTPOnn 3a pacnpOCTpaHeH1eM 3flfln (HanpiMep, c nOMOLbIO Ab POCBoeT1TenbCKOm geJTenbHOCT1 1 nponaraHAbi l4cnOJ1b3OBaH&i;i npe3epBaTMB0o3), oco6eHHO cpeA& noApOCTKOB. no &4ToraM 3KcnepwMeHTa MO)KHO cAejiaTb BbIBOA, 'ITO pOnb My)KYWH B COXpaHeHI4&1 penpOAYKTi4BHOrO 3AOpOBbS U B nnaH&lpoBaHWW ceMbL oL,eHMBaeTC COBepweHHO HeAOCTaTO4HO KaK CaMUM HaceJIeH&4eM, TaK U Me,OAU4UHCK14MM pa6OTHIKaM&4, 14 noHaAo6i4TCm eLu.e MHoro BpeMeH&4, 4To6bl 3Ta cmTymas4i &13MeHt4jiaCb. nlJaH&4pyg AaaJbHer414e warm, none3Ho 6bino 6bl BK1IO'4&Tb B HUX opraHW3aLXkmO AL4CKYCC&1&1, KOTOpas BbISBI4J1a 6bi, no4eMy Ba3eKTOM14S AO cuMx nop 3aKOHOAaTenbHO He npW3HaHa, HecMOTP1 Ha TO, 4TO 3T0 6onee 6e3onacHaX, MeHee AoporocToALLAasi u 6onee npocTasi onepa4msi no CpaBHeHO410 c nepeBH3KOr4 MaTo'HbIX Tpy6. Pacw4pHsi c4epy peanu43aLL4uu npoeKTa, HeO6XOAmMO B KaSeCTBe np14Op&4TeTHb1X CTaB14Tb 3aAa'4 pacCw&peH&lS] B03MO)KHOCTH Bbi6opa CpeACTB KoHTpaLAenLAi4&1, yBeH4teHme OTBeTCTBeHHOCT&4 My)K'4H, 6onee aKTHBHa; pa6oTa c noApoCTKaMl4. CyuL4ecTByeT TpaAWL145, LITO pa6oTa no nflaHJUpOBaH11O CeMb&4 Haqk4HaeTCR B )KeHCKMX KOHCyJ1bTaLt&45lX. nnaHIipysi aKTc4BN3aL#4io pa6oTbI C My)K'4HaM&4, cneAyeT noAyMaTb o6 OpraHU3a14UU OMyKCK14kX KOHcyj1bTaLk4m1 cunaM1 Bpat4er o6uAeA npaKT1K1, yponoroB unu xupyproB, pa6oTaIoLL4mx B nonmKnMHHKaX.

nlpJloxKeHHe A MeToAo.normsl oL0eHKU pe3yJlbTaTOB 3KcnepIMeHTa B illo6ep4ax MeTon: npu oi4eHKe pe3ynbTaTOB nio6epeLkKOro 3KcnepIMeHTa 6bin mcnofJb3oBaH MeTOA oAHopa30ooro rpynnoBoro o6cneAOBaHMA c npeABapUTenbHbIM U 3aKJIOLii4TeOJbHbIM (nocT-) TecT1pOBaH1eM.

no 3 MapTa

lpeABapuTenbHoe TeCTupOBaHue COCTORnOCb B nepwoA c 6 4)eBpanA 1995 roAa. nOCT-TeCT4poBaHwe COCTOSJ1OCb B nepwoA c 13 MapTa no 9 anpen;i

1996 roAa. Ha Ka)KAoe U3 o6c11eAoBaHmA nOTpe6OBaJlOCb 20 nOnHblX AHeiA, B Te4eHMe KOTOpbIX nPOBOA1nOCb Ha6ftoAeHme 3a onpawLuBaeMbIMu U npMBneqeHme na4UeHTOB B nOArpynnbi. o6cneAoBaHwsi nOAKpenneHbi co6eceAOBaHwrM14 1QaHHbie C KlKOqeBblMH HOCMTeSJWMM MH4PopMaLAmm, a TaKwoe C FoKyc-rpynnamm, B KOTOpbie BOWJIL MeAmLUwHCKK1X pa6OTHK14u U naL,UeHTbi. Bbi6opKa: B TeCTMPOBaHMM Morliw npMHS;Tb y4acTme Bce naLAmeHTKL OT 16 neT U CTapwe, Ae.naawme a6opT, MMHma6opT U nonyLiaBiue rMHeKonorumeCKMe ycnyrM, npoxoAMewHe

nie4eHme B pOoAOMe nu160 o6pau4aBw1ecsi B )KeHCKYIO KOHCynbTaLk4io. PecnoHAeHTKM AOR)KHbl 6bin rOBOPMTb Ha PYCCKOM 5l3blKe U AaTb corilacue Ha yLacTme B o6cneAOBaHMM. npu

onpeAeneHi* pa3mepa Bbl6opKU KaK Ans npeABapMTenbHoro, TaK U gnsw nOcT-TecTMpOBaHMSl, mcnOJlb3OBaJIMCb cpeAHeMec5lqHbie CTaTMCTM4eCKwe noKa3aTeinLu AJnR AaHHoro peruoHa u YL4TblBaCSlR TOT c?aKT, qTO c6opa MH(jopMammL OTBOAw1nOCb LieTbipe HeAenA (Ta6&nu4a I). FOTOBHOCTb OTBe4aTb Ha BonpOCbl BO Bcex noArpynnax 6blina o4eHb BblCOKOU (Ta6nu4a II). CpeAm noArpynn naULAeHTOK He 6b611O OTMeL4eHO HUKaKUX KpynHblX A3MeHeH14u B CMblCJ1e coLA4anbHo-AeMorpad)pM4ecKMx xapaKTepUCTUK, UCTOpUU penpOAyKTWBHOu (tYHKLJ.4 3AOpOBbS1 1n1 MHAMKaTOpOB COCTOFIHL451 3AOpOBbSi, XOT1 HeKOTOpbie I13MeHeHW1 B cocTaBe noArpynn Ha 3Tanax npeABapuTenbHoro u nOCT-TecTupoBaHwl 6b6AW (Ta6fut,bl III-IV). 3TU m43MeHeHMA He OKa3blBanJI BnM'sHMFI Ha pe3ynbTaT npoBeAeHHbIX 4CcneAOBaHM0. XapaKTepMCcTM14K MeA14LkHCKMX pa6oTHMKoB o6o6uLeHbl B Ta6iniLAe XI.

AflSl

npaKTtcrwecKwe xefRCTB14r: BOnpOCHLIKM Ha aHlrnUlUCKOM Il3biKe 6blnu nepeaeAeHbi Ha pYCCKUUA, 3aTeM AnH1 nPOBepKm npaB4JlbHOcT4 6b6IJ BbinOJ1HeH o6paTHbIi nepeBoA. 4HneHbl KOHCynbTaUL,OHHOA rpynnbi O3HaKOMMJInCb C cOAep)KaH4eM BOnpOCHuKa, nocne qero 6bimJo npOM3BeAeHO ero unMAOTHoeD TeCTUpoBaHue. flocne 3Toro B BOnpOCHUK 6biJu1 BHeCeHbi Heo6xOAmMble u3MeHeHMFl, OH 6bin nepeneqaTaH U nepeAaH JnJJ O3HaKOMneHMH1 rpynne, npOBOAslLLAeul o6cneAOBaHme, nocne 4ero 6bl1no npoBeAeHo ("nMnOTHoe") TeCTMPOBaHMe Ha MecTe, U 6binM BHeceHbI OKOHHaTenbHbie M3MeHeHWS;. KoMaHAa U3 4eTbipex MHTepBbiOepOB npowuna TpexAHeBHylo nOArOTOBKy: MeTOAMKa o6cneAOBaHM4, TeXHuKa onpoca, 3aTparMlaH4e LUAeKOTnl4BblX TeM, MeTOAUKa pa6oTbl C AaHHbIMu U rapaHTupOBaHUe KOHcmgeHL4UanbHOCTU, TeXHUKa pa6OTbl C Bbi6OpKOUi, opraHM3aLAms pa6oTbl B pOAAOMe VI KnJH4Ke, ynpaBneHL4e nO0JyqeHHblMw AaHHblM14, KOAMpOBaHUe U aAMUH1CTpaTMBHbie BOnpOCbl. Onpoc naLLUeHTOK npOM3BaOA4ncF KaK MO)KHO 6nm)Ke KO BpeMeHM BbinfCKM, 4To6bi nony'eHHbIA yxOA OHM MornJ o4eHWTb B nOnHOA Mepe. nlaLAmeHTKu nocAepoAoBoro nepmoAa TaK)Ke onpaw14BanlCb KaK MO)KHO 6nmwKe KO BpeMeH1 npeAno11araeMor4 BbinfCKM, )KeHLLA14H, Aenaaiwwx a6opT uJnI MUHU a6opT, onpawmBanJ He MeHee qeM 3a ABa 4aca nociie OKa3aHlMS mM MeAM4LAHCKWX yCnyr, nauLMeHTKw, o6pauLtaBw1ecsi 3a rMHeKOJlorm4ecK1MM yclyraMM, onpawL.BanICb cpaay nocne nocew,eHMFl UMM Bpa4a

(onpoCbl npu BbixoAe). lOcKOnbKy naLJmeHTKaM, npflPweALwIM nfOJly4Tb rHeKOnorHMecK14e yCnyrM, npMXOAmnOCb 3aAep)K1BaTbCg nocne BL43UTa, XOTFI OHM, CKOpee Bcero, cnefwMA AOMOA, 6bilo peweieHO AenaTb MM He6O11bWoo nOAapOK (KycoK AyWwcToro Mbina) 3a y4acTMe B onpoce. 3anonHeHMe KOHTpOnMpoBa111 caM1.

OnpOCHbIX JICTOB An1 MeAm4L,HCKWX pa6oTHAKoB nocAeAHMe Bce IHTepBbio 6b61114 aHOHuMHbIMu. HMKaKOu onO3HaBaTenbHOA

CoBepLueHCTBOBaHse CtiCTeMbi 3,QOpOBbq xKeHLLUH B POCCHUlCKOa OeUeoawu

MH4)opMaLA4I4 Ha onpOCHbIX n1CTaX He 6bino, nocne o6o6u.eHMrn M4HopMauL4L4 Bce onpocmble nuICTbi 6binu yH4ITo)KeHbI. YqacTTie a onpoce 6bino nOnHOCTblO Ao6poBonbHbIM.

nlepeMeHHble BeJ14uIuHbi 4 noKa3aTenl4: pa3A1WHbie aCneKTbi

MeAu4uLHCKuX

M3MeHeHML

pa6oTHI4KoB. B

caMooT4eTbi, KJIMHMqeCKaB

nyHKTbi onpOCHoro JMCTa 3aTparMBanM KJ1MHm4eCKOrl ,eSTenbHOCTM u peaKL,ulo Ha HMX naLJi4eHTOK 14 OCHOBHOM uCTOYHu4KaMu AaHHbIX AnFi oLAeHKt4 npoeKTa 6bmui

CTaTt4CTWKa ku LHTepBbIo C KnioqeBbiMW HOCLTen1m1M

4H()opMaLA4m. H

no aonpocaM, Hanpu4Mep, COCTOSHMWI 3AOpOBbsi, 4mcna noceUAeHHr4 Bpasa rocnMTa.n3aLUU B npeApoAoBoA nepMoA He conOCTaBAn1L4Cb C 3anfcsCML, cAenaHHbIMM

CaMooTmeTbi

MeAl4lAMHCKkiX

yqpe)KIeHHslx,

CBeAeHge 1 B TaKl4X caMoOTqeTaX UHOrAa MornU 6bITb npeAB35ITbIMi, mCnnb3OB=Hme aanuceu MeAL41HCK14X yqpe)KAeHmA 6bino 6bl YpeBaTO CB01M1M npo6neMaMm, oco6eHHo B cny-aSIx, KorAa 3anu4cu 14 o4eHwBai1Cb,

KaK

TaKOBbIe.

XOTR

BeAyTcsl He nOApo6HO 14 He no onpeAeneHHoMy CTaHAapTy. 06bitHO caMOOTBeTbi KacaT8nbHO ycnyr B o6naCTU4 3ApaBooxpaHeHt4FCconOCTaB1Mbi c MaTept4aiaM4, COAepwauAimics B 3anucsix MeAi4LI14HCKHX yqpe)KAeHu1u. Ecnu4Ke BO3HWKaIOT npoTWBope41SI, ICHOCTW no noBoAy Toro, KaKO14 UCT04HUK WH(pOpMa4wm1 Cq4TaTb 3OJ1OTbIM CTaHgapTOM", HeT.

npmnoweH"e E noApo6Hbie Ta6J1HL4bi

Ta6nmLta I. O)KU,AaeMbie H pLeACTBI4TeJlbHbie pa3Mepbl

Bbi6opOK B

noArpynnax;

P03JIbTaTbi npeAiapBlTeJIbHoro TeCTWpOBaH4si U nOCT-TeCTt4pOBaHw5l noarpynna oLLeHKa npenB. nocT-TecTWPOBaHme TeCTLpOBaHme

nocnepojA.

a6opT MIHma6opT

rIHeKoJn. MeA. pa6OTHMK

80-100 200 80-100 200 136

94 96 87 155 103

100 95 99 110 132

A4aHHbIe nmo6epeL(Koro 3KKcnep4MeHTa

-Ta5uli4a

IL. PeaKicw,s

onpaw IBaeMbIx no nOArpynnaM, npeABapHTenbHoe U nOCT-TeCTHpOBaHUe (B CKo6Kax) nlpeMneM. HenpueMn. OTKa3 FloTepHbI He paccm. % OTBeT. 100 [1001 0 [0] 0 [0] 0 [0] 6 [0] 94%[100%] 98 [102] 3 [2] 0 [0] 0 [4] 2 [3] 98% [93%] 94 [103] 0 [0] 2 [3] 0 [1] 5 [01 93% [96%] 167 [116] 7 [0] 8 [3] 0 [0] 4 [3] 93% [95%] 136 [136] 0 [0] 33 [3] 0 [0] 0 [1] 76% [97%]

TeCTHPoBaHue

rloArp. nocnepoA a6opT MmHMa6opT rMHeKon.

MeA. pa6OTHMK

AlaHHbie nho6epeLKoro 9KcnepFiMeHTa

noTepRHbl = npH

npoBeAeHmm nOCT-TeCTHpOBaHNrP pecnOHAeHTbi 6binH yTepRHbI

He paccm. = He paccmaTPMBan1MCb Te BonpOCHu4Ku, KOTOpbIe mcnOnb3oBanMCb

BUAy.

B nunOTHOM TeCTIPOBaHHH

AnR nOArOTOBKH UHTepBbioepOB (npeABapHTenbHoe TecTHpoBaHi4e), nocne 4ero HeKOTOpbie i43UeHeH&lR 6binU CAAleaHbl B TeKCTe BonpocHHKoB. TaKwKe He paccmaTpmaanMCb Te BonpocHuKu, B KOTOpbIX He 6bin AaH OTBeT Ha MHOrme BOnpOCbl - TaKme clyq4am paCCMaTpHBanfCb KaK OTKa3.

COBCpWeHCTBoaHMe CHCTeMbi OXpaHbi 3,OPOBbH .KeHLW4H B POCC14cKoa

Ta6n4ia

IlIl.

CoULjanbHo-AeMorpaaO1IecKme

xapaKTepl4cTMKM

naLtmeHToK

oenepaLuu

(nocnepoAosoIq

MHHma6opThi, rmHeKonorMs), npeABapwTenbHoe TecTU4poBaHiue tU nocT-TecT14poBaHt4e

nocneponopok nePOLM

Bo3PacT (cp.)

nepmoA,

a6opTb,

A60pT

npeAf. TecT

nOCT TecT

n=94

n=100

25,2

28,8

28,0

83,0 8,5 0,0 6,4 0,0 2,1

85,0 3,0 1,0 11,0 0,0 0,0

82,3 4,2 6,3 7,3 0,0 0,0

85,3 7,4 2.1 5,3 0,0 0,0

6,4 19,1 42,6 7,4 24,5

8,0 33,0 34,0 5,0 20,0

1,0

1,1

13,5 43,8 18,8 22,9

13,7 43,2 18,9 23,7

61,7

57,0

62,5

46,3

12,8

14,0

9,4

8,4

npeAE. TeCT n=96

noOT

TecT

n=95

rpaxAaHCKoe COCTToHUe

(%) 3aMyxeM COBMeCTH. npOIcUBaH1e pa3seAeHa

He3aMY)K BAOBa OTCyTCTB. 06pa3oBaHue (%) Ha8anbHoe cpeAHee y4wnwuAe

TeXHuKyM YHMBePCcTeT pa6oTa (%)

nOJnHas

unuW qacTwqHas

3aHRTOCTb cTyAeHTKa

MuHMa600T

Bo3paCT (Cp) rpa)KAaHcKoe

rMHeKo orms

npe-

nocT-

n=94 30,4

n=100 29,3

78,2 9,2 8,0 2,3 2,3 0,0

58,2 18,4 11,2 12,2 0,0 0,0

1.1 22,9 34,5 12,6 28,7

7.1 29,3 16,2 18,2 29,3

60,9 9,2

npe-

nocT-

n=96 29,5

n=95 27,8

72,3 15,5 7,7 2,6 1,9 0,0

78,2 16,4 2,7 1,8 0,9 0,0

1.9 21,9 38,1 9,7 28,4

0,9 21,0 41,8 13,6 22,7

71,7

58,7

42,7

22,2

14,2

13,6

CocToRHIe

(%) 3aMy)KeM CosMeCTH. npO)KIBaHNe pa3BeAeHa He3aMy)K

BAoBa OTCyTCTB. o6pa3oaaHSe (%) Ha4anbHoe cpeAHee yqnA1LLte

TeXHu4KYM yHusePCu4TeT pa6oTa (%) noJIHaR 4nu 3aHRTOCTb CTyAeHTKa

4aCT14qHas

cH=cTaTHcTM'ecKI

He3Ha4MT.*

p<0,05

p<0,01

p<0,001

,aaHHbienio6epeuKoro 3Kcnepi7meH7Ha

COBepWueHCTBOBaHUe CUCrembi OX8HbJ 311OpOBbSw XeHLUH B POCCUUcKOUl Peepau=U

Ta5,Hnu,a IV. lICTOPUR penpOAyKTHUBHOuI 4yHK4Hm l8auLeHTOK (nocnepOAOBoA nlepHOA, a6opT, MHHHaBOpT, rHHeKonorHfi), npeABapHTe6IbHoe TeCTHpOBaHHe H nOCTTeCTHPOBaHUH

noCnepOAOBOU nepHoA npeABapUT.

BO3paCT nepBoi

aGOPT

nOCT-TeCT n=100

TeCT

n=94 21,9

21,3

npeABapHT. TeCT

nOcT-

n=96 20,0

n=95 19,6

12,5 85,4 2,1

7,4

91,6 1,1

TeCT

6epeMSHHOCTH (Cp)

(%)

>KHBOpO)KAeHHbie

HeT

1-2 >2

0,0

94,7 5,3

96,0 4,0

96,8

98,0

3,2

2,0

88,3 11,7

87,0 13,0

74,5 16,0 5,3 4,3

57,0 22,0 11,0 10,0

MepTBOpONcAeHHbie

(%) HeT 1 nnn 6onbwe

BbIKMAbIWHI

100,0 0,0

98,9

92,7 7,3

93,7 6,3

HK 40,6 37,5 21,9

HK 30,5 26,3 43,2

1,1

(%)

HeT 1 mnM 6onbwe HCKyCCTB a6opT

(%)

HeT 1 2 3 MnM 6onbwe

MHHH-860PT

BO3p8CT nepBoI

rHHeKOnOrMR

npeaBapHT. TeCT

nOCT TeCT

npeABapHT. TeCT

nOCT TecT

20,4

20,3

20,9

20,7

12,6 82,8 4,6

22,2 65,7 12,1

31,0 67,1 1,9

28,2 69,1 2,7

98,9

90,9

99,4

98,2

1,1

9q1

0,6

1,8

78,2 21,8

83,8 16,2

85,8 14,2

82,7 17,3

HK 28,7 25,3 46,0

39,4 23,2 12,9 24,5

38,2 29,1 18,2 14,5

6epeMeHHOCTH (Cp) WKHBOpOX(AeHHbie

(%)

HeT

1-2 >2 MSPTBOPO)KASHHble

(%) HeT I nmn6onbwe BbiKMiAbIWH (%)

HeT 1 mnm 6onbwe HCKyCCTB a6OpT

HeT 1 2 3 MnM 6onbwe

(%)

cH=cTaTMcTM4ecKM He3HaI4MO*

23,2 45,5 31,3

p<O,O5

p<O0O1 ***

3KcnepuiMeHTa

p<o,oo. AaHHble nO6epe4Koro

CoBepweHcTBoBaHme cHcTeMbi oxgaHbi 3DAODOBbR .weHLu4H B POCCUUCKOU Oeepauu

Ta6nuua V.

CocTosule 3AopOBbHf naui4eHTOK (nocneponoBoru nepmon.

rmHeKonormsI),

a6OpT.

MNHMa6opT.

npefx3apulTenbHoe TeCTIpoBaHUe U nOCT-TeCTIpOBaHU nocnePoAOBo0 nepuoA npeABapUT.TeCT nOCT-TeCT

n=94

a6opT p

n=100

npeABapulT.

nOCT-

TeCT

n=96

n=95

npo6neMbl 3AOPOBbSI

(%) HeT

74,5

53,0

90,6

85,3

1 iu.nm6onbwe

25,5

47,0

9,4

14,7

28,7 71,3

21,0 79,0

71,7

44,6

92,7

98,9

28,3

55,4

7,3

5,3

23,0

30,2

1,1 20,0

roAa (Aa -%) poauana

18,8 13,5

16,8 15,8

Aenana a6opT

npeABapMT.

nOCT-

TeCT

TecT

n=155

n=110

OCnONCHeHi1si npu

6epeMeHHOCTm (AaHHoA/nio6oA Apyroui HeT

unu1

6onbwe

oCnoMHeHmR npm 6epeMeHHOCT4 (npeAb'AyLek -%) HeT

unu

6olbwe

KypeHue (Aa - %) Te4eHme npownoro

M14HM-a6opT

rWHeKonorms

npeABapHT.TeCT

nOCT-TeCT

n=87

n=99

npo6neMbli 3AOPOBbS

(%) HeT

46,0

52,5

1 u 6onbwe

29,0

31,8

54,0

47,5

71,0

68,2

HeT

1 U 6onee

27,6

28,3

46,2

50,0

72,4 21,8

71,7

53,8

50,0

23,2

19,1

OCJ1o)KHeHMS 6epeMeHHOCTU1 (HacTofuu4eA /nio6ogi)

OCnO)KHeHU414 6epeMeHHOCTTU (npeAblAyu4eg)

HeT 1

6o0nee

KypeHue

(Aa

-%)

55,6

...

10,1

7,1

8,2

11,6

12,7

Te4eHwe nocneAHHX 12 MecsLIeB (Aa-%) powKana

8,0

Aenana a6opT CH=cTaTMcTH4ecKH

13,8 He3HaL4Mo*

p<O,05

22,2 p<0,O1

3KCn6plfMeHTa

p<0,001;

/aHHbIe

nio6epeliKoro

COBCpLLJeHCTaOBaHHe CbfCTeMbi OXMaHbi 3JOJBb51 )eHWl4H

Ta6nuL4a VI. Mcnonb3oBaHme KOHTpaLIenTLBOB

POCCkUUCKOa Veepaukim

(naUmeHTKH nocnepoaOBoro nepHoAa,

MmKma6opT, rMHeKoJ1orMsl, npeABaprTenbHoe U nocT-TecT14poBaHl4e nocnepoooiq nept4oa a6opT npeAB.TeCT nOCTp npeAjB.

iqcnOJnb3OBaHme COBpeMeHHbIX

unui

nony4eHme

n=94 0,0

n=100

65,0

KOHTPa8LenTMBOB

B HaCTOSUtee BpeMs

n=96 **

nOCT-TeCT

a6opT,

n=95

39,5

60,0

17,9

(%)

MeTOA(bi) KOHTpaL4enl4II mcnOnb3OBaH (bi) no.ny4eH(bi) (%)

unui

16,0

Apyrme ropMOHanJbHbIe cp-Ba

21,0

5,2

0,0

1,0

0,0

BMC

6,4

21,0

4,2

4,5 10,6

0,0

32,0 3,0

0,0

28,6 0,0

42,1 0,0

0,0

1,0

0,0

0.0 0,0

TOJnbKo npe3epBaTMBbl npe3epBaTMBbl + cnepMaL&4Abl TOJnbKO cnepMaLIuAbi Apyrme nperpaAbi CTepH3mAaJuLk

M4Ht-a6opT npeAB. TeCT n=87 mcnOflb3oBaHme mun

coBpeMeHHbIX

nony4eHme

52,9

nOCT TeCT n=99 69,7

KOHTpa4fenTuBOB

0,0

rLHeKorioriS npeAB. nOCT TeCT TeCT n=110 n=155 60,0 72,7

B HaCTORULee BpeMs (%) MeTOA(bl) KOHTpa4enlp4l mcnonb3oBaH (bl) nony4eH(bl) (%)

uanu

9,2

Apyrne ropMoHanbHble cpeCGTBa

35,3

12,3

BMC

0,0

1,0

14,9

0,0

15,2

1,8

TOnbKo npe3epBaTWBbl

19,4

24,1

22,7

6,1

24,5

25,5

2,3

8,1

0,6

0,0

Apyrme 6apbepbl

1,2 1,2

CTepMn03a4UP

2,0 2,0

1,9 0,6

0,0 0,0

0,0

0,6

0,0

npe3epBaTHBbl+ cnepMaLMAb' TOJnbKO cnepMa4L,AbI

CH = CTaTWCTM4eCK14 He3HaLBMo p<O,05 ** p<O,O1 * p<0,001 cTaTL4CT14Ka TeCTVIpOBaHL45 X2 # An nocnlepo,QoBbix naLAIeHTOB paccmaTpUBaeTCR Icnonb3QBaHme .4aNHHIe ilo6epeAlKoro YKcnepieHrTa

22,7

TOQJbKO npeAblayWLX MeToAOB

CoBepWeHcTBoBaHme CmCTeMbl OXQaHbi 3AODOBbH .weHLUH 8 POCCoaCKOL

Ta6nmua Vila MenwKo-caHUT.

nPoceuUieHUe U YxoO U poAnoMax U NKeHCKHX nocJIeDOR,lbUrOneD a nDeasaDmTeabHoe u nOCT-TeCTHDOBaHMO TeMbi 6.cn O 3Dopobe (KKOHCJbTaUUMU) % naUmeHTOK. npe- (n=94) KYPeHme 37,2 anKOrOJlb 40,4 nUTaHUe 92,6

cezepaUUU

KOHCYJ1bTaUUHX. naU*OHTKI nOny4M8. HHP-UUIO nOCT- (n=100) p 45,0 CH 28,0 CH 62,0

AUCKOM(POpT npw 6epeMeHHOcTm

71,3

80,0

OTAbiX U YnPa)KHeHMS1 YXOA 3a HOBOPO)KAeHHbIM rpyAHoe BCKaPMJU4BaHte nOArOTOBKa K POAaM PUCKH He6e3onaCHbix a6opTOB nbrOTbi MaTePHHCTBa KOHTPaLAenLtL4U MHTepeaJn Me)KAy poAaM/BpeMFi POAOB CHrHanbw onacHocTtl: KPOBOTeYeHUe CU.nbHbie rOnOBHbie 6onU CUnbHa9 PBOTa BbICOKa9 TemnepaTypa nOTepU C03HaHU9/KOHBynbCUU Pa3pSiB nnOAHbIX o6onoBeK 6biCTpbie onyxaHH9 KOHe6HOCTeA pe6eHOK BHYTPU nepecTaeT weBenUTbC9 ToMb 6.eCn O SalOpobe IDO*AOM) KypeHUe anJKOrOnb nUTaHeL4 YXOA 3a Co6oU YXOA 3a pe6eHKOM rpyAHoe BCKaPMJUBaHIe KOHTpaL4enLrn9 L4HTePBan Me)KAY poAaaM4/BpeMA POAOB

62,8 25,5 23,4 25,5 29,8 47,9 17,0 13,8

54,0 60,0 36,0 58,0 42,0 73,0 54,0 43,0

74,5 43,6 50,0

73,0 27,0 25,0

58,5

34,0

43,6

21,0

63,8 74,5 72,3

50,0 43,0 60,0

8,5

58,0

9,6 76,6 35,1 21,3 39,4

39,0 80,0 82,0 91,0 81,0

7,4

38,0

yOx (KOHCYnBTaUUm) nOnyB4UnU nPeHaTanbHbiU YXOA nony4Ujn npeHaT. yxoA 6Oiee 4eM U3 OAHOrO I,CTOqHHKa Bce npeHaT. KOHC-LAmm/6O,nbWYIO 4aCTb Y OAHoro BpaBa nfOJwaeMshm

rOCnUTanlU3alAUU BO 6 peM9 6epeMeHHOCTU noceUXeHme KYPCOB MOnOAbiX maTepeU B npeAPOA. nepwoA nOnyHeHUe BMTaMHHOB/MMH. BeU4eCTB BO BPeM9 6epem-Tr

nfOnYaeMb; VXOn (DOAAOM) Haxo)KAeHme B OAHOU nanaTe C HOBOpO)KAeHHbIM KOHTaKTC HOBopoKAeHHbIM Cpa3y nocne POAOB rpyAHoe BCKaPMJ1BBaHLe AOnOnHMTenbHOe nUTaHUe An9, HOBOPO)KAeHHoro AeTCK. nfTaHLe MOWKHO MO)KHO nocie BinUCKt B39Tb AOrMOU nPmCyTcTBi4e naPTHePa npf CXBaTKaX H POAaX BU3UTbl OTL4a B nanaTy BbiAa4a CpeACTB KOHTPa4Len4LUU A Fi niaHHPOBaHH9 CeMbU nonyBeHUe BmTaMUHOB/MMH. BeXLLecTB

p<0,05 ** p<0,01 *** p<O,OO1 .4aH.bIe nlo5epewKoro s9cK7epuueHra CH=CTaTMCT. He3Ha94MO*

CH CH

CH *

CH CH

5,3 37,0 % naUUieHTOK, OTBOTUBWUIX "al" 100,0

100,0

41,5 73,4

6,0 65,0

60,6

54,0

17,0 79,8 2,1 8,5 63,8 69,4

9,0 83,0 57,0 50,0 78,0 99,0

0,0

2,1 3,2

16,0 4,0

0,0 0,0

65,0

cTaT-Ka TeCT-Ht4VI

45,0 X2

CH CH

COBepW=eHCTBOBaHMe C54CTeMbi OXpHbi 311OpoBbq xeHLUUH B POCCrniCKOLU OeeaMu

Ta6nmua V116. MeanNKO-CaHT.

npoCoBLueHme U yXoA. nauMeHTKU. npmWefWme AenaTb a6ODT. MmHua6opT i 3a rKHOKOROErMOCKNMN ycnyraMH. npepBapHTeJlbHOe U nOCT-TeCTMpOBaaHe TeMh % naLtHOeTOK, nony4aoutwx MH4)OpMatmio OT MeA.pa6OTHNKM A6opT MUHH-a6opT rMHoKOJ1ormN

n=96

n=95

npeAB.

nocT-

n=87

n=99

npeAn.

nOCT-

npeA4.

nOCT

28,7

69,7

...

56,8

90,0

23,0 19,5

56,6 59,6

49,7 43,9

65,5 55,5

52,9 21,8

85,9 87,9

56,1

30,9

5,7 5,7 17,2

48,5 40,4 23,2

32,7 3,6 0,0

41,3 11,6 6,5

n=155

n=110

KoHTpaL,enT. cp-Ba (KC)

38,5

nO6OqH.S1Bn-JI nniocbI OT HeCnonOb3OB.

37,5 28,1

34,7 34,7

32,3 1,0

26,3 3,2

nUlTepaTypa o KC nPOCMOTP BUAeO O

7,3 2,1 28,1

1,1 4,2 7,4

nnaHMpOBaHu14 CeMbU 6e3onacHbIA ceKc

15,6

17,9

29,9

43,4

63,9

17,3

npo4*PnaKT

16,7

18,9

96,6

84,8

66,7 43,8

54,7 88,4

penpoAqyKT.mcTopwFi

81,6 85,1

anneprL451 Ha MeAl4KaM-

56,6 62,6

88,5

82,1

93,1

73,7

Tbl/aHecTe3Mlo oTHoweHL4e K 6epeMeHHOCTr

HK HK

12,5

15,8

19,5

34,3

HK HK HK

KC mCnOnb3OBaTb KC KOrAa HaL4lHaTb UX KaK

40,0

***

mcnonb3OBaHme

qaCTOTa 6epeMeHHOCTm

OCnO)KHeHLUU

npw a6opTe lICTOpUR 6one3HH/KOHCyubT-UU

MeA. U4CTOpUi

OTHoweHMe Ka6opTy

11,5

7,4

10,3

T.3peHws napTHepa nilaHbi Ha 6yAyIoauAe

66,7

10,4

5,3

19,2

17,7

8,4

4To o)KUAgaTb/KaK 6yAeT

12,6 19,5

46,5

15,6

HK HK

18,9

25,3

85,9

I43MepeHMe Kp. AaBfleHWF1 L43MepeHL4e Beca o6uui OCMOTP OCMOTp Bnarant1uAa

54,5

100,0

99,0

aHlanM3 Ha cnf,1

98,9

100,0

99,0

100,0

98,9

88,9

aHaJn13 KPOBM ((cW4)Wnlc)

100,0

81,8

aHaJnU3 MO04 OCMOTP Ha npegmeT MH4)eKI4Lu anaranuna

81,3 99,0

87,4 100,0

CH CH

0,0 0,0

y,nbTpa3ByK

49,0

42,1

9,4 0,0

14,7 0,0

nposeAeHa npoLeAypa

YxOA

aHa.fW3 Ha 6epeMeH. KC nony4eHO

1,0

16,7

1,1

89,5

% pecnOHAeHTOK, nOny4aioLLtx ycnYrU 98,9 3,0 HK HK 0,0 6,1 ** HK HK 1,1 7,1 HK HK

100,0

8,1 88,9

HK HK

18,4

39,4

1,1

32,3 43,4

HK HK

100,0

0,0

100,0 0,0

CH CH

HK HK HK HK HK

0,0

100,0

0,0

99,0 99,0 1,0

100,0 0,0

P<0,O1

5,7

1,0

99,0

CH=CTaTU4CTWUeCKlU He3Ha4iUMO* p<O,O5 X2; 4aHHble IodVepet4Koro SKc7ephMMeHTa

** ***

TUn a6OPTa BaKyyM BbiCKa6n4BaHt4e npOAOnIXHT.68pOM-TH 6onee 12 HeAenlb MeHee 12 HeAenb

CH *

P<O,OO1

CTaTl4CTKa TeCTPO8saHMfI

QoaWwleHcTBoBaHU4e

cUCTem4

OX=Hbi 321oposbg weHLUUH B POCC14rcKoU

oePenmuu

Ta6AmHga Vill. OTHOUeH140 K nlOJlY4HHOMY YXOAY; UHH4OpMaIA. UHAUKaTOpbi no noBoAy nOnri4oHHbix ycAyr: nloCeopoAoB. nlepmoA, a6opT H mmHma60pT, rUH8KOnormn, npeAB. U nOCT-TeCTMpoeaHme

nocAepoAosoo

nepuoA

npeAB.TeCT

nOCT-

HeyAO6HbI6 4acbi o6cny)KmeaHHA(%

n=94 10,6

TpyAHO Ha3HaBHTb Bpem-m npmema ()4,3 Ha Aopory YXOANT 6OAbwle 30 MHH. MHoroO PeMeHN yXOAHT Ha O)KUAaHUG B

20,2 56,4

n=100 7,0 12,0 12,0 40,0

HK HK HK HK

15,0 16,1

15,0 17,4

15,0 15,9

6,0 4,9

a6OPT p

npeAB.

nOCT-TOCT

n=96 9,4 2,1 5,2 60,4

n=95 7,4 5,3 4,2 37,9

CH CH CH

7,3 3,1 21,9 0,0

89,5 12,6 2,1 3,2*

CHi

16,5 13,4

16,5 17,0

15,0 15,8

16,5 12,8

16,5 15,0

6,0 6,4

8,5 4,7

8,5 5,2

HK HK

CH * CH *

0O"PGAN K RPA4Y(%) 3OTpATbI

(%)

KOHCYnlbTa411B, aHlanB3bl neKaPCTBa TpaHcnopT U YxOA 3a HoBopo)KAeHHbIM

nOTePBi goxoAa 1UHAeKC YAOBn@TBOpOHUfl

npalCrM. 3HaHeHBe (PO;AOM)

TeopeTBH.3HaqeHBe npaKTWq. 3HaqeHme NHAeKc nOIy4HeHNS

(KOHCYJlbTaL4UU)

TeopeT"q.3Ha4eHme

NHAOKC YAOBSeTBOpOHUR

UH4)opmagm

KOHCYAbTaL4uu unu rAe-nm6o eu4e) TeopeTiq. 3HaHeHme

npaumx.

3HaHeHme

KHAeKc nOAY48HI4l

NH4)opmaL4H

POAAoMO)

4,0 4,0 2,0 5,1 MUHHH-a60PT

TeopeTUA4.3Ha4eHme npaKTM4. 3HaseHBe

HOyA06HbIO 4acbi o6cny)KmeaHMA (%) TpyAHO Ha3Ha4HTb BPeMM

(%)

Ha Aopory yXOAMT 6Onbwle MHorO BpeMOHu

MU4H.

yXOAHT Ha O*KuAaHHO B

npeA'3. TeCT

nOCT

n=87 3,4 2,3

n=99 14,1 7,1

20,7

rUHeKoniorms p

npjeAB.

nOCT TecT

n=155 0,6 1,3

n=110 0,9* 3,6

38,4

5,8

3,6

47,3

75,8

66,5

74,5

97,7 31,0 73,6 25,3

64,6 11,1 41,4 12,1

39,4 65,8

22,7 39,1

7,1

0,0

16,5 17,8

16,5 13,1

15,0 12,7

15,0 13,3

8,5 6,7

8,5 10,5

5,0 6,4

5,0 6,2

0OHPeAU K NPa4Y (%) 3aTPOTbI (%) KOHCY.nbTaLAMM, allanM3bl

nieKapcTBa TpaHcnOpT U yx0A 3a HOBopo>qAeHHblM nOTePs' AoXoaa

UHHAKC YAOBneTOOPeHMS1 (KOHC-4UUM)

TeopeTUH.3HaYeHHe npaKTL4q. 3Ha4eHm4e mHAeKc nony4eHmsl

NH4)opmaLtm

KOHCYAbTaL%mm unu rAe-nm6o eu4e) TeopeTLUH.3Ha4eHme npaicrm4.3HaHeHL1e CHI=CTaTt14eCKM HesHaqMT..*p<0.005 **p<0.001

***p<0.00

,4aHHble lvo6epewKoro 3KcnepGMeHTa

COBepWeHCTBOBaHoHe C&fCTeMbl OXpaHbi 3SllOpBbR .WeHlUIH B POCCHlfCKOf 0eAepanuMl

TaG6nma IX. OTHOW6H.e naL4MHTOK K OTASJ1bHbIM 3neMeHTaM yxoAa (nocnepoAoBoU nepmOA, a6opTm, M4HNa6OPTbI,

ruHeKonormsi), np6ABaPUTeJbHOO U nocr-TOCTMpOBaHUO

% pecnoHAeHToK, OTBUTHBUwXx"ocerAa" Mnu "0o6iBHo" nocnepo4oAoio nepuoA a6opT npeAB. noCT. p nPeAB. nocT.

n=94

n=100

88,3 77,7

94,0 88,0

60,6

96,0

HanUPUe Bi6opa

54,2

53,0

XOpOWWUU KoHTaIcr

86,1 71,3

96,0 35,0

80,8 64,9

3a6oTa O naLAmeHTe XOPOWwU yxoa

KoHCynbTa4gma BexnUBoe OTHOweHUe yAejiniiocb AoCTaTo4Ho BpeMeHu YBa)KUTenlbHOe OTHOw6eHUe K U4HTUMHbIM Bonpocam

CH ...

n=96

n=95

93,8 90,6

97,9 95,8

99,0

98,9

100,0

96,8

97,9 86,5

98,9 63,2

96,0 95,0

89,6 93,8

86,3 96,8

81,9 81,9

98,0 100,0

99,0 95,8

98,9 92,6

CH CH

He pa3rOBap4BalOT C To60U CBbICoKa

87,5

2,1

PoggoM Be)KnJ4Boe OTHOweHUe

96,8

87,0

99,0

100,0

yAejnipjoCb AoCTaTo4Ho BpeMeHu

63,8

88,0

30,9

97,0

97,9 100,0

yBaX>(TenbHOe

92,7 99,0

HaJniM4e Bbi6opa

26,6

63,0

XOPOWl.11

90,4

97,0

nOOuApFi,nmCb BOnPOCbI

99,0 97,9

100,0 100,0

CH CH

86,1

38,0

88,5

81,1

gaBanJCb OTBeTbl Ha Bonpocbi

93,6 49,0

94,0 96,0

81,7 93,8

98,9 98,9

CH *

84,0 94,6

96,0 100,0

100,0

99,0

97,9

88,5

9,5

nooLiApFJn1Cb Bonpocbi gaBanUCb OTBeTbI Ha BOnPOCbI

yBa)KMTe,nbHoe OTHOwLeHLe K BbICKa3blBaeMbiM

CH *

MHeHV1PM

OTHOwBeHAe K UHTLUMHbIM BonpocaM KOHTaKT

yBa)KOTefJbHoe OTHoweHLe K

BbICKa3blBaeMbIM MHeHUPM

3a6oTa o naLtmeHTe XOPOwUJU YXOa He pa3rOBapuBaKOT C

To6oA

CBbicoKa

MmHH-a6OpT KOHCynb rTaqIu Be,KnUBoe OTHoweHWe yje.nnOCb aOCTaTO4HO BpeMeHU YBa)KUTe,nbHOe OTHoweHHe K

CH CH

rUHeKOnorUn

npeAB.

noCT.

n=87

n=99

88,5 86,2 80,5

100,0 97,0 88,9

... ** CH

npeAB.

nOCT.

n=155

n=110

95,5 94,8 89,7

98,2 99,1 100,0

CH *

HTWMHbIM BonpocaM

HanM4we Bbl6opa XOPOWkl' KOHTaKT nOOflAtSI.VnCb BOnpOCbI AaBani1Cb OTBeTbi Ha BOnpOcbd yBa)KMTeBJbHoe OTHOwBeHLe K BNCKa3bIBaeMbiM

75,5

96,0

83,9 9,2

83,8 70,7

77,0 70,1

84,5

100,0

93,5 67,7

99,1 94,5

92,9 89,9

92,9 88,4

97,3 99,1

690

87,9

89,7

99,1

62,1

99,0

90,4

36,7

74,5

90,9

MHeHuPM

3a6oTa o naLmeHTe xOpOwUJU yxoA He Pa3rOBaPUBalOT C To6oU CBbICOKa

CH=CTaTUPeCKU He3Ha4T.,* p<0,005 **p<00O1 .4aHble n7to6epei4Koro 3KcnepmmeHra

***p<0,001

COBepweHCTBOBaHme CHCTCMbi O92Hbi 3aOpOBbR .KeHwbf H B POCC&UUCKOU 0eepaUNN

Ta6niuua X. neDfloDa.

B3rnRnMb

noTpe6lTeneg

nfDsapMTeOJbHoe

Ha noIly4eHHbIi

yxona

nauMeHTKm

nocnepo0o.oro

u nOCT-TeCThpOBaHUe

npoUeHT OTDaBBWfX npefLnO4TSHNe

KTO AOmKeH o6ecne4HBaTb YXOA B npeApoAoBoA nepUOA Bpa4 o6uLJeu nPaKTUKU aKywepKa

aKywep-rwHeKOJ1or MHeHL4F HeT KTO AOJ1)KeH nPUHUMaTb POAbl Bpa4 o6LLAeA npaKTMK&. aKywepKa

aKywep-rHHeKOJlor MHeHMR HeT KaK nfl8TMTb 3a MeAM4LAHCKoe o6cnymlcBaHme Bce pacxoAbl 143 CBoero KapMaHa Hamlorm + U3 cBoero KapmaHa TOJnbKO HanorU

)KeHCl4lHbl

MmeTb

nm xceHU4MHbl ne4e6Horo 3aBeAeHMH?

HaxoxKAeHme

26,0 4,0

92,6

65,0

3.2

5,0

2,1

0,0

6,4

14,0

91,5

85,0

0,0

1,0

94,7

98,0

97,9

100,0

13,8

65,0

KoHCyJ1bTaL4si,

21,3

30,0

87,2

79,0

43,6

47,0

79,8

84,0

40,4

44,0

34,0

41,0

79,8

76,0

npeAno4TuTenbHbl 3annaHMPoBaHHbie Bpa4oM B npeAPOAOBoA nepmoA

nlpeAno4TMTenbHo

1,1

4,0

npaBo

npeAno4TiITeJnbHa )KeHCKaSi pa6oTaiouLaS B Be4epHee opeMs

3,2

28,7 npaBo

MmeTb

n=100

31,0 16,0 49,0

Bbi6opa

Bpa4a? AOnfKHbl

nOCT-TeCT.

n=94

6,4 41,5 23.4

MHeHMR HeT

AoflxcHbi

npeAB.TeCT.

Bbi6opa

BCTpem4l

OAHOA nanaTe

HOBOpO)KAeHHbIM npeAnoTHmTenbHo rpyAHoe BCKapMJnUBaHuie Tpe6oBaHuKo HOBOpoXKAeHHoro

npeAnOTUiTeneH AOcTyn noceTUTeneU npeAno'4THTenbHo

npUCYTCTBme

napTHepa

npu4

npMCYTCTBme

napTHepa

npm

poAax npeAno4T4Te.nbHo

poAopa3peLueHM nlPeAno4TITenbHa P8HH5R BbinICKa U3 pOAAOMa CH=CTaTmCTm4eCKM He3Ha'*iMo*

p<O,O5

p<O,01 ***

4aNHbHemoeGpe6LKoro 3KaKlBepiueHTa

p<O,001 cTaTICTMKa TecTwPOBaH&i4l X2

COBep weHCTBOBaHbe CUCTeMbi OXpaHbI 34lOpOBbH )KeHCllIH B PoCcoa1CKoa1

(1enepau

TaOfnuua XI AaHHbie o MeAHLLHHCKHX pa8OTHHKax, npeABapITenbHoe u noCT-TOCTMpOEaHHS B03paCT

npe-

nOCT-

35,6

37,3

Amanla3OH

12,2 19,66

11,6 19,67

)KeHCKMI My)KCKOA

98,1% 1,9%

97,7%

pOAAOM

78,6%

75,2%

KOHCYTIbTaBLLmF

19,4%

24,1%

cpeAH,U

non M9CTO pa6OTbi 3aHmMaOMan

3aB.OTAerleHmeM

AOnl)KHOCTb

cneLtmaniCT Bpa'4-npaKTMKaHT cTapwaFi aKywepKa aKywepKa MfiaAwlaFi aKywepKa npo4me (rnaBHbIM o6pa3oM MegceCTpbl)

cH=cTaTHcTM4ecKH He3HaqMmo*

p<O,05

X2 ,4aHHble.7/o6epeKoroP

p<0,01 ***

3KcnepfMeMHTa

2,3W.

9,7%

7,5%

18,4% 2,9% 4,9% 50,5% 4,9% 0,0%

18,8% 6,8% 3,8% 54,1% 3,8% 5,3%

p<O,001 CTaTWCTuKa TeCTupo0saHM

CoaepuweHcBoBaHme CMCTeMbi OXpBHbi 3nOpOBbR )weHLUfH B POCClCKOa Oenepaumu

Ta6nu4a Xii.

YpomeHb

3HlaHU4A

OTHOweHIe

MeAHL414HCKLIX

pa6oTHHKOB

K OTAe@JbHbIM

acneKTaM npeAoCTaoneHun ycnyr, npeABapuTenbiHoe u nocT-TecTupoBaHme flpoqeHT cornacUmnuixcs npeAB.

nOCT

MuHHa6opTbilnpeAnO4TOTebHee o6bl4Hblx a6opTOB

93,2

92,4

BceM naLA[4eHTKaM, nP"weA1w8 M AenaTb a6OpT, cnegyeT AasaTb KOHCynbTa4LM1 B o6naCTu KOHTpaL,enL,lUU U nOMOraTb MM Bbl6paTb MeTOA KOHTpaLnLk,14

99,0

99,6

Bce naLm4eHTKM nocilepoAoBoro nepHoAa AOJn)KHbi noi1y4aTb KOHCynbTaSL1O U 14H4)OpMaLAt4iO no BOnpOCaM KOHTpaLkenLAmm AO BbinfCK14 U3 popAoma

99,1

99,2

Bce ,KeHu14HblI, An0 3AOPOBbSl KOTOPblX 6epeMeHHocTb Mo)KeT npeACTaBJnISTb yrpo3y, AOn)KHbi nonyJLaTb Heo6xoAmmyio 14H4)OpMaLUUIO U KOHCynbTaL1414 B o6nacTM KOHTpa4enLU,U

99,1

99,6

)KeHuALHbl, KOTOPbIX 14HTepeCyKOT BOnpOCbi nnaHMPOBaHMS CeMbM, AOnfKHbl MmeTb B03MO)KHOCTb npOATU Bce Heo6xogwMbie o6cneAoBaHMA U cAaTb na6opaTOpHbie aHlanJ43bl 3a OAHO noceLLOeH1e

94,2

95,3

Bce )KSHUAMHbl, KOTOpbie 6onbwe He )KenalOT MmeTb AeTeW, AOJDKHbl UMeTb npasO Ha xmpypri4eCKYKo CTepwnw3aLukmo

93,2

92,4

Bce My)K414Hbl, KOTOpbie 60nbWe He *enaiOT UMeTb AOOJ)KHbl MmeTb npaBO Ha XmpyprMIIeCKyiO CTept4nI43a,41io

AeTeA,

80,6

87,7

A,ni Toro, 4To6bl HaceJeHme oTAaBano npeAnoLcTeHme He a6opTaM, a KOHTpaLUenL,UU, Heo6xoAL1Mo npOBOAUTb npOCBeTUTenbCK1e KaMnaHUU c mcnOnb308aHmeM CpegCTB MaccOBOA 14H4)opMaaLA4

99,1

98,7

CnegyeT CTpeM1TbC5I K TOMy, 4To6bl My)K4HHbl Aenmnm 6peMs OTBeTCTBeHHOCTU B Bonpocax ninaH1poBaH145 ceMbL

100,0

99,2

npm )KeHCKWX

AOn)KHbl rpynni

99,0

98,3

Aon)KHa

66,0

64,8

nOnb3OBaTbCFI

84,5

91,9

B pOA14flbHOM AoMe BO BpeMsi CXBaTOK p5AOM AOOn)KHbI HaXOAUTbCR MX napTHepbi

C pO)KeHinLaMm

62,1

63,1

B POAMJ1bHOM AoMe BO BspeM5 pOgOB pRAOM AOJVKHbl HaXOAUTbC51 mX napTHepbl

c pO)KHeHLMam

45,6

47,5

KOHCynbTaLkm5X

pa6OTaTb rpynnbi nOArOTOBK14 K poAaM

BpeMn

poAos

1 pO0AmnbHblX AOmax npeApoAoBor0 o6yL;eHHuI u

poAopa3peweHWsl

)KeHuHI4Ha

HaXOATbCSI B oTAeJ1bHOri nanaTe AInJ KOHTPOnJ napTorpa4)oM

xoAoM

poAos

cneAyeT

COBepagMeHCTBOBaHme CHCTeMbl OXpaHbi 3IIO2OBbq weHLUH B POCC&UCKOi

Ta6nmu4a XIl. YpomeHb 3HaHUM acneKTam npeAoCTasBneHu (npoAonxKeHMe)

OTHOwleHme MeAI4I4HCKUX

ycnyr,

npeABa PTeJbHoe

CeaeDuu

pa6oTHMKOB K OTAOnbHblM focT-TecTNpomaHue n

nlpoLAeHT cornacumwuxcu npeAB.

nOCT

88,4

87,7

73,8

79,7

BCKapMnmBaTb

62,1

76,3

AO)lKHbi nlOJ1yqaTb 4MeTb B03MO)KHOCTb HaBeLi.aTb ero U OKa3b[BaTb MaKC14MaJlbHO B03MO)KHbIA yXOA

83,4

89,4

Ecnu4 )KeHWu14Hbl B penpOAYKT14BHOM 1o3pacTe HeAonony4aloT Heo6xOAUMoro fllTaHM4 (BKnio4aA MOnOAe)Kb AO ABaALaTM neT), TO mM CJ2eAyeT AaBaTb nfTaTenJbHbie Ao6aBK1M, B oco6eHHocTM,

97,1

98,7

6epeMeHHbIM )KeHLL4MHaM nflTaTeClbHbie Ao6aBKM cn1eAyeT AaBaTb Ha perynnPHou OCHOBe

85,4

88,6

KOPMsL4UmM MaTepRM nMTaTenbHbie Ao6aBKM cneAyeT AaBaTb Ha

82,5

88,1

BblSJ1eHUe U nle4eHMe 3a6oj1eBaHL4r, nepeAaiaoLU4xci llO)lOBbIM nyTeM, AOJ1)KHO OCYL4eCTBI15TbCA B )KeHCKMX KOHCyn1bTaLA4lx

99,0

99,2

CBeAeHl51 AAA MOnoAe)Km, CBA3aHHbie C CeKCOM U penpOAyKTMBHOU OYHKLA4eri 3AOpOBbA, AO)1)KHbl npeAnaraTbc; B )KeHCKMX KOHCynbTaiA4mX

94,2

95,8

npeAoTBpau2eHue 6ecnnoAu14, ero ne'eHie U KOHCynbTL4poBaHme AOJDKHO ocyLieCTBR51TbC51 B )KeHCKMX KoHcyJIbTai451x

96,1

98,3

CJSeAyeT

CTpeMWTbCA K TOMY, HTO6bi nOMOUb no yXoAy 3a HOBOpo)KAeHHbIMM

BCeM naLAmeHTKaM pa3pewaTb HaxOAUTbCsI nO4TM

MY)KBUHbl

OKa3blBanJ1

noCAiepOAOBOrO nepmoAa cneeAyeT B OAHOU naniaTe Co CBOUM

HOBOPO)KAeHHbIM

locuie pOAOB KeHLU4MHe cJ1eAyeT nO3EOn;1Tb rpyAbio no Tpe6oBaHMIo HOBOpo)KAeHHoro Eciui

HOBOpO)KAeHHbi4

6oJleH,

pOAMTeJUi

MH(IOpMaL4kmo 0 COCTOsHmm ero 3AOpOBbR,

)KeBJe3O u conm 4)ojimeBo4 KMCJnOTbl

peryn51pHoO

OCHOBe

COBepweHCTBOBaHHe CHCTeMbi OXDBHbi 3JlOpOBbq YeHLUIH B POCCUU1CKOU Oeneauuu

Ta6mnua XII. YposeHb 3HaHmA acneKTaM npeAOCTasJ1eHII (npoAoncKeHMe)

OTHOwUeH1e MeA4ULHCKUX npeABapiTenbHoe

ycinyr,

pa6oTHmKOB K OTAellbHbiM i nocT-TeCTUpoBaHMe

npoLAeHT cornacnmwuxcu npeAB.

nOCT-

95,1

97,0

94,2

97,0

28,1

45,3

82,5

83,5

88,3

92,4

pe6eHKa c

70,8

75,0

MCnOnb3OBaHMM

91,3

94,9

A6opT cJneAyeT paccMaTpMBaTb, KaK nepawqHoe cpeACTBO KOHTpoj1n1 HaA po)KAaeMocTbIO, a TaK)Ke BCnlOMOraTeJlbHoe cpeACTBO B cnyqae,

68,0

72,5

94,2

95,8

ecnu )KeHLlUHbi nonyqatOT noBoAy npaBWJbHOCTW wcnOnb3OBaHwfl AaHHoro KOHTpa4LenTHBHoro cpeAcTBa u ecni OHM 3HaIOT, 9TO HeKOTOpbie nO6OqHbie RBJ1eHM9 CqUTalOTC9

95,2

95,8

)KXeHLLHbl,

Haxo,AEsmeC

B nOCT-KnuMaKTepw4ecKoM

nepuoAe,

A,oJKHbl i4MeTb BO3MO)KHOCTb nOny'4Tb ropMoHanibHylO Tepanuio B )KeHCKOu4 KOHCYJ1bTaLAt41

npOBepKa Ha paK rpyA,

1 weAKM MaTKU AOJDKHa oCyu,eCTB)1%STbCs B

)KeHCK1IX KOHCYJ1bTa"m4X

ropMoHanbHble KoHTpaLJenT4BbI (MMHw-nwulonm) onaCHOCT1

He npeAcTaBnsmoT

AnFl KOpMsU.L4UX maTepeA

npOCBeTNTenbCKas pa6oTa B Bonpocax ceKca u KOHTpa4LenLU14 He BeAeT K nOBbiweHI4o ceKcyanbHoA aKTMBHOCTM u Hepa36opq4BocTM B CB53RX cpeAu4 MOnOAe1)K YPOBHU

6ecnhioAM1 CeMbI4 OTAaIOT

y )KeHLLk1H, KOTOpbie npu npegnoITeHme a6opTaM, a He

BTop1qHoro

nh1aHmpoBaHI414

BbIWe

KOHTpaL1enI,41 nloBTopHbie a6opTbi nOBbIWalOT 4pe3MepHO Manb1M BeCOM

npu

a6opTe

PUCK

HaMHorO

6eposTHOCTb po)4AeHLuH

BbIwe,

L9eM

npu

ropMOHanbHbMX KOHTpaBLenT1BOB U cnupanieu

ecJui KOHTpagLen1fL1

OTHoweHme

He cpa6oTaJla

KOHTpaLAenTMBaM

ynyIWWTcS;,

ecnu

ycnyrm

KOHTpauLen1LA4i4 6yAyT AeWeBbIMm u 6onee AOCTynHbIMu

KoHTpaL.enL.msi

OCHoBaTenbHYIO

cpa6aTblBaeT

LiaLA4e,

KOHCYJ1bTaLI4io

HoPManJbHbIMu U H14KaKoro BpeAa 3AOpOBblO He npMHeCYT

COBeUpLueHCTBOBaHke CHCTeMbi OXpaHbi 3J2OPOBbI )eHLUkWH

B PoccUUcKoU

(PeaeDaub

Ta6nmLla XII. YpOBeHb 3HaHIA U OTHOLueHme MeA"LULHCKtIX pa60THMKOB K OTASJebHbiM acneKTam npeAocTasneHu. ycnyr, npeABapuITenbHoe u nocT-TecTupoBaHue (npo4oJDKeHwe) npo4eHT cornacsuBmxcn npeAB.

nocT-

95,1

95,3

p CH

OTHoweHme K KOHTpaLBenTIBaM nyqwe, ecjin Bce HeO6xOAmMbie o6c,neAoBaHwq, alHanM3bl A KOHCYJ1bTaBLJ, MO)KHO OCyLLkeCTBUTb B xoAe OAHoro noceLLAeHUIi MeAL;4UHCKOro yqpe)KAeHMS1

92,2

96,6

)KeHLLiMH

91,2

94,9

37,9

44,5

)KeHaWuHbl, npowejeAuwe Kypc nOArOTOBKL K pOgaM, mCnlblTblBwIOT MeHbWMA CTpax nepeA pOAaMm, B pe3ynbTaTe qero poAbi y HUX He TaKle AnUTeAbHbIe

92,3

94,5

HoBopo)KAeHHblI

MewL4tuHCKoro

19,4

26,3

meH*HrwTa y HOBopo)KAeHHbix 6onee 3epoSTHa, ecnu Bce CBOUMm MaTepsiM4

56,3

62,7

qTO

51,5

58,5

Ecnu AaBaTb HoBOpo)KAeHHblM AeTcKoe nHTaHiIe uJnl BOAy C rnlOKO301, nOBblwaeTCI BepOHTHOCTb TOrO, 4TO MaTb He CMO)KeT KOpMLUTb rpyAbKO

72,8

72,9

78,6

84,3

59,3

75,4

BCKapMjIWBaTb rpyAbio pa3 B TpL-qeTbipe qaca, y HUX r4nep6wlwpy6MHeMMI Bblwe, qeM y Mj1aAeHLAeB, KOTOpbIX BCKapMnWBalOT rpyAbio no Tpe6oBaHWLo

46,6

58,9

Tpe6oBaHme K po)KeHuL4e np4HS]Tb npu nOCTynneHl'4 B pOAAOM Ae3NH(0MrWnpyKIU.14t AYW He MmeeT noA co6o0 HayqHoro o6oCHoBaHwi

71,9

83,1

HeT HNKaKWX HayqHbIX nOATBep)KAeHL4V TOMy, qTO pO)KeHNiLe KJlU3My, CH143L4TCA BePOITHOCTb MHJfeKLLM4 KaKile-TO Apyriie nlOJO)Ki4TeJlbHbie pe3yJi bTaTbI

74,4

71,1

KoHTpaLAenLAmw cpa6aTblBaeT qau,e, ecnu COOTBeTCTBYIOLLOee o6opyAoBaHme nOCTynalOT peryjspHoA OCHOBe

cneAyeT

AH(pOPMMPOBaTb

TOM,

noJno)KuTenJbHbie CTOPOHbl HeL4Cnonb3OBaHL4L

nepmOA

pOAOB

cpeAHeM

HaxOALTCS cnyTHLK, eciul

3nmAeMms

aAeKBaTHOU

qeM

3aKJlio4alOTCS

pSLAOM

poKeHmkeO

cnyTHLKa HeT, POAbI AJ19TCSI AOflbwe

cKopee

pa6oTH4Ka, qeM OT

KOHTpauLenTLBOB

ecnu

KOpoqe,

KOHTpauenTLlBbl

nOnyqWT

WHc1¢eKLKIO

Co6CTBeHHOu MaTepw

MJiaAeHL,bl cOAep)KaTCFI B OAHOU nanaTe, a He CO

Pa3AeneHme maTepek U mnaAeHikeB nocAe pOAOB BeAeT K TOMy, MaTb B nocnepoAoBou nepHoA He qyBCTByeT ce6e cIacT1lMBOVi

MaTepL,

pLa)Ke

KOTOpbIe

nnoxo nL4TalOTCR,

CnOCo6Hbl BCKapMn1HBaTb

rpyAblo PaHuuii nepexOA Ha KOpMneHHe KOPOBbUM MOJ1OKOM MO)KeT npwaBeCTr HeXBaTKe )Kenie3a B opraHU3Me HoBopO)KAeHHOrO U alHeMLi

Ecnui

MnaAeHL4eB

BePOHTHOCTb

pa3BWTMl1

CH=CTaTMCTH4ecKK

He3HaqI4Mo*

p<0,05

P<0,0I

ecnu unu

p<0,001

4aaHmble n/o6epelmro 3KcnepHmeHTa

cgenaTb

3TO gaCT

CTaTMCTiiKa TeCTLpoBaHMR

COBWepeHCTBOBaHme CUCTMem

Ta6nNua

XiII.

OXPHbi 3I0p0Bb

OTHOweHUle

YWeHdLU4H B POCCHaCKO9 OeIe6UML

Men&iUIHCKt4X

pa60THuIKOB

OTAOeJbHbIM

*CnelKTaM

npeAsapMTenbHoe U nOCT-TeCTHDosaHme nlpoAeHT BblCKa3aBUwx MHOHSe O TOM,

gOnqecnoMo2KSHRMN

4TO B HaCTORI4uO EPeMs CyuIOCThyeT 'nepe6op" no cneAyiou4um nomulmnM:

nfpoTsonoKa3aHMA An

npiMeHeHwa BMC

flpoTuBonoKa3aHWA Ana np&MmeHeHmA ropMOHanbHbIX

npeAB.

noCT-

18,4

18,0

23,3

12,0

KOHTpaB0enTHBOB

nlepeA a6opToM Tpe6yioTC aHauii3U, KpOBM

14,6

11,3

AnA KOHTpatAenLU4M Tpe6yIoTcA aHanM3bl KpOBU

12,6

7,5

6,8

12,0

nlepeA a6opToM Tpe6yIoTc An,n

alHanju3bU Ha 6aKTepIw

KOHTpai4enLtL4M Tpe6yIOTcA alHlanj13b Ha 6aKTept4II

10,7

4,5

CnM,

8,7

3,8

BM4 m cnMA,

7,8

4,5

2,9

6,0

8,7

6,8

11,7

6,8

Kypcbu

B npeApoAoBou nepmoA, npM3BaHHbie noAroToBBTb POAMTenef4 K POAaM

0,0

0,8

06paaosaTenbHbie maTepuanumi Ann 6epeMeHHbIx )KeHu.AL4H

3,9

2,3

0DaKTopbl, B COOTBeTCTB.14 C KOTOpblMU 6epeMeHHOCTb nonaAaeT B KaTeropmio 'pl4CKoBaHHo0V4

9,6

3,8

15,5

12,8

3,9

8,3

nlepeA

a6opToM Tpe6yloTcA alHanMb3

BOLA

AJ.ng KOHTpatAenLkl4M Tpe6ylOTCa alHanM3bi Ha

O653aTenbHMe KOHCyJ1bTaW.14

4Ans nonb30saTejIew

KOHTpa4LenTOMBHIX CpeACTB

PeKoMeHAosaHHhie noceLu.eH4g MmeA"LuMHCK4X y4pegKAeH4 B nPOAPOAOBoM nepflOA rocnUTaJ1I.3aau,A*

B nept4oA 6epeMeHHOcTkl

npaBi3na no MICTOTe

U4 Ae3.MH4eKLHM4

onpeAenKioLuLe AeriCTBM4A B 4pe3Bbl4aruHbIX ciTyaw4ax npIu poAax VIHCTPYKLk4U4,

cH=CTaTHCTM4eCKfr

He3Ha4uMO*

p<005

p<001

X2 ,4aHHwme n7ioepeUKoro 3Kcnep(HMeHTa

p<O,OO1

CTaTMCTILKa TeCTI4pOBaHMR

COue8iWeHCTBOBaHlfe CbfCTeMbi OXDHbl 3,aOpOBbq YXeHLJLH B POCCi4rfCKOA

Taf6lnuua XIV, a6nOJ1HeTeBnba

OeaeauuM

YpOBeHlb non3rOToBKu me6,U4HCKX 4a60THuKoB, 21ena,1 nonYHT yO noaroTonKye npeeapHTenbHoe u nOCT-TeCTBpeaaHae meAHL4NHCKme

pa60THINK1,

nonyO4BMuee

nOArOTOMK KoKeCnaioL.e nonyINTb

(%)

npeAn.

meMe^UNHICne pa60THNKU4, nOArOTOBKY (%)

nOCT-

npeA4 .

nOCT-

24,3

21,1

31,1

34,6

45,6

36,8

31,6

Tema

flpeAOTBpaL.eH4e

cnnOAa Ui

63,1

68,4

3a6oneBaHMu, nepeAaBaembix nOHYoBblm nyrem, KOHCynbTa1' 4

17,5 4onpocam 31,6

KoNcynbTa4i& no ceKca u penpOAYKTHBHOr4

flOpYHKL,

3AOTOBb

14,6

42,9

15,5

30,1

47,6

52,6

22,3

26,2

42,7

48,1

29,1

27,1

KoHcynbTaI4m U ycnyru no KOHTpa4eniAmw

nlp8AOTBpauAeHme 6ecnnlOAMS1,

*41,7

KOHCynbTaLAm4 u ne4eHme

06y4eHMe B npeApOAOBOU nePNOA, noAroToBKa K POAam

I]oAAep)KKa rpyAHoro BCKapMjnuBaH14R Li KOHCYJ1bTai&414 CH=CTaTHCTIqeCKH He3HaL4MMO*

p<0,05

p<0,01

,4aHHbenlo6epewKoro 3Kcnepi7MeHTa

p<0,001 CTaTUCTUKa TeCTMpOBaHMR X2

VI. CHOCK14 [1 ]

[2]

AaHHer

(D. 3AopoBbe

MaTepL

pe6eHKa B POCCWV4CKOPi

cIeAepaLu.

(Maternal and Child Health in the Russian Federation). KOHCynbTaHTa (pyKonMCb), 1994.

pooKnaA

pQenapTaMeHT

Cu1y)K6a

3ApaBooxpaHeHWP

o6u.ecTBeHHoro

3AOpOBbS,

LteHTp

CoLAaJabHb]X

npomilnaKTLKe

cily)K6, LI

KOHTpOnio

pacnpocTpaHeHmeM 3a6oneBaHv1P, HaLkWoHanbHbIV1 L,eHTp no MeALALJHCKOM

CIWA.

CTaTWCTMKe

OcHoBHasi

L4 MeAmLAWHCKas

CTaTMCTIKa:

POCCOACKaS

m CoeAWHeHHbie WJTaTbi AMepMKL: Bbl6opoqHo no roAam 19801993. (Vital and Health Statistics: Russian Federation and United States:

OeAepaiLts

Selected

Years

1980-1993.

DHHS

Publication

No.

(PHS)

95-1485.

Hyattsville, MD: DHHS. June 1995).

[3]

BCeMVApHaR

OpraHL43aULAi5i

3ApaBOoxpaHeHwsi/,eeTCKW1

OOH.

c1OHA

nepecMoTpeHHble pac4eTbi noKa3aTeneO MaTepWHCKo0 cMepTHOCTI, 1990 r.: HoBbtm noAxoA B03 L lOHlCE0 (Revised 1990 Estimates of Maternal Mortality: A New Approach by WHO and UNICEF. Geneva: WHO, 1996.) [4]

[5]

[6]

BceMLpHas OpraHMw3aLm 3gpaBooxpaHeHwR/J&eTcKLA0 VOHA OOH. nepecMoTpeHHble paCqeTbi noKa3areneL1 MaTepLHCKOLA cMepTHOCTI, 1990 r.: HOBbu noAxoA B03 m KOHLCEO (Revised 1990 Estimates of Maternal Mortality: A New Approach by WHO and UNICEF. Geneva: WHO, 1996.)

C.K., Moppoy C. K. CTWMynvlpoBaHwe a6opToB: MApOBOA o630p, 1990. (Henshaw S. K., Morrow E. Induced Abortion: A World Review, 1990 Supplement. New York: Alan Guttmacher Institute, 1990).

XeHWo

nonOB Poccuuv

A.A.

fnaHLIpoBaHme m CTV1MynJ1pOBaHLAe a6OpTOB B nocT-coBeTcKOlr

Haqahle

nonyIeHAI

90-x

WHLHopMaLtAm

rOAOB: HeyAOBfleTBOpeHHbIe nOTpe6HOCTH B (Popov A. A. Family Planning and Induced

Abortion in the Post Soviet Russia of the Early 1990s: The Unmet Needs in Information Supply. Moscow: Center for Demography and Human Ecology Working Papers. Vol. 16, 1994.) (7]

BceMwpHas

Ko4)epeHi*ms

OpraHM3aL.mq 3ApaBooxpaHeHMi5. B03 no Bonpocam COOTBeTCTByMW1X

CornacHTernbHan TeXHO1OAr

pOAOB.

(WHO Concensus Conference on Appropriate Technology for Birth, Forteleza Brazil, 22-26 April 1995. Copenhagen: WHO, 1985.) [8]

CTUBeHCOH n. Me)KAyHapOAHbie pa3nWW9A B wCnOJ1b30BaHwm aKywepCKL4X BMewaTe.rbcTB.,Q0oKnaA o6 MccneAoBaHAL4. (Stephenson P. International

Differences in the Use of Obstetrical Interventions. Report on a Study. Copenhagen: WHO, 1992.)

CoBepweHcrTBoaHue CUCTrMbI 3AiOpOBb? xeHHLUPH B POCCUaCKOa Oeneouu

[9]

BceMHpHhfi 5aHK. flwnoTHbI0 npoeKT no pec)OpMe 3ApaBooxpaHeHUP B POCCU>CKOA 0PeAepaL,i4w. )J,oKnaA o6 3KcnepTW3e npoeKTa. (World Bank.

Russian Federation Health Reform Pilot Project, Staff Appraisal Report No. 15585-RU. Washington, D.C.: World Bank. 1997). [10]

Buccep A.ll., BpyriHWKc H., PeMeHH-K H. nlnaHMpoBaHwe ceMb6 B Pocci*: onbiT M MHeH51" BpaqePi-rMHeKonoroB. (Visser A. P., Bruyniks N., Remennick L., Family planning in Russia: experience and attitudes of gynecologists. Advances in Contraception 1993; 9: 94-104.)

[11]

Bmccep A. n., nlaBneHKo IA. , PeMeHHMK npaKTwKa u OTHoLueHLe 6b6muLAwxxCOeTCKiX

Bpyv1H1Kc H. JlerepT fl. >KeHULUH K KoHTpaLAenTMBaM.

fl.,

(Visser A. P., Pavlenko I., Remmenick L., Bruyniks N., Lehert P. Contraceptive Practice and Attitudes in Former Soviet Women. Advances in Contraception 1993; 9: 13-23.) [12]

BceMwpHas OpraHw3aLws 3ApaBooxpaHHeHme. 3auWTa, cTLMynMpoBaHMe u no,Aep)KKa rpyAHoro KopmneHvI^: Oco6as ponb cny><6 no oxpaHe MaTepuHcTBa. CoBMecTHoe 3asBjieHLe B03/lOHVI CEc. (World Health

Organization. Protecting, Promoting and Supporting Breast-feeding. The Special Role of Maternity Services. A Joint WHO/UNICEF Statement. Geneva: WHO, 1989).

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