미혼여성의 성, 피임, 그리고 인공유산 - 수출공단지역의 사례연구 (Sexuality, Contraception, and Induced Abortion among Adolescents and Young Adults in the Export Processing Zones of Korea)
-
- 한국인구학
- /
- 제19권1호
- /
- pp.93-122
- /
- 1996
본 연구는 최근 심각한 건강문제로 부상하고 있는 미혼여성의 성, 피임, 그리고 유산행동의 결정요인을 연구한다. 자료는 구로(서울), 구미(경북), 마산-창원(경남) 등의 수출공단 지역에서 수집되었고, 표본은 1) 프로그램 참가자인 공장노동자, 2) 유흥업소 종사자, 3) 산부인과 환자로 재분류된다. 연구결과는 유흥업소 종사자가 혼전 성관계, 성감염증, 피임실패, 원치 않는 임신, 인공유산 등에 노출될 위험이 가장 큰 집단임을 보여준다. 유흥업소 종사자 중에서 20%가 첫 경험의 결과 성병에 걸렸고, 약 70%가 비효율적인 피임법을 사용하여 2회 이상 임신하였다. 전체표본에서 임신경험자의 비율은 60% 수준이었으며, 집단별로는 프로그램 참가자 36%, 유흥업소 종사자 64%, 산부인과 환자 91%로 나타났다. 이 비율은 각 집단의 인공유산 경험자의 비율과 정확하게 일치하였으며, 그것은 모든 임신은 원치 않는 것으로 결국은 인공유산으로 끝난다는 것을 의미한다. 조사당시 성활동을 한다고 응답한 여성 중에서, 인공유산의 경험횟수는 프로그램 참가자 1.6회, 유흥업소 종사자 2.3회, 산부인과 환자 1.9회로 나타났다. 이들의 80%는 4달안에 유산시술을 받았고, 첫 유산의 전체건수 중2/3는 20세에서 23세 사이에 시술된 것이었다. 약 1/4은 유산후유증을 경험하였으며, 이들의 60%는 후유증을 치료하기 위하여 병원을 찾거나 약을 복용하였다. 유산경험 후에도, 이들의 피임사용율은 유흥업소 종사자를 제외하고는 그렇게 높지 않았다. 본 연구에서 나온 중요한 정책적 건의내용은 공장노동자는 물론 유흥업소 종사자를 대상으로 중앙정부와 지방정부의 후원 아래 우수한 카운셀링 서비스와 가족계획 서비스가 제공되어야 한다는 것이다. 또한 유흥업소 부문은 근본적으로 개혁되어 유흥업소에서 일하는 미혼여성들이 원치 않는 임신, 성감염증, 그리고 인공유산 등의 위험으로부터 제대로 보호를 받아야 한다고 믿는다.
It is utmostly important to establish the efficient fitable way of peoples' active participation in primary health care especially in the areas where the public or governmental service input for the basic health care is insufficient like as in rural areas of Korea. In light of above reason, this study focused mainly on the evaluation of roles and activities of village health workers (VHWs) who were selected from grass- root level of village people in order to derive further motivation for active participation. This is believed to be a sort of feedback mechanisms. Actually, the authors collected the activity reports of VHWs who had been devoting themselves in the primary health care services of Jeomdong Area, of Yeoju Gun one of Korea University Community Health Action Programmes and survey record on the VHWs activity from correspondent people. 1 hose data were analyzed through computer programmed package. The activities performed by VHWs were limited to the performance in 1985 for conveniance. The summarized results were as follows; 1) General characteristics of VHWs. Among a total of 28 VHWs in the area, about 39.3g of them have been replaced up to the date since the implementation in 1983, because of moving out, occupational employment and of others. The age of majority (75.0%) lied between the range of 30-50, and educational background of 67.9% belonged to category of primary school graduation, about 50% of them experienced to be or were also entiled "chief of women club" of corresponding villages. 2) Work-load of VHWs. Each VHW was assigned for tasks of health care for average 55 households of 248 persons. They shared approximately 6 days a month for the activity in average and it covered 17 cases of basic health care in a month. A half of the VHWs performed home visits irregularly without solidified schedule. 3) Work performance analysis. Informations collected through VHWs were compared with data from official vital registration at local administration center "Myon Office" in 1985. VHWs collected 100.8 of new born, 116.2 of death, 58.3 of move in and 74.8 of move out in comparison with 100.0 of official registration each. Pregnant women of 79.8% of mothers among the total pregnancy of 94 which were confirmed as normally delivered or aborted cases by all means afterwards had been detected by VHWs as being pregnant and all of them received some of antenatal cares by VHWs. All(100%) of delivered women were detected by VHWs through home visits and they were cared postnatally. Whereas, according to the records of birth registration, the places of delivery were clinic in 33.7%, and mother's home in 66.3%, VHWs reported them to be clinic in 48.9%, midwifery in 20.2%. It was cleared that most of misinformation was caused by uncautious filling of birth registration at notification. Among the total of 717 eligible women under age 44 years, family planning status of 92.6% was reported by VHWs confirming practice of control to be 70.8% of reported fertile women. 4) Attitude of VHW on the roles and functions. Although 92.0% of VHWs expressed VHWs to be worthwhile, only 52.0% of them had dignity and satisfaction in their activity and 44.0% of them had passive attitude of working saying they followed direction regardlessly. Concerning difficulties in performance as a VHW, 60.7% of them pointed out lacking of medical and health related knowledge by themselves. Still, 64.0% of them thought visiting unfamilier house to be awful and 40.0% complained forms of activity to be difficult and hard. It was also revealed that 56.6% confessed lack of interest on community health service itself. Most of VHWs needed more educational training especially on clinical fields such as cares of gynecological diseases, hypertension, diabetes, and other chronic diseaes of the aged. Regular on-the-job basic trainings were said to be needed twice a year.
1. Background Women's health and their involvement in health care are essential to health for everyone. If they are ignorant, malnourished or over-worked, the health &-their families as well as their own health will suffer. Women's health depends on broad considerations beyond medicine. Among other things, it depends upon their work in farming. their subordination to their families, their accepted roles, and poor hygiene with poorly equipped housing and environmental sanitation. 2. Objectives and Contents a. The health status of rural women : physical and mental complaints, experience of pesticides intoxication, Farmer's syndrome, experiences of reproductive health problems. b. participation in and attitudes towards housework and farming c. accessibility of medical care d. status of maternal health : fertility, family planning practice. induced abortion, and maternal care 3. Research method A nationwide field survey, based on stratified random sampling, was conducted during July, 1986. Revised Cornell Medical index(68 out of 195 items). Kawagai's Farmers Syndrome Scale, and self-developed structured questionnaires were used to rural farming wives(n=2.028). aged between 26-55. 4. Characteristics of the respondents mean age : 40.2 marital status : 90.8% married mean no. of household : 4.9 average years of education : 4.7 yrs. average income of household : \235,000 average years of residence in rural area : 36.4 yrs average Working hours(household and farming) : 11 hrs. 23 min 5. Health Status of rural women a. The average number of physical and mental symptoms were 12.4, 4.7, and the rate of complaints were 22.1%, 38.8% each. revealing complaints of mental symptomes higher than physical ones. b. 65.4% of rural women complained of more than 4 symptoms out of 9, indicating farmer's syndrome. 11.9 % experienced pesticide overdue syndrome c. 57.6% of respondents experienced women-specific health problems. d. Age and education of respondents were the variables which affect on the level of their health 6. Utilization of medical services a. The number of symptoms and complaints of respondents were dependent on the distance to where the health-care service is given b. Drug store was the most commonly utilized due to low price and the distance to reach. while nurse practitioners were well utilized when there were nurse practitioner's office in their villages. c. Rural women were internalized their subordination to husbands and children, revealing they are positive(93%) in health-care demand for-them but negative(30%) for themselves d. 33.0% of respondents were habitual drug users, 4.5% were smokers and 32.3% were alcohol drinkers. and 86.3% experienced induced-abortion. But most of them(77.6%) knew that those had negative effects on health. 7. Maternal Health Care a. Practice rate of contraception was 48.1% : female users were 90.9% in permanent and 89.6% in temporary contraception b. Induced abortions were taken mostly at hospital(86.3%), while health centers(4.7%), midwiferies(4.3%). and others(4.5%) including drug stores were listed a few. The repeated numbers of induced abortion seemed affected on the increasing numbers of symptoms and complaints. c. The first pre-natal check-up during first trimester was 41.8%, safe delivery rate was 15.6%, post-natal check-up during two months after delivery. Rural women had no enough rest after delivery revealing average days of rest from home work and farming 8.3 and 17.2. d. 86.6% practised breast feeding, showing younger and more educated mothers depending on artificial milk 8. Recommendations a. To lessen the multiple role over burden housing and sanitary conditions should be improved, and are needed farming machiner es for women and training on the use of them b. Health education should begin at primary school including health behavior and living environment. c. Women should be encouraged to become policy-makers as well as administrators in the field of women specific health affairs. d. Women's health indicators should be developed and women's health surveillance system too.
The levels of health knowledge, attitude and practice of housewives considerably effect to the health of households, communities and the nation. This study was designed to grasp the levels of health knowledge, attitude and practice of houswives and analyse the various factors effecting to health in order to provide health education services as well as materials for effective formulation and implementation of health policy to improve the health of the nation. This study has been conducted through interviews by trained surveyers for 4,281 housewives selected from 4,500 households throughout the country for 40 days during July 11-August 20, 1983. The results of survey were analysed by stepwise multiple regression and path analysis are summarized as follows; 1. Based on the measurement instrument applied to this study, the levels of health knowledge, attitude and practice of housewives were extremely low with 54.5 points out of 100 points in full. Higher level with 72 points and above was approximately 21 percent and lower level with 39 points and below was approx. 24 percent. The middle level was approx. 55 percent. In order to implement health programs successively, health education should be more strengthened and to improve the level of health knowledge, attitude and practice (KAP) of the nation, political consideration as a part of spiritual reformation must be concentrated on health. 2. The level of health knowledge indicated the highest points with 57.3 the level of attitude was the second with 55.0 points and the practice level was the lowest with 50.0 point. Therefore, planning and implementation of health education program must be based on the persuasion and motivation that health knowledge turn into practice. 3. Housewives who had higher level of health knowledge, showed their practice level was relatively lower and those who had middle or low level of it practice level was the reverse. 4. Correlations among health knowledge, attitude and practice (KAP) were generally higher and statistically significant at 0.1 percent level. Correlation between total health KAP level and health knowledge was the highest with r=.8092. 5. Health KAP levels showed significant differences according to the age, number of children, marital status, self-assessed health status and concern on health of the housewives interviewed (p<0.001) 6. Health KAP levels also showed significant differences according to the education level, economic status, employment before marriage and grown-up area of the housewives interviewed. (p<0.001) 7. Heath KAP levels showed significant differences according to health insurance benificiary and the existence of patients in the family. (p<0.001). 8. Health KAP levels showed significant differences according to distance to government organizations, schools, distance to health facilities, telephone possession rate, television possession rate, newspaper reading rate and activities of Ban meeting and Women's club. (p<0.001) 9. Health KAP levels showed significant differences according to electric mass communication media such as television, radio and village broadcasting etc. and printed media such as newspaper, magazine and booklets etc., IEC variables such as individual consultation and husband-wife communication, however, there was no significance with group training. 10. Health KAP of the housewives showed close correlation with personal characteristics variables, i.e., education level (r=.5302), age (r=-.3694) grown-up area (r=.3357) and employment before marriage. In general, correlation of health knowledge level was higher than the levels of attitude or practice. In case of health concern and health insurance, correlation of practice level was higher than health knowledge level. 11. Health KAP levels showed higher correlation with community environmental characteristics, Ban meeting and activity of Women's club, however, no correlation with New-village movement. 12. Among IEC variables, husband-wife communication showed the highest correlation with health KAP levels and printed media, electric mas communication media and health consultation in order. Therefore, encouragement of husband-wife communication and development of training program for men should be included in health education program. 13. Mass media such as electric mass com. and printed media were effective for knowledge transmission and husband-wife communication and individual consultation were effective for health practice. Group training was significant for knowledge transmission, however, but not significant for attitude formation or turning to health practice. To improve health KAP levels, health knowledge should be transmitted via mass media and health consultation with health professionals and field health workers should be strengthened. 14. Correlation of health KAP levels showed that knowledge level was generally higher than that of practice and recognized that knowledge was not linked with attitude or practice. 15. The twenty-five variables effecting health KAP levels of housewives had 41 per cent explanation variances among which education level had great contribution (β=.2309) and electric mass com. media (β=.1778), husband-wife communication (β=.1482), printed media, grown-up area, and distance to government organizations in order. Variances explained (R²) of health KAP were 31%, 15%, and 30% respectively. 16. Principal variables contributed to health KAP were education level (β=.12320, β=.1465), electric mass comm. media (β=.1762, β=.1839), printed media, (β=.1383, β=.1420) husband-wife communication (β=.1004, β=.1067), grown-up area and distance to government organizations, in order. Since education level contributes greatly to health KAP of the housewives, health education including curriculum development in primary, middle and high schools must be emphasized and health science must be selected as one of the basic liberal arts subject in universities. 17. Variences explained of IEC variables to health KAP were 19% in total, 14% in knowledge, 9% in attitude, and 10% in health practice. Contributions of IEC variables to health KAP levels were printed media (β=.3882), electric mass comm media (β=.3165), husb-band wife com. (β=.2095,) and consultation on health (β=.0841) in order, however, group training showed negative effect (β=-.0402). National fund must be invested for the development of Health Program through mass media such as TV and radio etc. and for printed materials such as newspaper, magazines, phamplet etc. needed for transmission of health knowledge. 18. Variables contributed to health KAP levels through IEC variables with indirect effects were education level (Ind E=0.0410), health concern (Ind E=.0161), newspaper reading rate (Ind E=.0137), TV possession rate and activity of Ban meeting in order, however, health facility showed negative effect (Ind E=-.0232) and other variables showed direct effect but not indirect effect. 19. Among the variables effecting health KAP level, education level showed the highest in total effect (TE=.2693) then IEC (TE=.1972), grown-up city (TE=.1237), newspaper reading rate (TE=.1020), distance to government organization (TE=.095) in order. 20. Variables indicating indirect effects to health KAP levels were; at knowledge level with R²=30%, education level (Ind E=.0344), newspaper reading rate (Ind E=.0112), TV possession rate (Ind E=.0689), activity of Ban meeting (Ind E=.0079) in order and at attitude level with R²=13%, education level (Ind E=. 0338), activity of Ban meeting (Ind E=.0079), and at practice level with R²=29%. education level (Ind E=.0268), health facility (Ind E=.0830) and concern on health (Ind E=.0105). 21. Total effect to health KAP levels and IEC by variable characteristics, personal characteristics variables indicated larger than community characteristics variables. 22. Multiple Correlation Coefficient (MCC) expressed by the Personal Characteristic Variable was .5049 and explained approximately 25% of variances. MCC expressed by total Community environment variable was .4283 and explained approx. 18% of variances. MCC expressed by IEC Variables was .4380 and explained approx. 19% of variances. The most important variable effected to health KAP levels was personal characteristic and then IEC variable, Community Environment variable in order. When the IEC effected with personal characteristic or community characteristic, the MCC or the variances were relatively higher than effecting alone. Therefore it was identified that the IEC was one of the important intermediate variable.