TEXHA4ECKWE nlYsflmKALmL BCEMIPHOrO BAHKA N2 404 R /Am Cepop "Cooal7bHbie 3aAaa.L nepexoAHoro nepso,a nlpOeKT B CTaL14 peaiW3auwLi W TP404 BbIHOCLITCS Ha WLpOKOe o6cywgeHme RUSSIAN COBepweHCTBOBaHme CLCTeMbI OXpaHbl 3AOPOBbR )K>eHLMH B POCCO1lCKO egepaLAwo Pe3ynbTaTbl I7L4IoTHoro npoeKTa I 1 nlaTpi,1tAWR CTLIBeHCOH OtpaHC L,QOHHe l1 OJibr-a Otpof1oBa TaTb Ha Mef1bHIAK WUaHTaJ1 Bop3ana I i I TEXHIt4ECKUE nlYsJlUKAL4UI BCEMVIPHOrO EAHKA Ng 404 R Cepn uCOL40HanbHbie 38Aa4i nepexoAHoro nepioAa" COBepweHCTBOBaHme CLCTeMbi OXpaHbl 3AOpOBb51 )KeHU4I4H B POCCHACKOA Oeqepatmm Pe3ynbraTb I mJorHoro npoeKTa naTpI14M5 CTkBeHCOH CPpaHC ,OHHer Onbra cjponoBa TaTb,rHa MenbHMK WaHTan Bop3ana BCeMMpHhIiZ BaHK BaWMHrTOH, OKpyr Kony6mq Copyright © 1998 MeWyHapOAHbi 6aHK peKOHCTPYKiLMI m pa3BMTLi5/BceMMpHbl.1 BaHK 1818 H Street, N.W. Washington, D.C. 20433, U.S.A. Bce npaBa coxpaHeHbi Ony6nLKoBaHo B CoegLHeHHbtX WTaTax AMepLKM nepBbiL4 TMpa)K - anpeJib 1998 r. 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ISSN: 0253-7494 Bo BpeMFi noaroToBKL AoKnaga nlaTpmLLsI CTLBeHcOH m C)paHc ,D,OHHeVi SIBJ1FIlLMCb KoHcyJ1bTaHTaML 6bIwero oTAeiia JDOACKLX pecypcoB JQenapTaMeHTa cTpaH EBponbs L Cpe,He0i A3LIL BceMLpHoro 6aHKa. Ofibra OtpOROBa RBJlReTCLI KOOpQLHaTOpOM npoeKca OT MLHLcTePcTBa 3,paBooxpaHeHLI51 POCCLI¶CKOCI cteAepaLLIm. TaTbRHa MeJ1bHMK pa6OTaeT rnaBHbIM BpaqoM POWJ1bHoro goMa r. flio6ep[Abl, PoccMi1cKas OtegepaLLIs. WaHTan Bop3ana siBiiseTcs KOHCOJ1bTaHTOM oTAenia coLALaJ1bHoro pa3BLTLI" J,enapTaMeHTa cTpaH EBponbl L CpeAHei A3ML BceMmpHoro 6aHKa. BI56nLIorpaLI)MqecKLe gaHHbie ny6nLKaLALL Ha aHlJrlL4CKOM R3blKe L3 KaTanora bLD6nLoTeKbI KoHrpecca 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 98-14708 CIP CoAOepKaHme npeAuCJ1oBme .......... iv Pe3KOMe ................................. v Bbipa)KeHme np1M3HaTeJ1bHOCTW .. iv 1. BBeAeH&Ue ......................................................................... 1 Il. PenpoAyKTMBHoe 3AOPOBbe KeHLU14IH B POCCMUCKOU OeAepa4m ...................i........................ 3 III.C4CTeMa OXpaHbi penpOYKTU BHorO 3AOPOBbfl B POCCMUCKOU C1eAepaL m .................. 8 IV. nOABeAeHUe ITOrOB .mo6epeLAKorO 3KCnepMeHTa......................................................... 12 V. 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Oco6oe 3Ha4eHme Mmenm cneAyioL4ue peKOMeHAaLAmi4: * O6y4eHme cneLk4aniu4cToB, oco6eHHo B o6JaCT14 nflaHJ4pOBaHU14 ceMb1, nponaraHAbi 3AOPOBoro o6pa3a )KU43HU4 U MeA"LAHHCKoro npOCBeLL4eH14R. * PacwmpeHme ycJyr no niiaHMpOBaHMIO CeMb14, KOTOpbl8 AOnOKHbl CTaTb HeoTbeMJleMori LacTbIo pa6oTbl no npeAOCTaBneHmio rMHeKOnor"qeCKO4 noMoLL4, npoBeAeH4lo a6opTOB U o6cJIy)Kt1BaHmio naLA4eHTOK B nocJ1epOAOBor nep"oA. * CoKpai4eHme 4mCna cny4aeB rocnfTanM3aLAw4 14 Bbl3OBa Ha KOHCYJ1bTa4LfIO B nePflOA 6epeMeHHOcTm, a TaKoKe KOJ114eCTBa o6f3aTej1bHbix aH3an11430B u npo0LeAyp, KOTOpbie Heo6xoAi4Mo npOAT14 B LBenHx nony4eHmS nOMOLu4 no Bonpocam nnaHHPOBaHUH4 ceMbu4, a6opTa u alHTeHaTa8jbHo4 noMouL4. - * noBblweHue Ka4eCTBa o6Cny)Kt4BaH14R, oco6eHHo yKpenneH1 e o6pa3oBaTeJIbHMx aCneKTOB, BKnKo4eHme nfLLAeBblx Ao6aBOK B paLA4OH 6epeMeHHbMx U COBepLweHCTBOBaH1e cny)K6 14HTeHC14BHOr Tepanf414 B aKywepCTBe A HeOHaTOJlormm. * AKywepcK1e cjnyw6b] B 6o.nbH14Lax AOJDKHbi 6biTb npMBeAeHbi B COOTBeTCTBUe c peKOMeHAaLAt4uM14 B03 u IOHMCED no "Apy)KOCTBeHHOMy" MeAU4LU1HCKOMy o6cJ1y)KMBaHmio MaTepe u MmnaAeHL4eB. TaKoA noAxoA BKJKO0aeT noBceMeCTHoe HaJlH4'4e naJlaT, o6opyOSBaHHbIX AnDJ COBMeCTHOrO npe6blBaHMA MaTep u14 HOBopo)KAeHHoro, nooLL4peH14e rpyAHoro BCKapMjnUBaHUsH no Tpe6OBaHU1I MflaAeHLAa, a He no pe)K14My, npaKTf1KY KOHTaKTa MaTepI C HOBOpo)KAeHHbJM cpa3y nocnie pOAOB, np1MeHeHi4e yCOBepweHCTBOBaHHbIX MeTOU14K peaHmmwAtm HOBOpO)KAeHHbIX. I COBePpweHCTBOBaH4e CmCTeMbi OXpaHbi 3aOpOBbS xemHuH B PoccHUUcKoU Oeepawfu 3a npOBeAeHIeM 3Toro 3KcnepwMeHTa Ha6nioAaji KOHCynbTaTt'BHbir COBeT, B COCTaB KoToporo BXOAMJUn npeACTaBITeJi4 ropoAa Iio6epLbi, MMHIICTepCTBa 3ApaBooxpaHeHM4I, MOCKOBCKOU o6nacTM Ui BceMwpHoro 6aHKa. 3aTpaTbi npeAycMaTpiBsaJU o6y4eHkle cneLti4anJ4CTOB, 3aKynKy o6opyAoBaHmsi, a TaioKe K0HTpa4LenTl4BOB M nl4Ln±eBblx Ao6aBoK. OCHOBHbie 3aTpaTbi npoeKTa 6bunm nPO4)MHaHCMPOBaHbl 3a C4eT rpaHTa, npeAOCTaBJ1eHHoro npaBMTeBfbCTBOM InOHMN, ynpaBneHMe KOTOPbIM ocyLLAeCTiJnmn BceMMpHbir 6aHK. Awo Ha4ana peanMmaLmMH 3KcnepMmeHTa U no ero 3aBepwQeHmL 6biw npOBeAeHbl t4ccneAosaH49, OLenbIO KOTOPbIX cTania OLAeHKa npMnemJ1MOCTL4 L43MeHeHl4u MeeA.4LAMHcKor4 npaKT&4KI4 An9/ meAnepcoHana u naLAeHTOK, BbIFHCHeHme MHeHmU1 noTpe6MTeneru o MeAl4ULAHCK0M o6ch1y)K4BaHl4M 1 oL0eHKa BII9H14R 3TUIX U3MmeHeHM Ha Ka4eCTBO OKa3aHW5I MeeAt4LA4HCKOA nOMOuAc . 2 II. PenpoAyKTUmHoe 3AopoBbe )KeHL4HH B PoccUicKoU O eA epa4nu B 1995 r. npOAOJunK4TeJ1bHoCTb )KM3H' )KeHILLMH cocTaBiniHna 72 roAa, 4TO M3HaTenbHO HmIKe, L4eM B CTpaHaX 3anaAHoi EBponblU CWA [2]. nocne nepBbIX 3aMeTHbiX AOCTM)KeHMA B OTHoWeHi4m npOAOJ1)KL4TeJ1bHOCTM )KW3HI, OTMe4aBWMXCS B nepBou nOIOBmHe ABaA,LaToro BeKa, HacTynmna CTarHat4A [21. K 1990 r. nPOAOJDKMTeJ1bHOCTb )KM3HI4 )KeHCKorO HaceneHM4 AOCTmriia caoero nMKa, paBHoro 74,4 roAa, a 3aTeM cTania 6blCTpO CHI4)KaTbCs AO COBpeMeHHoro ypOBHFI [2] . HawnHasi C 1985 r., POCT YPOBHI CMepTHOCTM 14 CH)KOeHMe pO)KAa8MOCTt4 npmBeJnu K COKpaULLeHILio eCTeCTBeHHOrO np14pocTa HaceiIeHus (P1ucyHoK 1A, 16) [2]. 3TU TeHAeHLAMM Bbl3blBalOT 6onbWyIO TpeBory y PYKOBOACTBa pOCCMACKOrO 3ApaBooxpaHeHmsi, 14 AOn)KHbl y4HTblBaTbCS B onpeAeneHm npi4Op4TeTOB An M pa3pa6aTblBaeMbwx nporpaMM nnaHwpoBaHl4I4 ceMbI4.1 PUCYHOK l.a. 06u4He YPOBHH pOX4AaOMOCTM H CMepTHOCTh B POCCnACKOA OeAepaL4U 3a nePUOP, 1991 -1995 rr. (Ha 1000 MlTeneg) 16 - 15 15 1.' 4.5 14 13 12 --i|-!-o6upvR ypOBeHb 11-1 f ;CMepTHOCTU -o6u4Mii ypOseHb 10 rpOC4AeHNR 9 ~9.4 3 6 I I 1991 1992 1993 1994 1995 ,AaHH1e ,eanapTaAeHTra s4pasooxpaHeHnHG H CO14fafl7HbIX c,y,W6 CIIIA, 1995r. 3 COBemmeHCTBOBaHme CHCTeMbJ OXpgHbJ 3zOpOBbR .KeHLuWH B PoccUiUCKoiU ceepauuH PUcCYHOK 1.6. npoAon)KUiTenbHOCTb WU3HN MY)CKOrO U weHCKOrO HaCe6J1HUR B POCCUiUCKOU OeAepamlU 3a nePUOA 1991 -1995 rr. 75 72 70 7. 65 635 5 -nPOAOnKTenbHOCTb )KN3HU 2 [mce H.] 60 -nPOAOnXDICTenbHOCTb ICIU3HU , 57 1 [MY)K.] 58 55 50I I 1991 1992 1993 1994 1995 roA .4aHHble.74enapTameHTa 3ApaBooxpaHeGHHR H coL4Hrfahbx cn7yw6 CliA, 1995r. 3a nocneAHee AeCSITmfleTMe o6uAr4i YPOBeHb MaTepiHCKOU CMepTHOCTU B POCCUUCKOU OeAepa4Mm yMeHbUi^4JCA He3HaIMTenbHO. CTaTWCTM.ieCKt.e AaHHbie, npeACTaBneHHbie B OT4eTax MMHU4CTePCTBa 3ApaBOoxpaHe8HMS, MOryT HeAoLOOeHmBaTb peanbHYIO cmTyaLAmo - no oL0eHKaM B03 Ui IOHICECP B HaCTORUAee BpeMA B POCCUUCKOU c3eAepaLU,UU MaTeP4HCKas CMepTHOCTb COCTaBJsieT 75 CMepTeA Ha 100 TbICS4 )K4BOPO)KAeHHbIX (To eCTb B 4 - 7 pa3 BbLUe, 4eM B 3anaAHoi EBpone U CWA) [3].OCHOBHblMU4 npM4HHaMm MaTepMHCKOU CMepTHOCTU 5IBJ15IIOTCSI KpMMI4HanbHbie a6pmTbi, KpOBOTe4eHI U1 Onr-recTo3b (TOKceMmsi) (PICyHOK 2) [2]. 4 CoBepuJeHCTBOBxHMe CMCT M6I Oq NeHHblLOpOBb5 KeHlUMH B POCCUUCKOU (eepau Li PHCYHOK 2. flnpwHbI MaTepHHCKON CMePTHOCTH B POCCHiCKOA OeAepagUmm. A,aHHbie 3a 1993 r. 6epeMeIHcrTb 7% npo- -- 35%u A 111 ------- -- --- 1 flfl -a6oprr i i - --2996 - - n - C-. -0 A4aHHbie ALenapTameHTa 3ApaBooxpaHeH5q £4 coL4HiiabHbIX cn7yx~6 CLLIA, 1995 r. POCT YPOBHsR flpIMmHeHM45 KOHTpaLkelTI4B0B 6bIn He3Haqi4.TeJ1bHbIM B CBR13M C POCTOM 'rncna Ao6pOBOnbHbIiX CTepM.Ju43aLAmAi (PI.CYHoK 3) [4]. CTept4nl3aLkmS~ KaK meTOA KOHTpBLJ,enLAi.Im 6binua pa3peweHa B 1990 r. [nlpMKa3 MW~H3ApaBa N2 484]. OAHaKo nipMKB3 KacauiC5 TOJ1bKO )KeHLLAI4H. B npliWa3ax MAH3A,paBa Aaw He yflOML4HaeTCA B03MO)KHOCTb Ba3eKTOM1.IM (My)KCKag KOHTpaLiBflTi4BHaFi CTepmiMu3aL;mFi), B CBA3L4 C 4em 3Ta npoLAeAypa He flPOM43BOARMTCR 14 OCTaeTCSI, c npaBOBOA T04IKL 3peHMS1, "(TeMHOr4 o6J1aCTbIO)) [5]. CornlaCHO CTaTl4CTI4K M MH3ALpaBa opaJIbHbie K0HTpaLiAflTLBbI (OK) i4cnolOJb3yIOTCSI Ton1bKo 2-4% )KeHL1I4MH penlpOAYKTM1BHorO B03paCTa, a BHYTPImmaTO'4Hbie cpeA~CTBa (BMC) - OKO,no 20% )KeHWLI4H penP0AWKTIOBHoro so3paCTa [1,4]. OA~HaKO CTaTL4CTI14Ka MMH3ApaBa moNKeT HeA0ooLeHMBaTb YP0BeHb wcflonb3OBaHMS~ KOHTpaLAenTwBoB, T.K. )KeHI4A14HbI moryT nloKynaTb opaJIbHbie KOHTpaLAenlTIBbi 6e3 peLAenTa B meCTHbIX KIVIOCKax mnM anTeKaX mJ1m flOly'4aTb BMC 4n11 A~PyrMie K0HTpaLtAflTt4Bbi no 'IaCTHbIM KaHafiam. A60pT OCTaeTCFI OCHOBH-bIM meTOA~OM peryn1L4poBaH4MI po)KAtaeMOCT14. B 1992 r. COOTH0weHmBi a6opToB 14 )KmBbix POAOB 6bulo cnyioeLyLauL4M: Ha KawAJbie 1000 POA~OB nlPmx0AMJ1OCb 2165 a6opToB [1]. CorniaCHO oLAeHKam, cpeAtHFISl POCCMHACKaFi )KeHLLt,HHa B TBL4eHMB aceg )KM3HH A~eJaeT 6-8 a6opToB [1 ]. Ensi~ cpaBHeH14SE COOTHOweHme a6opToB 14 )KmBbIx POAOB B 3aflaALHbIX CTpaHaX COCTaBJ1ieT OT 90 (ronilaHAMRn) A~o 346 (CWA) Ha 1000 [5]. Eo.nbWMHCTBO a6opToB (71,4%) )KeHLLAiMHb AEen1aIOT B camom pacLABeTe penpozAyKTMBHoro BoapacTa [6]. JAeCflTb nlpoLAeHTOB a6opToB flPIXO,A14TCIA Ha nlOALPOCTKOB 14 fl4TM 19% - Ha 5 )KSeH14MH B BO3paCTe 35 nieT u cTapwe [6]. 32% npoLAeHTa a6opToB 6bio cAenaHo BO BTOPOM TPuMeCTpe 6epeMeHHoCTM, KorAa PUCK MaTePMHCKOr CMepTHOCTM uin 3a6oJieBaBMOcTM 3HaU4TeQJbHO Bbiwe, L4eM pUCK, CBA3aHHblr4 c a6opTOM B nepBOM TPUMeCTpe [6]. PNCYHOK 3. YpO6eHb MCnOJ1b3OBaHHU CpOACTE KOHTPa4Lt6nL4H B POCCUACKOR ePeAepaiwn B nepMOA 1991-1995 rr. (Ha 100 XKeHL4MH 4*OpTHJbHoro BO3pacTa) 40 . x38.8 35 ;8- ; ' 3 t8 *37.3 30 - 7.4 25 *4.cero 20 ....19......M I - 19 1 9.3 19.8 1995 18.1 15 15.1 UCTO ", 1996 fl 4OaHbIe M3TOTrepcrHbB ,na 3fpaOOxpaeHNR U pKMeAUHCKOiB lPObWlM HTHOpTU B03. B 1996 r. Kecapeeo CeL4eHI4 6blo flPMMBHBHO TOJ16KO B OKOI1O 10% cJiy'aeB, J1MWb B pB^KMX cJly'aRx npMMSHsnu1Mb BBKyyMHbI6 3KcTpBKTopbI 4lI unu urflLAbI. (puc 4). JJ.jis CpaBHBHIIR, o6u4~ee 'rncno cJly'4aeB xIlpyprl9ecKoro BMKTObCTBB BO BpBMR pOBOB B CTpSNBX 3a aKHiOi Emponbl U CWA HBMHoro npesbiwaiiu pSKoMSHMoBBHHbIB cTBH;apT6I B03 no poMoBCfloMoNCSHIIo. 6 COBepWeHCTBOBaHMe CfCTeMbl OXp8Hbi 3AO=OBb9 )KXeHWH B POCCUUiCKOUl bePaUUU PHCYHOK 4. K03S¢NL%IIHT aKyW.pCKoro BMetuaTJlbCTBa npH pOAOBCnOMO)KeHUM B PNO (Ha 100 pOAOB), 1991-1995 rr. 12 10 10.1 8 _ 6 +KecapeBo ce4eHN 4 -BariHanbHble onepaTHUHbie BMeWaTenbCToa 2 0.5 1991 1992 1993 1994 1995 roA AiaHHble MiUHUCTepCTBa 3aPaBOOXpBHeHIqR U MeCAl4NHCKOKf flpOMMbIWJIeHHoCT;b, 1996 r. C 1990 no 1993 rr. 3a6oJleBaeMoCTb rOHopee B0Oapocna Ha 78% (Co 128,0 CnY4aeB Ha Ka,KAbIe 100 TbICs'4 4eqoseK Ao 228,1 cny4aeB Ha Ka)KAbie 100 TbICsH LienoBeK), a cuMA4pMcoM - B nfTb paB (c 5,3 cIly4aeB Ha Ka)KAbie 100 TbICF14 4enoBeK Ao 33,8 cny4aeB Ha Ka)KAbie 100 TbICF14 4enoBeK) [2]. 3a6oneBaeMOCTb renaTUTOM A U B CHU3U4JnaCb (c 226,7 CJly4aeB Ha Ka)KAbie 100 TbICM4 4eAoseK B 1990 r. Ao 136,2 Ciy4aeB Ha KawAble 100 TbIC^H 4enJoBeK a 1992 r.), HO OHa no-npe)KHeMy HaMHOro BbSieW, 4eM B 3anaAHor EBpone 14 CWA. [2]. O4)MLA4aJbHO 3apermCTpupoBaHHble cny4a 3Bapa)KeHm1i B4L/CnlloAoM B PoccuM HeyKJ1OHHO pacTyT - c 581 cny4aq no COCTOSHUIO Ha 30 CeHTm6ps 1992 r. Ao 717 cnyLiaeB no COCTOSIHUIO Ha 1 anpens 1994 roAa [2]. OKOAo nOJ1OB&lHb6 Bcex BbISBi1eHHbIX cjiyHaeB - 3TO AeTm AO 15 AeT [2]. 7 Ill. CHCTeMa OxpaHbI penpOAyKTHBHoro 3AOpOBbSg B POCCUACKOU OVeAepaiuu PoCC14UCKoe npaBUTenJbCTBO TpaA3U14OHHO yAe11Fino 6OrnbWoe BHUMaHMe oxpaHe 3AOpOBbSP )K8HLLkMH 14 AeTeA. C14CTeMa MmeeT MHo)KeCTBO Ba3)KHblx npe1mMyL4eCTB, T.K. OHa co3AaBaniacb no npMHL14ny cnpaBeAnJBoCT1 u AOcTynHOCT1I. OAHaKo Co BpeMeHeM u no mepe COKpaLL4eHUP peCypCOB C14CTeMa MeA4LkHCKOA nOMOLLl4 )KeHLW4HaM penpOAyKTIIBHoro B03paCTa cTaiia He30eKTUMBHOR: Ay6nmpo3aHme 4yHKLM4A, qpe3mepHoe MHBeCTMpOBaHMe CpeACTB B CTaL14OHapHOe o6CJly)KMBaHme u npeHe6pe)KeHme TaKuMu Ba>KHHbIMM ycilyraMm, KaK nepBM4Han MeAML4LHCKai nOMOLU.b, nponaraHAa 3AOPOBoro o6pa3a )KU3HU U CaHuTapHo- MeAM4LkHCKoe npoCBeLl4eHue. YnpasneHue pQo 1992 r. pa3pa6oTKa CTaHAaPTOB MeA14mLHCKOi npaKTMKM u KOHTponb 3a mx co6rnKoAeHmeM 6bri4n npeporaTrBoB MMH3ApaBa. BnocneAcTBVIM OTBeTCTBeHHOCTb 3a o6ecne4eHme u 4)1HaHCMPOBaHme 3ApaBooxpaHeHFiP 6bLnm nepegaHbi c LteHTpanbHOrO YPOBHI Ha o6J1acTHoA (permoHanbHbIM BJ1aCTRM). B 3TO wKe BpeMH roCyAapCTBeHHbig KOMUTeT caHuTapHoro U 3n1Aem4olorH4eCKorO KOHTPOJnIX (roccaH3n"AeMHaA3op) 6bu1 BbiBeAeH m3-noA KOHTpOJn1 MMMH3ApaBa. B 1996 r. roccaHanwAeMHaA3op 6bin Bo3BpaLLUeH nOA KOHTPOJ1b MMH3ApaBa, B BeAeH14e nepBorO 3aMeCTMTenjiF MMHMCTpa. roccaH3nmAeMHaA3op o6Ina,aeT WLIPOKUMU nonHoMoq4uM1M B o6JnaCTM CaHTapMm, rmrmeHbIl, 3nfAeMmonJorm1 MH4)eKLA4OHHbIX 3a6oneBaHMr4, a TaioKe HeKOTOpblx acneKTOB 3aLLA4Tbl oKpy)KaiouAer cpeAbt. KoM1TeT YCTaHaBniBaeT CTaHAapTbI MH4eKO4OHHorO KOHTPOJ15I B 6w1bH14Lax (MHorUe 13 KOTOPhLX B 3HaBMTeBJbHO1 CTeneHM ycTapeiiM nuw60 He34)4)eKTMBHbl), ocyXueCTBn1eT KOHTPOIb 3a q)yHKLA4OHmpoBaHmeM 6onbHM4L, MmeeT nOJ1HOMOI14Sl HanaraTb WTpaq)bl U npecneAOBaTb B yrOIIOBHOM nOpRAKe TeX MeAUmL14HCKMX pa6oTHMKoB, KOTOpble HapywaloT YCTaHOBneHHbie npaBt4na. CTpax nepeA HaKw3aHueM 3a AeCiCTBRl, MAyLUm4e Bpa3pe3 yCTaHoBjneHHbIM cTaHAapTaM, 3aqacTyio CTaHOBFITCFI OCHOBHbIM KaMHeM npeTKHOBeH4S1 Ha nflT1 npOBeAeHu14 pe4opM. 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MonoAeIKb B Bo3paCTe OT 17 AO 19 neT COCTasBJI5A1M 13% nauL,eHTOK nOCTHaTanbHoro nepMOAa, 6% naLiMeHTOK, pe6WBW1X cAejiaTb a6opT M MuHuia6opT U 13% naLMeHTOK, o6paTMBWMXCSl 3a rMHeKOAorM4eCKuMM ycnyraMu. qwcno Kyp&4J1bLLA&4LA CO BpeMeHeM yBeJu'I'*IJ1oCb B rpynne nOCTHaTa.nbHoro nepMoAa (c 5% Ao 23% p<0,001) A B rpynne naLAmeHTOK, cAeJ1aBw1x MuHua6opTbl (c 22% Ao 56% p<0,001), u OCTaFOwCb HeM3MeHHblM B Apyrux noArpynnax Ha YPOBHe OKOno 20% OT o6uAero 'ucna o6cJieAoBaHHbIx. pepT&4nbHOcTb, KaK U O)IK&AanOCb, 6bina HL43KOU, OAHaKO AOBOj1bHO 6onbwoe KOn4IeCTBO )KeHU4AMH B Ka)KAoA noArpynne coo6wA&nj11i o TOM, ITO OHM ywe Aenanm TpU unum 6OAbwe a6opToB (PMCYHOK 5). aianee, OT 7% Ao 22% )KeHUL4UH B KaA,gOU noArpynne coo6uLLMjun, LITO B TeqeHMe npoweAWWx ABeHaA3LaT1 MecS1LeB OHM nu46o yKe poKan, 1n16o ywe Aenanu a6opT (npwio)KeHi4e E, Ta6n&4LAa V). 13 3TUX AaHHbIX cJieAyeT, 'TO )KeHULAMHbl paccMaTPMBaKOT a6opT, KaK BseCbMa cepbe3Hoe cpeCTBO KOHTPOJIn1 3a po)KAaeMocTbio, a wcnonb3OBaHwe nnaHMPOBaHMKO KOHTpaBLenTUTBHbIX CpeACTB HaXOAUTC5I Ha HeAOCTaTOIHOM ypOBHe. 3Ta TeHAeHLHL4S1 OCTanaCb HeM3MeHHOA U nocne npOBeAeH14I MeponpMATHR no ceMbM (CM. npi4lo)KeHHe B, Ta6.nmu.a VI) 16 CoBeDlwueHCTBOBaHme CMCTeMbi OXpOHbI aaOp3Bb51 KeHLU14H a PoccUUcKoU OZegauuu PUCYHOK 5. nfpoLIeHT na4MeHTOK nocne POAOB, a6opTa, MMHt.-a6opTa U o6paTBUHXCuS 3a rNHeKoJorH'4eCKNMu ycAyraMm, B nOArpynnax npeAOBapHTeJ1bHoro U nlOCT-TeCTHpOBaHHSl, coo6u14UBWUX, 4TO y HUX 6bWO TPH unu 6onee a6opToB rMHeKonorm -- MII4HI-a6opT a6opTEnpeAK. TcCT a60pT o 5 10 15 20 25 30 35 40 45 50 nlpoLeHT A4aHHbse rno6epeu4Koro aKcnepufmeHTa OXPaHa 3AOPOB3b5 a MaTep a Bce Oa4eHTKw nocnePOAoBoro nepmoga coo6L4mm o TOM, 0To nOu2y430 5 npeHaTanbHblu yXOA, npu 3TOM 6on1bW1HCTBO 43 HUX o6cny)KMBafOCb OAHWMH U TeMw Ke MeAmLA14HCKWMW pa6OTHMKaMt4 B Te4eHle Bcero nepwoAa 6epeMeHHOcT4, 4TO qBnsmTCm CyL4eCTBeHHbiM AOCTW)KeHmeM B cq)epe Me[u4LHcKoro o6cfy)KI4BaHw4. OAHaKO o6beM ycnyr, npeAOCTaBneHHbIM )KeHLL4AHaM B nep1oi0 6epeMeHHocT1, ecnu UCXOAUTb 143 4Ucnla KOHcy.nbTa4mr1, nonyL4eHHbIX B npeApOAOBoA nepuOA, u U3 KOA14qeCTBa rocnllTamU3aL~4 B nepuoA 6epeMeHHOCTU CyLL4eCTBeHHO npeBbIwan CTaHAapT Apyrtx eBponeuiCKux CTpaH (PU4CYHOK 6; npfnox(eHme E, Ta6n14Lka Vila). npoLAeHT coo6L4wBW14x o TOM, LITO B nepwoA 6epeMeHHocT1 OHm 6b1n14 rocnfTanJ3NpoBaHbl XOTi 6bl OAHa)KAbl, HeCKOnbKO yMeHbW14j1Cs no mepe ocyLLeCTBaneHus npoeKTa, HO pa3HWLY 3Ty HeJIb35 C'I1TaTb CTaTWCT14'IeCK CyL4eCTBeHHOu. B cpeAHeM B4CnO nOnyIeHHbIX B npeApOAOBOU nepmoA KOHCynlbTaLA14U no mepe ocyLLteCTBneHu4 npoeKTa Aa)Ke yBenJAW)OCb, 6onee 50% noArpynnbl (noCT-TecTupoBaHiue), Coo6Lu41j1 0 TOM, 'TO UMm nOJIyqeHo 20 uMn 6onee KOHcynbTaLxu.. CpeAHee KOJ1M4eCTBO KOHcy)nbTauLMr B npeApOAOBoA nepmoA (15,6 - B nOArpynne nPeABapmTenbHOrO TeCTmPOBaHms, 19,4 - B noArpynne nOCT- TecT1poBaHwl; p<0,001) He uMeno OTHOweHMU K AeMorpacM144ecKHM xapaKTepUCTHKam AaHHOU nOArpynnbI, HanmmBiO XpOHUqeCKUX MeAI4LA14HcKMx 3a6oneBaH149, OCJIO)KHeHMI B xoAe npe)KHerl 6epeMeHHocT4 14unu gaae OCnO)KHeHL4r B xoAe TeKYL4Ae 6epeMeHHOCTL4. 17 COBe9UJeHCTBOBaHme CHCTeMbi OXpBHbl 3LODOBb )KeHLLiH B POCCUiUCKOU Oenepauuu PHCYHOK 6. npoL4eHT xKeHUINH, rocnUTaJUl3UpOBaHHbIX BO BPeMsl 6epeMeHHocrm u/unu o6paUAaBLUNXuC K spa4y 20 unu 6onee pa3 B TeS4SHme npeApoAoBoro nepHoAa; npeABaPHTenJbHoe U nocT-TecTHpoBaHHe 20+ APO040BbIX J :lnpeABTecT rocnNT-3a4 -- - I I IzI 0 10 20 30 40 50 60 70 npOIAeHT AlaHHb,e mo6epeu,oro aKcnep&uMeHTa no mepe npOBeAeH4si npOeKTa B )KW3Hb B COAep)KaHme aHTeHaTa)lbHoro yxoAa 6bl)o BHeCeHO HeCKOJbKO CyLLteCTBeHHbIX N3MeHeHH1 (nlpmno,KeHme 5, Ta6nuu,La Vila). YBej1i44L4JoCb WC=lO naL\meHToK, coo6u.LL4BWMx 0 TOM, BTO B xoAe 6epeMeHHOCTU MM AaBaj1mCb CBeAeHmfl o nOArOTOBKe K po)KAeHM4o pe6eHKa, o6 yxoAe 3a HOBopo)KAeHHbIM, 0 AOCTOMHCTBax MaTepuHCTsa, o nnJaHMPOBsaHM ceMbW. K cowKaneHmio, no mepe peBwfaLAIW npoeicra CHH31JAOCb BHMmaHme K KOHCynlbTaLAmsiM no noeoAy nNTaHNS u npeAynpe)KAaIoLu4x npH3HaKOB OCJ1O)KHeHMI4 BO BpeMA 6epeMeHHocTM. 1l13y4eHme pe3ynbTaTOB He BbISBLU1O CTaTNCTU44eCKfr Ba)KHbIX M3MeHeHMi B 4aCTOTHOCTm flpOBeAeHI4U KOHCYJnbTaLmA O BpeAe KypeHMH (npu TOM, 4TO 4MCJO KyPu1nbLL4MLA Bo3paCTaJio), BpeAe ynOTpe6feHWl alKorojlsl, 0 BaWKHOCTN oTAbixa 14 4fl3H4eCKNX ynpa)KHeHI4M. C ApyroA CTOPOHbi, cyLLAeCTBeHHO YJ1y4WMJlOCb coAep)KaHme yxoAa BO BpeM% poAoB, poAopa3peLleHuf 14 B nocnePOAOBoA nep"OA (nlpMno,KeHme 6, Ta6nuiu,a Vlla). flpeABapMTenbHoe TeCTPOBaHMe B Ha4ane npOBeAeHm5 npoeKTa nOKa3anO, 4TO TOJlbKO 2% )KeHLLtUH 4Menm B03MO)KHOCTb HaXOAMTbCF B OAHOA naiiaTe CO CBOUMM HOBOpo)KAeHHbIMI4. K 3aaepweHuio npoeKTa 3Ta LAL44ppa so3pocina Ao 57%, noBbicCmiaCb TamKe 4aCTOTHOCTb KOHTaKTOB C HoBopo)KAeHHbIM4 Ha paHHeM 3Tane. Bo3pocno 04nCJ1O OTLAOB, nOny44rBWlMX B03MO)KHOCTb nPL4CYTCTBOBaTb npm pOAax, XOTI YPOBeHb OTLtOBCKOrO y4aCTMSl OCTanCSI HU3KU4M. nlocKonbKy B nePHOA nOCT-TecTMpoBaHL4$ 6onbWMHcTBo po)KeHMu, HaxOAHn,L4Cb B OAHOA nanaTe Co CBOUMM HOBOpo)KAeHHbIMM, y cecTep U aKyLwepOK 6uino 6onbwe BpeMeHM AnsI Toro, 18 COBeplweHcTBOBaH&fe CICTeMMb OXpBHbl 3fODOBbH )KeHlULH B PoccUU4cKoU4 sPeepaauu qTO6bi COCpeAOTOqMTbCS Ha npOcBeTMTenbCKOr4 AegTenbHOCTM. qmcno )KeHLI4MH, coo6L4MBwMx O TOM, BTO OHM nOJiy'*iiun KOHCYJ1bTaBLkm o6 yxoge 3a HoBopo)KAeHHbIM, o rpyAHOM BCKapMJIMBaHM4, O nnlaHUPOBaHMM CeMbM U1 0 3AOpOBOM o6pa3e )KM3HU cyLLAeCTBeHHO B03pOC1O. YpoBeHb rpyAHorO KOpMneHMS1 MnageHtAeB, KOTOpblA 6bIn y)Ke AOCTaTO4HO BbICOKU4M U B HaBaAe npOBeAeHmR npoeKTa, K KOHL4y npOeKTa nOgHiHRJCH Ao 78 npoL4eHToB. OAHaKO Agon MnaAeHLAeB, nony4aiouMAx AonOJ1HMTenbHoe nfTaHme TaKoKe Bo3pocna, HecMOTpA Ha ycMnRM no pa3bACHeHMlO Toro, LITO TaKaA npaKTMKa mewaeT rpyAHOMY KOpMnjeHIlo U Mo)KeT np&BeCTM K He)KeJ1aTeBibHbIM NH(OeKLA4M. BMeCTe c TeM, pa6OTHMKM poAAoMa npmgep)KmBanmCb npaBmna, 3anpeLLaiouLero BblAaqy )KeH4L4HaM B MoMeHT BbIfnCKM 3MBmeHTeBfeg rpyAHoro MonoKa. TaoKKe B 3HaLMTeJ1bHoA CTeneHM Bo3pocno nOTpe6neHme KOPMFlLLtUMH )KeHLLAMHaMm BMTamMHOB H MMHepanbHbiX Ao6aBOK PHCYHOK 7. CBeAeHMs o6 yXoAe. AaHHbie, noJlyLieHHbie B pe3yJlbTaTe npeABapHTeAbHoro u nOCT-TeCTmpO.aHUI4 KOHTpa4en4USI -U- npNCyTCTh. napTHepa rpyAH.BCKapMA. nOCT-Tec a0 npe^m.TeCT paHHUA KOHTpaKT coEM.mlpe6bim. 0 10 20 30 40 50 60 70 80 npoL4eHT ,1aHHb/e n.lo6epeukoro aKcnepmMeHra nAaHMpoBaHme CeMbH U a6opTbl BO3MO)KHO, Ham6oJIee 3aMeTHbIM M3MeHeHHeM B nocJlepOgoBoM yxoAe no pe3yJlbTaTaM nOCT-TeCTMpoBaHmm 6biuio yBenJ4eHme KOUI4eCTBa )KeHL4MH, coo6UA4MBWMX, LITO OHM nony'unM nepeA BbinfMCKO cpeACTBa KOHTpa4enL4Uu (MuHu-nunKonu) u coBeTbi no nnaHHpOBaHHIo ceMb1 (CM. PMCYHOK 8; rlpmno,KeHMe B, Ta6nwL4bi VI, VIla-6). B Apyrmx noArpynnax Bo3pOCn1O KOnJmeCTBO )KeHLLANH, 3asBMBWsmx 0 TOM, 4TO OHM mcnOJlb3yloT "coBpeMeHHbie" MeTOAbi 19 CoBepweHCTOoBaHUe c&icTembi OXpaHbi 3SlOpOBbR xKeHUi&IH B POCCUICKOU O eaepa=uu KOHTpaLAenLAmm, nim60 HeAaBHO UX nojiyqunui. OAHaKo MHorLe U3 3TUX nalLA4eHTOK He nolnb3ylOTC TaKUMM BbICOKO3c"eKTABHbIM4 CpeACTBaMM KOHTpaLAen4f4w, KaK BHyTpMmaTOqHbie cnupanu uuM OpanbHble KoHTpaLenTABbl. TaKMM o6pa3oM, Ha BpeMF1 3aBepweeHms aHaJU3a pe3ylJbTaTOB npoeKTa *4dno )KeHU4MH, nOJ1b3yluOLLAXCSI HaAe)KHblMM MeTOgaMM KOHTpaLAen4Wl4, B mccneAoBaHHbix noArpynnax nafLAUeHTOK nocne MMHu4-a6opTa, a6opTa unu o6paT4BMW1xcs no nOBOAy rmHeKOnorUm, COCTaBBJ1O OT 18% AO 52%. PUCYHOK 8. NCnOnJb3OBaHme HaAe)KHbIX MeTOAOB KOHTpaLenm4H cpeAm naLWmeHTOK noc.ne pOAOB, a6opTa, MNIHH-a6opTa U o6paTmBwNXcsS 3a rNHeKoJnorl44ecKo nOMOUAbIO; noArpynnbi npeABapuTenbHoro u nOCT- TeCTMPOBaHM9 rHHeKonormsI M14HI-a6opT - - r F IlD noCT- .TeCT a6op npeAB.TecT nocnepoAoB. r 0 10 20 30 40 50 60 70 npo ueHT ,aaHHbie nIo6epewKoro 3Kcnepf4MeHTa MOKHO CKa3aTb, qTO YCwnUm, nPeAnPUHPlTbie MeA"LAAHCKMMH Pa6OTHNKaM" AnHs nOBbIWeHms1 MH4bOpM1pOBaHHOCT4 naLUUeHTOK, OKa3aIm HenoCpeACTBeHHoe BAWF5Hme Ha mcnO1b3OBaHwe nocneAHMMM KOHTpa4aenTHBHbIX cpeAcTB (npmno)KeHme B, Ta61NMLAbi Vlla-6). qTO KacaeTCA naLUmeHTOK, AenaBWwx a6opT, nOny4eHme UMM MH4OpMaLUUM O nnaHMPOBaHUU CeMbU npeTepnejio JnMWb He3Ha4MUTefJbHbie M3MeHeHMP. B CBOIO o0epeAb, 3TU )KeHUAl4Hbl no CPaBHeHMIO C ApyrMmm nOArpynnaMM B MeHbweM CTeneHu coo6u.Aanm o TOM, qTO B HacTosIu.ee BpeMR OHm nOJ1b3ylOTCS 34, eKTMBHbIM4 CpeACTBaMW KOHTpaLOenLkmm u1nu HeAaBHO TaKOBble nOJny4mJ1m. AAH 3aUWMTbl OT HexKenaTenibHoA 6epeMeHHOcTL OHM CKnOHHbI nOAb3OBaTbCA npe3epBaTUBaMm. B OTnL1qt4e OT HUX, naLAmeHTKm nocnepoAOBoro nepMOAa, naLuMeHTKN, AeenaBWUJe MMHUa6opTbl, M B MeHbweu4 CTeneHfH naLi4eHTK4, o6pau.LaBWi4ec 3a rMHeKOnorreCKL4MM yCnyraM4 o6uAero nOpR^Ka, CTanm nOny'aTb ropa3Ao 6onee cyuuLeCTBeHHyIO WH4opMaBJmio no rinnaHMpOBaHMIO ceMbW. 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XapaKTepMCcTM14K MeA14LkHCKMX pa6oTHMKoB o6o6uLeHbl B Ta6iniLAe XI. 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 OnpOCHbIX JICTOB An1 MeAm4L,HCKWX pa6oTHAKoB nocAeAHMe KOHTpOnMpoBa111 caM1. Bce IHTepBbio 6b61114 aHOHuMHbIMu. HMKaKOu onO3HaBaTenbHOA 27 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: nyHKTbi onpOCHoro JMCTa 3aTparMBanM pa3A1WHbie aCneKTbi M3MeHeHML KJ1MHm4eCKOrl ,eSTenbHOCTM u peaKL,ulo Ha HMX naLJi4eHTOK 14 MeAu4uLHCKuX pa6oTHI4KoB. B OCHOBHOM uCTOYHu4KaMu AaHHbIX AnFi oLAeHKt4 npoeKTa 6bmui caMooT4eTbi, KJIMHMqeCKaB CTaTt4CTWKa ku LHTepBbIo C KnioqeBbiMW HOCLTen1m1M H 4H()opMaLA4m. CaMooTmeTbi no aonpocaM, Hanpu4Mep, COCTOSHMWI 3AOpOBbsi, 4mcna noceUAeHHr4 Bpasa 14 rocnMTa.n3aLUU B npeApoAoBoA nepMoA He conOCTaBAn1L4Cb C 3anfcsCML, cAenaHHbIMM B MeAl4lAMHCKkiX yqpe)KIeHHslx, 14 o4eHwBai1Cb, KaK TaKOBbIe. XOTR 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 BeAyTcsl He nOApo6HO 14 He no onpeAeneHHoMy CTaHAapTy. 06bitHO caMOOTBeTbi KacaT8nbHO ycnyr B o6naCTU4 3ApaBooxpaHeHt4FC conOCTaB1Mbi c MaTept4aiaM4, COAepwauAimics B 3anucsix MeAi4LI14HCKHX yqpe)KAeHu1u. Ecnu 4Ke BO3HWKaIOT npoTWBope41SI, ICHOCTW no noBoAy Toro, KaKO14 UCT04HUK WH(pOpMa4wm1 Cq4TaTb 3OJ1OTbIM CTaHgapTOM", HeT. 28 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. 80-100 94 100 a6opT 200 96 95 MIHma6opT 80-100 87 99 rIHeKoJn. 200 155 110 MeA. pa6OTHMK 136 103 132 A4aHHbIe nmo6epeL(Koro 3KKcnep4MeHTa -Ta5uli4a IL. PeaKicw,s onpaw IBaeMbIx no nOArpynnaM, npeABapHTenbHoe TeCTHPoBaHue U nOCT-TeCTHpOBaHUe (B CKo6Kax) rloArp. nlpeMneM. HenpueMn. OTKa3 FloTepHbI He paccm. % OTBeT. nocnepoA 100 [1001 0 [0] 0 [0] 0 [0] 6 [0] 94%[100%] a6opT 98 [102] 3 [2] 0 [0] 0 [4] 2 [3] 98% [93%] MmHMa6opT 94 [103] 0 [0] 2 [3] 0 [1] 5 [01 93% [96%] rMHeKon. 167 [116] 7 [0] 8 [3] 0 [0] 4 [3] 93% [95%] MeA. 136 [136] 0 [0] 33 [3] 0 [0] 0 [1] 76% [97%] pa6OTHMK AlaHHbie nho6epeLKoro 9KcnepFiMeHTa noTepRHbl = npH npoBeAeHmm nOCT-TeCTHpOBaHNrP pecnOHAeHTbi 6binH yTepRHbI u3 BUAy. He paccm. = He paccmaTPMBan1MCb Te BonpOCHu4Ku, KOTOpbIe mcnOnb3oBanMCb 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. 29 COBCpWeHCTBoaHMe CHCTeMbi OXpaHbi 3,OPOBbH .KeHLW4H B POCC14cKoa oenepaLuu Ta6n4ia IlIl. CoULjanbHo-AeMorpaaO1IecKme xapaKTepl4cTMKM naLtmeHToK (nocnepoAosoIq nepmoA, a6opTb, MHHma6opThi, rmHeKonorMs), npeABapwTenbHoe TecTU4poBaHiue tU nocT-TecT14poBaHt4e nocneponopok nePOLM A60pT npeAf. TecT nOCT TecT p npeAE. TeCT n=96 noOT TecT p n=94 n=100 n=95 Bo3PacT (cp.) 25,2 25,2 CH 28,8 28,0 CH rpaxAaHCKoe COCTToHUe (%) 3aMyxeM 83,0 85,0 CH 82,3 85,3 CH COBMeCTH. npOIcUBaH1e 8,5 3,0 4,2 7,4 pa3seAeHa 0,0 1,0 6,3 2.1 He3aMY)K 6,4 11,0 7,3 5,3 BAOBa 0,0 0,0 0,0 0,0 OTCyTCTB. 2,1 0,0 0,0 0,0 06pa3oBaHue (%) Ha8anbHoe 6,4 8,0 CH 1,0 1,1 CH cpeAHee 19,1 33,0 13,5 13,7 y4wnwuAe 42,6 34,0 43,8 43,2 TeXHuKyM 7,4 5,0 18,8 18,9 YHMBePCcTeT 24,5 20,0 22,9 23,7 pa6oTa (%) nOJnHas unuW qacTwqHas 61,7 57,0 CH 62,5 46,3 * 3aHRTOCTb cTyAeHTKa 12,8 14,0 CH 9,4 8,4 CH MuHMa600T rMHeKo orms npe- nocT- p npe- nocT- p n=94 n=100 n=96 n=95 Bo3paCT (Cp) 30,4 29,3 CH 29,5 27,8 CH rpa)KAaHcKoe CocToRHIe (%) 3aMy)KeM 78,2 58,2 * 72,3 78,2 CH CosMeCTH. npO)KIBaHNe 9,2 18,4 15,5 16,4 pa3BeAeHa 8,0 11,2 7,7 2,7 He3aMy)K 2,3 12,2 2,6 1,8 BAoBa 2,3 0,0 1,9 0,9 OTCyTCTB. 0,0 0,0 0,0 0,0 o6pa3oaaHSe (%) Ha4anbHoe 1.1 7.1 * 1.9 0,9 CH cpeAHee 22,9 29,3 21,9 21,0 yqnA1LLte 34,5 16,2 38,1 41,8 TeXHu4KYM 12,6 18,2 9,7 13,6 yHusePCu4TeT 28,7 29,3 28,4 22,7 pa6oTa (%) noJIHaR 4nu 4aCT14qHas 60,9 71,7 CH 58,7 42,7 * 3aHRTOCTb CTyAeHTKa 9,2 22,2 * 14,2 13,6 CH cH=cTaTHcTM'ecKI He3Ha4MT.* p<0,05 p<0,01 p<0,001 ,aaHHbie nio6epeuKoro 3Kcnepi7 meH7Ha 30 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 nOCT- TeCTHPOBaHUH noCnepOAOBOU nepHoA aGOPT npeABapUT. nOCT-TeCT p npeABapHT. nOcT- p TeCT n=100 TeCT TeCT n=94 n=96 n=95 BO3paCT nepBoi 21,9 21,3 CH 20,0 19,6 CH 6epeMSHHOCTH (Cp) >KHBOpO)KAeHHbie (%) HeT 0,0 0,0 CH 12,5 7,4 CH 1-2 94,7 96,0 85,4 91,6 >2 5,3 4,0 2,1 1,1 MepTBOpONcAeHHbie (%) HeT 96,8 98,0 CH 100,0 98,9 CH 1 nnn 6onbwe 3,2 2,0 0,0 1,1 BbIKMAbIWHI (%) HeT 88,3 87,0 CH 92,7 93,7 CH 1 mnM 6onbwe 11,7 13,0 7,3 6,3 HCKyCCTB a6opT (%) HeT 74,5 57,0 HK HK 1 16,0 22,0 40,6 30,5 2 5,3 11,0 37,5 26,3 3 MnM 6onbwe 4,3 10,0 21,9 43,2 MHHH-860PT rHHeKOnOrMR npeaBapHT. nOCT TeCT p npeABapHT. nOCT p TeCT TeCT TecT BO3p8CT nepBoI 20,4 20,3 CH 20,9 20,7 CH 6epeMeHHOCTH (Cp) WKHBOpOX(AeHHbie (%) HeT 12,6 22,2 * 31,0 28,2 CH 1-2 82,8 65,7 67,1 69,1 >2 4,6 12,1 1,9 2,7 MSPTBOPO)KASHHble (%) HeT 98,9 90,9 99,4 98,2 CH I nmn 6onbwe 1,1 9q1 0,6 1,8 BbiKMiAbIWH (%) HeT 78,2 83,8 CH 85,8 82,7 CH 1 mnm 6onbwe 21,8 16,2 14,2 17,3 HCKyCCTB a6OpT (%) HeT HK HK 39,4 38,2 1 28,7 23,2 * 23,2 29,1 CH 2 25,3 45,5 12,9 18,2 3 MnM 6onbwe 46,0 31,3 24,5 14,5 cH=cTaTMcTM4ecKM He3HaI4MO* pqAeHHblM 73,6 41,4 * nOTePs' AoXoaa 25,3 12,1 * 7,1 0,0 UHHAKC YAOBneTOOPeHMS1 (KOHC-4UUM) TeopeTUH.3HaYeHHe 16,5 16,5 15,0 15,0 npaKTL4q. 3Ha4eHm4e 17,8 13,1 -* 12,7 13,3 CH mHAeKc nony4eHmsl NH4)opmaLtm (B KOHCYAbTaL%mm unu rAe-nm6o eu4e) TeopeTLUH.3Ha4eHme 8,5 8,5 5,0 5,0 npaicrm4.3HaHeHL1e 6,7 10,5 -* 6,4 6,2 CH CHI=CTaTt14eCKM HesHaqMT..*p<0.005 **p<0.001 ***p<0.00 ,4aHHble lvo6epewKoro 3KcnepGMeHTa 36 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. p n=94 n=100 n=96 n=95 KoHCynbTa4gma BexnUBoe OTHOweHUe 88,3 94,0 CH 93,8 97,9 CH yAejiniiocb AoCTaTo4Ho BpeMeHu 77,7 88,0 CH 90,6 95,8 CH YBa)KUTenlbHOe OTHOw6eHUe 60,6 96,0 ... 99,0 98,9 CH K U4HTUMHbIM Bonpocam HanUPUe Bi6opa 54,2 53,0 CH 100,0 96,8 CH XOpOWWUU KoHTaIcr 86,1 96,0 * 97,9 98,9 CH nooLiApFJn1Cb Bonpocbi 71,3 35,0 86,5 63,2 gaBanUCb OTBeTbI Ha BOnPOCbI 80,8 96,0 89,6 86,3 CH yBa)KMTe,nbHoe OTHOwLeHLe K 64,9 95,0 93,8 96,8 CH BbICKa3blBaeMbiM MHeHV1PM 3a6oTa O naLAmeHTe 81,9 98,0 99,0 98,9 CH XOPOWwU yxoa 81,9 100,0 95,8 92,6 CH He pa3rOBap4BalOT C To60U CBbICoKa HK HK 87,5 2,1 PoggoM Be)KnJ4Boe OTHOweHUe 96,8 87,0 99,0 100,0 CH yAejnipjoCb AoCTaTo4Ho BpeMeHu 63,8 88,0 92,7 97,9 CH yBaX>(TenbHOe 30,9 97,0 99,0 100,0 CH OTHOwBeHAe K UHTLUMHbIM BonpocaM HaJniM4e Bbi6opa 26,6 63,0 99,0 100,0 CH XOPOWl.11 KOHTaKT 90,4 97,0 CH 97,9 100,0 CH nOOuApFi,nmCb BOnPOCbI 86,1 38,0 88,5 81,1 CH gaBanJCb OTBeTbl Ha Bonpocbi 93,6 94,0 CH 81,7 98,9 * yBa)KOTefJbHoe OTHoweHLe K 49,0 96,0 93,8 98,9 * BbICKa3blBaeMbIM MHeHUPM 3a6oTa o naLtmeHTe 84,0 96,0 * 100,0 100,0 CH XOPOwUJU YXOa 94,6 100,0 * 99,0 97,9 CH He pa3rOBapuBaKOT C To6oA CBbicoKa HK HK 88,5 9,5 MmHH-a6OpT rUHeKOnorUn npeAB. noCT. p npeAB. nOCT. p n=87 n=99 n=155 n=110 KOHCynb rTaqIu Be,KnUBoe OTHoweHWe 88,5 100,0 ... 95,5 98,2 CH yje.nnOCb aOCTaTO4HO BpeMeHU 86,2 97,0 ** 94,8 99,1 * YBa)KUTe,nbHOe OTHoweHHe 80,5 88,9 CH 89,7 100,0 K HTWMHbIM BonpocaM HanM4we Bbl6opa 75,5 96,0 84,5 100,0 XOPOWkl' KOHTaKT 83,9 83,8 CH 93,5 99,1 * nOOflAtSI.VnCb BOnpOCbI 9,2 70,7 67,7 94,5 AaBani1Cb OTBeTbi Ha BOnpOcbd 77,0 92,9 92,9 97,3 CH yBa)KMTeBJbHoe OTHOwBeHLe K 70,1 89,9 88,4 99,1 BNCKa3bIBaeMbiM MHeHuPM 3a6oTa o naLmeHTe 690 87,9 89,7 99,1 xOpOwUJU yxoA 62,1 99,0 90,4 74,5 He Pa3rOBaPUBalOT C To6oU CBbICOKa 36,7 90,9 HK HK CH=CTaTUPeCKU He3Ha4T.,* p<0,005 **p<00O1 ***p<0,001 .4aHble n7to6epei4Koro 3KcnepmmeHra 37 COBepweHCTBOBaHme CHCTCMbi O92Hbi 3aOpOBbR .KeHwbf H B POCC&UUCKOU 0eepaUNN Ta6niuua X. B3rnRnMb noTpe6lTeneg Ha noIly4eHHbIi yxona nauMeHTKm nocnepo0o.oro neDfloDa. nfDsapMTeOJbHoe u nOCT-TeCThpOBaHUe npoUeHT OTDaBBWfX npefLnO4TSHNe npeAB.TeCT. nOCT-TeCT. p n=94 n=100 KTO AOmKeH o6ecne4HBaTb YXOA B npeApoAoBoA nepUOA Bpa4 o6uLJeu nPaKTUKU 3,2 26,0 aKywepKa 1,1 4,0 aKywep-rwHeKOJ1or 92,6 65,0 MHeHL4F HeT 3.2 5,0 KTO AOJ1)KeH nPUHUMaTb POAbl Bpa4 o6LLAeA npaKTMK&. 2,1 0,0 CH aKywepKa 6,4 14,0 aKywep-rHHeKOJlor 91,5 85,0 MHeHMR HeT 0,0 1,0 KaK nfl8TMTb 3a MeAM4LAHCKoe o6cnymlcBaHme Bce pacxoAbl 143 CBoero KapMaHa 6,4 31,0 Hamlorm + U3 cBoero KapmaHa 41,5 16,0 TOJnbKO HanorU 23.4 49,0 MHeHMR HeT 28,7 4,0 AoflxcHbi nM )KeHCl4lHbl MmeTb npaBo Bbi6opa Bpa4a? 94,7 98,0 CH AOnfKHbl nm xceHU4MHbl MmeTb npaBo Bbi6opa 97,9 100,0 CH ne4e6Horo 3aBeAeHMH? npeAno4TuTenbHbl 3annaHMPoBaHHbie BCTpem4l C 13,8 65,0 Bpa4oM B npeAPOAOBoA nepmoA npeAno4TiITeJnbHa )KeHCKaSi KoHCyJ1bTaL4si, 21,3 30,0 CH pa6oTaiouLaS B Be4epHee opeMs nlpeAno4TMTenbHo HaxoxKAeHme B OAHOA nanaTe c 87,2 79,0 CH HOBOpO)KAeHHbIM npeAnoTHmTenbHo rpyAHoe BCKapMJnUBaHuie no 43,6 47,0 CH Tpe6oBaHuKo HOBOpoXKAeHHoro npeAnOTUiTeneH AOcTyn noceTUTeneU 79,8 84,0 CH npeAno'4THTenbHo npUCYTCTBme napTHepa npu4 40,4 44,0 CH poAax 34,0 41,0 CH npeAno4T4Te.nbHo npMCYTCTBme napTHepa npm poAopa3peLueHM 79,8 76,0 nlPeAno4TITenbHa P8HH5R BbinICKa U3 pOAAOMa CH=CTaTmCTm4eCKM He3Ha'*iMo* pCKOA 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 fl., Bpyv1H1Kc H. JlerepT fl. npaKTwKa u OTHoLueHLe 6b6muLAwxxCOeTCKiX >KeHULUH K KoHTpaLAenTMBaM. (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. 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