实现千年发展目标？：加纳、埃塞俄比亚和肯尼亚的公平与孕产妇健康
"Delivering" on the MDGs?: equity and maternal health in Ghana, Ethiopia and Kenya.
作者信息
Wirth Meg, Sacks Emma, Delamonica Enrique, Storeygard- Adam, Minujin Alberto, Balk Deborah
机构信息
Center for International Earth Science Information Network (CIESIN), Columbia University, Palisades, NY, USA.
出版信息
East Afr J Public Health. 2008 Dec;5(3):133-41.
OBJECTIVES
The Millennium Development Goals (MIDGs) have put maternal health in the mainstream, but there is a need to go beyond the MDGs to address equity within countries. We argue that MDG focus on maternal health is necessary but not sufficient. This paper uses Demographic and Health Survey (DHS) data from Kenya, Ethiopia and Ghana to examine a set of maternal health indicators stratified along five different dimensions. The study highlights the interactive and multiple forms of disadvantage and demonstrates that equity monitoring for the MDGs is possible, even given current data limitations.
METHODS
We analyse DHS data from Ghana, Kenya and Ethiopia on four indicators: skilled birth attendant, contraceptive prevalence rate, AIDS knowledge and access to a health facility. We define six social strata along five different dimensions: poverty status, education, region, ethnicity and the more traditional wealth quintile. Data are stratified singly (e.g. by region) and then stratified simultaneously (e.g. by region and by education) in order to examine the compounded effect of dual forms of vulnerability.
RESULTS
Almost all disparities were found to be significant, although the stratifier with the strongest effect on health outcomes varied by indicator and by country. In some cases, urban-dwelling is a more significant advantage than wealth and in others, educational status trumps poverty status. The nuances of this analysis are important for policymaking processes aimed at reaching the MDGs and incorporating maternal health in national development plans.
CONCLUSIONS
The article highlights the following key points about inequities and maternal health: 1) measuring and monitoring inequity in access to maternal health is possible even in low resource settings-using current data 2) statistically significant health gaps exist not just between rich and poor, but across other population groups as well, and multiple forms of disadvantage confer greater risk and 3) policies must be aligned with reducing health gaps in access to key maternal health services.
目标
千年发展目标（MDGs）已将孕产妇健康纳入主流，但有必要超越千年发展目标，以解决各国国内的公平问题。我们认为，千年发展目标对孕产妇健康的关注是必要的，但并不充分。本文利用来自肯尼亚、埃塞俄比亚和加纳的人口与健康调查（DHS）数据，研究了一组按五个不同维度分层的孕产妇健康指标。该研究突出了不利因素的交互性和多种形式，并表明即使在当前数据有限的情况下，对千年发展目标进行公平性监测也是可行的。
方法
我们分析了来自加纳、肯尼亚和埃塞俄比亚的DHS数据，涉及四个指标：熟练接生员、避孕普及率、艾滋病知识以及获得卫生设施的情况。我们沿着五个不同维度定义了六个社会阶层：贫困状况、教育程度、地区、种族以及更传统的财富五分位数。数据先单独分层（如按地区），然后同时分层（如按地区和教育程度），以研究双重脆弱形式的复合效应。
结果
几乎所有差异都被发现具有显著性，尽管对健康结果影响最强的分层因素因指标和国家而异。在某些情况下，居住在城市比财富更具显著优势，而在其他情况下，教育程度比贫困状况更重要。这种分析的细微差别对于旨在实现千年发展目标并将孕产妇健康纳入国家发展计划的决策过程很重要。
结论
本文突出了关于不公平与孕产妇健康的以下关键点：1）即使在资源匮乏的环境中，利用现有数据也能够衡量和监测孕产妇健康服务获取方面的不公平；2）不仅贫富之间存在具有统计学显著性的健康差距，其他人群之间也存在，而且多种形式的不利因素会带来更大风险；3）政策必须与缩小关键孕产妇健康服务获取方面的健康差距保持一致。
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