Department of Clinical Sciences, Social Medicine and Global Health, Lund University, Malmö, Sweden.
Int J Equity Health. 2013 May 29;12:37. doi: 10.1186/1475-9276-12-37.
In most resource poor countries, particularly sub-Saharan Africa, modern contraceptive use and prevalence is unusually low and fertility is very high resulting in rapid population growth and high maternal mortality and morbidity. Current evidence shows slow progress in expanding the use of contraceptives by women of low socioeconomic status and insufficient financial commitment to family planning programs. We examined gaps and trends in modern contraceptive use and fertility within different socio-demographic subgroups in Ghana between 1988 and 2008.
We constructed a database using the Women's Questionnaire from the Ghana Demographic and Health Survey (GDHS) 1988, 1993, 1998, 2003 and 2008. We applied regression-based Total Attributable Fraction (TAF); we also calculated the Relative and Slope Indices of Inequality (RII and SII) to complement the TAF in our investigation.
Equality in use of modern contraceptives increased from 1988 to 2008. In contrast, inequality in fertility rate increased from 1988 to 2008. It was also found that rural-urban residence gap in the use of modern contraceptive methods had almost disappeared in 2008, while education and income related inequalities remained.
One obvious observation is that the discrepancy between equality in use of contraceptives and equality in fertility must be addressed in a future revision of policies related to family planning. Otherwise this could be a major obstacle for attaining further progress in achieving the Millennium Development Goal (MDG) 5. More research into the causes of the unfortunate discrepancy is urgently needed. There still exist significant education and income related inequalities in both parameters that need appropriate action.
在大多数资源匮乏的国家，特别是撒哈拉以南非洲地区，现代避孕方法的使用率和普及率异常低，生育率却非常高，导致人口快速增长，母婴死亡率和发病率居高不下。现有证据表明，在扩大社会经济地位较低的妇女使用避孕方法方面进展缓慢，而且对计划生育方案的财政承诺不足。我们研究了加纳在 1988 年至 2008 年期间不同社会人口亚组中现代避孕方法的使用情况和生育率的差距和趋势。
我们利用加纳人口与健康调查（GDHS）1988 年、1993 年、1998 年、2003 年和 2008 年的妇女调查问卷构建了一个数据库。我们采用了基于回归的总归因分数（TAF）；我们还计算了相对和斜率不平等指数（RII 和 SII），以补充 TAF 在我们调查中的应用。
现代避孕方法使用率的平等程度从 1988 年增加到 2008 年。相反，生育率的不平等程度从 1988 年增加到 2008 年。还发现，2008 年城乡居民使用现代避孕方法的差距几乎消失，而教育和收入相关的不平等仍然存在。
一个明显的观察结果是，在未来修订与计划生育相关的政策时，必须解决避孕方法使用平等与生育率平等之间的差距。否则，这可能成为实现千年发展目标 5 方面进一步进展的主要障碍。迫切需要对造成这种不幸差距的原因进行更多研究。在这两个参数中仍然存在着显著的教育和收入相关的不平等，需要采取适当的行动。
