Department of Population, Family, and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
Office of Population and Reproductive Health, Bureau for Global Health, U.S. Agency for International Development, Washington, DC, USA.
Glob Health Sci Pract. 2018 Jun 29;6(2):390-401. doi: 10.9745/GHSP-D-18-00012. Print 2018 Jun 27.
Equality is a central component of the Sustainable Development Goals (SDGs). We took one SDG indicator and benchmark-percent of family planning demand met with modern contraceptives, with a benchmark of at least 75% in all countries-as a case study to illuminate recommendations for monitoring equality. Specifically, we assessed levels, patterns, and trends in disparity by key background characteristics and identified disparity measures that are programmatically relevant and easy to interpret.
Data were from the Demographic and Health Surveys in 55 countries that have conducted at least 2 surveys since 1990. We calculated absolute difference among subgroups, disaggregated by age, education, household wealth quintile, urban/rural residence, subnational region/administrative unit, and marital status. Our unit of analysis was survey, and we conducted largely descriptive analyses. To understand trends in disparity, we used a fixed-effect linear regression model to estimate an annual rate of change in absolute differences.
A significant level of disparity existed across various background characteristics, ranging from a median difference of 5 percentage points by marital status to 32 percentage points by administrative unit. On average across the study countries, national level of met demand has increased over time while disparity has declined in most disaggregates including by education, wealth, residence, and age. We found statistically significant positive correlations among 4 disparity measures-education, wealth, residence, and administrative unit. Disparities by wealth quintile were easiest to interpret over time and across countries.
At the global level, we recommend monitoring disparity in met demand by wealth quintile, which is strongly correlated with disparity by education, residence, and region and comparable across countries and over time. For monitoring by individual countries and for programmatic purposes, we further recommend monitoring disparity by first-level administrative unit, which can provide direct programmatic relevance.
平等是可持续发展目标（SDGs）的核心组成部分。我们以一个 SDG 指标为例，即现代避孕方法满足的计划生育需求比例，所有国家的基准至少为 75%，以此来阐明监测平等的建议。具体来说，我们评估了按关键背景特征划分的差异水平、模式和趋势，并确定了具有计划相关性且易于解释的差异衡量标准。
数据来自自 1990 年以来至少进行过 2 次调查的 55 个国家的人口与健康调查。我们按年龄、教育程度、家庭财富五分位数、城乡居住、国家以下地区/行政单位和婚姻状况对亚组进行了绝对差异的计算。我们的分析单位是调查，主要进行描述性分析。为了了解差异趋势，我们使用固定效应线性回归模型来估计绝对差异的年变化率。
在各种背景特征中存在显著的差异，从婚姻状况的中位数差异 5 个百分点到行政单位的中位数差异 32 个百分点不等。在研究国家中，平均而言，随着时间的推移，国家需求满足水平有所提高，而大多数细分指标（包括教育、财富、居住和年龄）的差异则有所下降。我们发现，4 个差异衡量标准（教育、财富、居住和行政单位）之间存在统计学上显著的正相关关系。随着时间的推移和国家之间的差异，财富五分位数的差异最容易解释。
在全球层面上，我们建议监测财富五分位数的需求满足差异，这与教育、居住和地区的差异密切相关，且在国家之间具有可比性，并随着时间的推移而变化。对于个别国家的监测和计划目的，我们进一步建议监测第一级行政单位的差异，这可以提供直接的计划相关性。
