Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK.
Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK.
Lancet Glob Health. 2020 Apr;8(4):e567-e579. doi: 10.1016/S2214-109X(20)30060-7. Epub 2020 Mar 9.
A quarter of a century ago, two global events-the International Conference on Population and Development in Cairo, and the Fourth World Conference on Women in Beijing-placed gender equality and reproductive health and rights at the centre of the development agenda. Progress towards these goals has been slower than hoped. We used survey data and national-level indicators of social determinants from 74 countries to examine change in satisfaction of contraceptive need from a contextual perspective.
We searched for individual-level data from repeated nationally representative surveys that included information on sexual and reproductive health, and created a single dataset by harmonising data from each survey to a standard data specification. We described the relative timings of sexual initiation, first union (cohabitation or marriage), and first birth and used logistic regression to show the change in prevalence of sexual activity, demand for contraception, and modern contraceptive use. We used linear regression to examine country-level associations between the gender development index and the expected length of time in education for women and the three outcomes: sexual activity, demand for contraception, and modern contraceptive use. We used principal component analysis to describe countries using a combination of social-structural and behavioural indicators and assessed how well the components explained country-level variation in the proportion of women using contraception with fractional logistic regression.
In 34 of the 74 countries examined, proportions of all women who were sexually active, not wanting to conceive, and not using a modern contraceptive method decreased over time. Proportions of women who had been sexually active in the past year changed over time in 43 countries, with increases in 30 countries; demand for contraception increased in 42 countries, and use of a modern method of contraception increased in 37 countries. Increases over time in met need for contraception were correlated with increases in gender equality and with women's time in education. Regression analysis on the principal components showed that country-level variation in met contraceptive need was largely explained by a single component that combined behavioural and social-contextual variables.
Progress towards satisfying demand for contraception should take account of the changing context in which it is practised. To remove the remaining barriers, policy responses-and therefore research priorities-could require a stronger focus on social-structural determinants and broader aspects of sexual health.
UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction.
四分之一个世纪前，在开罗举行的国际人口与发展会议和在北京举行的第四次妇女问题世界会议这两个全球性活动将性别平等和生殖健康及权利置于发展议程的核心。在实现这些目标方面的进展速度比预期的要慢。我们利用来自 74 个国家的调查数据和社会决定因素的国家级指标，从背景角度审视了对避孕需求的满足情况的变化。
我们搜索了来自反复进行的全国代表性调查的个人层面数据，这些调查包括性健康和生殖健康方面的信息，并通过协调每个调查的数据以符合标准数据规范来创建一个单一数据集。我们描述了性开始、第一次结合（同居或婚姻）和第一次生育的相对时间，并使用逻辑回归来显示性活动、避孕需求和现代避孕方法的流行率的变化。我们使用线性回归来检查性别发展指数与女性预期受教育时间之间的国家间关联，以及三个结果：性活动、避孕需求和现代避孕方法的使用。我们使用主成分分析来描述使用社会结构和行为指标的组合的国家，并使用分数逻辑回归评估各组成部分在解释使用避孕方法的妇女比例的国家间差异方面的效果。
在所检查的 74 个国家中的 34 个国家中，所有有性活动、不想怀孕和不使用现代避孕方法的妇女的比例随着时间的推移而下降。在过去一年中有过性活动的妇女的比例在 43 个国家中随时间而变化，其中 30 个国家呈上升趋势；避孕需求在 42 个国家中增加，而在 37 个国家中使用现代避孕方法增加。避孕需求满足程度随时间的增加与性别平等的提高和妇女受教育时间的增加有关。主成分分析的回归分析表明，国家一级避孕需求满足程度的变化主要由一个单一的组成部分来解释，该组成部分结合了行为和社会背景变量。
满足避孕需求的进展应考虑到实践避孕的不断变化的背景。为了消除剩余的障碍，政策反应——因此研究重点——可能需要更加关注社会结构性决定因素和更广泛的性健康方面。
联合国开发计划署/联合国人口基金/联合国儿童基金会/世界卫生组织/世界银行人类生殖研究、开发和培训特别方案。
