Center for Health Systems Research, The National Institute of Public Health, Cuernavaca 62100, Morelos, Mexico.
School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima 15102, Peru.
Int J Environ Res Public Health. 2020 Apr 29;17(9):3097. doi: 10.3390/ijerph17093097.
The purpose of this study was to assess whether government policies to expand the coverage of maternal health and family planning (MHFP) services were benefiting the adolescents in need. To this end, we estimated government MHFP expenditure for 10- to 19-year-old adolescents without social security (SS) coverage between 2003 and 2015. We evaluated its evolution and distribution nationally and sub-nationally by level of marginalization, as well as its relationship with demand indicators. Using Jointpoint regressions, we estimated the average annual percent change (AAPC) nationally and among states. Expenditure for adolescents without SS coverage registered 15% for AAPC for the period 2003-2011 and was stable for the remaining years, with 88% of spending allocated to maternal health. Growth in MHFP expenditure reduced the ratio of spending by 13% among groups of states with greater/lesser marginalization; nonetheless, the poorest states continued to show the lowest levels of expenditure. Although adolescents without SS coverage benefited from greater MHFP expenditure as a consequence of health policies directed at achieving universal health coverage, gaps persisted in its distribution among states, since those with similar demand indicators exhibited different levels of expenditure. Further actions are required to improve resource allocation to disadvantaged states and to reinforce the use of FP services by adolescents.
本研究旨在评估政府扩大孕产妇健康和计划生育（MHFP）服务覆盖范围的政策是否使有需要的青少年受益。为此，我们估计了 2003 年至 2015 年期间，10 至 19 岁无社会保障（SS）覆盖的青少年的政府 MHFP 支出。我们评估了其在全国和次国家层面按边缘化程度的演变和分布情况，以及与需求指标的关系。使用 Jointpoint 回归，我们估计了全国和各州的平均年百分比变化（AAPC）。2003-2011 年期间，无 SS 覆盖的青少年支出的 AAPC 为 15%，其余年份保持稳定，88%的支出用于孕产妇健康。MHFP 支出的增长使处于较高/较低边缘化程度的州组的支出比例降低了 13%；然而，最贫困的州继续显示出最低的支出水平。尽管由于旨在实现全民健康覆盖的卫生政策，无 SS 覆盖的青少年从更大的 MHFP 支出中受益，但各州之间的支出分配仍存在差距，因为具有类似需求指标的州表现出不同的支出水平。需要采取进一步行动，改善向处境不利的州分配资源，并加强青少年对 FP 服务的使用。
