Institute for Health Sciences, Kunming Medical University, 1168# Chun Rong Xi Lu, Yuhua Jiedao,Cheng Gong Qu, Kunming City, 50500, Yunnan Province, PR China.
Duke Global Health Institute, 919-681-7760, 310 Trent Drive, Durham, NC 27710 Map Box 90519, Durham, NC, 2770, USA.
Reprod Health. 2020 Jun 1;17(1):84. doi: 10.1186/s12978-020-00924-9.
BACKGROUND: Sexual and Reproductive Health (SRH) targets have been included as part of the United Nations Sustainable Development Goals and indictors are important to monitor progress towards these targets. SRH indicators are recommended for setting norms and measuring progress globally. However, given the diverse political, socioeconomic and cultural contexts in different countries, and lack of global agreement on broad indicators, it is important to select appropriate indicators for specific countries. Based on internationally recommended indicators and data availability in China, this paper selected four indictors to reflect SRH in China and interpreted these indictors by analyzing the underlying factors. METHODS: We employed secondary data analysis and key informant interviews. Secondary data were obtained from the China Health Statistical Yearbook (2005-2017), China Statistical Yearbook (2005-2017), and the sub-national estimates of the Global Burden Diseases Study 2016. We interviewed 36 key informants at national and sub-national levels. RESULTS: The four selected SRH indicators are contraceptive prevalence rate (CPR), adolescent birth rate, abortion rate, and availability of school sex education. CPR of married women has remained above 75% over the last three decades, indicating a high level of access to family planning (FP) services; however, unmarried but sexually active women have significant unmet needs for FP services. Although adolescent birth rates in China remain low, the abortion rate, abortion numbers, and the ratio of abortions to births increased from 2014 to 2016 while FP policy was relaxed. This suggests that abortion among unmarried women is a significant contributor to overall figures. Qualitative analysis of the availability of school sex education, reveals an absence of policy due to conservative attitudes of key stakeholders. CONCLUSION: Since SRH challenges vary significantly between contexts, indicators for measuring progress towards SRH targets should be selected based on country context. The CPR and abortion rate are currently available and important indicators to monitor the most basic part of SRH in China, but require modification to ensure they reflect universal access to quality reproductive healthcare by all reproductive age women, regardless of their marriage status. Policy and indicators on sex education need to be carefully developed to fit the context in China.
背景:性与生殖健康(SRH)目标已被纳入联合国可持续发展目标的一部分,指标对于监测这些目标的进展非常重要。SRH 指标被推荐用于设定全球规范和衡量进展。然而,鉴于不同国家的政治、社会经济和文化背景的多样性,以及对广泛指标缺乏全球共识,为特定国家选择适当的指标非常重要。基于国际推荐的指标和中国的数据可用性,本文选择了四个指标来反映中国的 SRH,并通过分析潜在因素来解释这些指标。
方法:我们采用了二手数据分析和关键知情人访谈。二手数据来自《中国卫生统计年鉴(2005-2017 年)》《中国统计年鉴(2005-2017 年)》和 2016 年全球疾病负担研究的省级估计数据。我们在国家和省级层面采访了 36 名关键知情人。
结果:选择的四个 SRH 指标是避孕普及率(CPR)、青少年生育率、堕胎率和学校性教育的可及性。过去三十年,已婚妇女的 CPR 一直保持在 75%以上,这表明计划生育(FP)服务的可及性很高;然而,未婚但有性行为的妇女对 FP 服务有很大的未满足需求。尽管中国的青少年生育率仍然较低,但 2014 年至 2016 年 FP 政策放宽后,堕胎率、堕胎人数和堕胎与分娩的比例有所增加。这表明,未婚妇女的堕胎是总体数字的一个重要贡献因素。对学校性教育可及性的定性分析表明,由于关键利益相关者的保守态度,缺乏政策。
结论:由于 SRH 挑战在不同背景下存在显著差异,因此衡量实现 SRH 目标进展的指标应根据国家背景进行选择。目前,CPR 和堕胎率是可获得的重要指标,用于监测中国 SRH 的最基本部分,但需要进行修改,以确保它们反映所有育龄妇女普遍获得优质生殖保健服务的情况,无论其婚姻状况如何。性教育政策和指标需要谨慎制定,以适应中国的国情。
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