【作者】 方利文；

【导师】 高尔生；

【作者基本信息】 复旦大学 ， 流行病与卫生统计学， 2003， 博士

【摘要】 [研究背景]：目前，我国已有效地控制了人口的快速增长，计划生育工作重点开始向稳定低生育水平，提高人口素质，促进家庭幸福，促进人口与资源、环境及社会可持续发展相适应的方向转移。我国政府高度重视生殖健康服务，对计划生育服务模式重新定位，强调以人的全面发展为中心，提供优质、综合的生殖健康服务。在“九五”期间通过计划生育优质服务试点，探索计划生育/生殖健康服务新的工作思路和方法。因此九五期间我国育龄妇女以生育、节育为重点的生殖健康状况及其服务状况的变化、发展以及存在的问题，成为研究的重要课题。 [研究目的]：总目的：评价近几年来开展计划生育/生殖健康优质服务的成效和存在的问题，为我国进一步全面推进计划生育/生殖健康优质服务提供策略建议，促进全国生殖健康事业的可持续发展。具体目的：研究我国育龄妇女的生育特点及发展状况；研究孕产期保健服务变化及其面临的问题；研究人工流产及其服务状况的变化；研究避孕模式和避孕服务状况的变化趋向；研究我国西部地区生殖健康服务状况及其困境。[研究方法]：调查设计：在《1997年全国人口与生殖健康调查》原有样本点采用相同的调查设计进行《2001年全国计划生育与生殖健康调查》。以分层、三阶段、整群、概率比例抽样方法在全国31个省（直辖市、自治区）抽取337个县（市、区）。在每个县分别抽取3-4乡（镇、街道），每个乡抽取一个村（居）民小组；共抽取1041个村（居）民小组样本点。对样本点所有符合调查对象标准的15-49岁的育龄妇女进行面对面问卷调查。调查育龄妇女39586名，应答率为98.27%。调查内容包括育龄妇女的一般人口学特征、生育、节育状况、人工流产状况及其相关的生殖健康服务等八部分。调查时点为2001年6月30日，历时2周。研究在设计、实施、分析阶段均进行了严格的质量控制。分析策略：以单因素分析和多因素分析相结合的策略对生育、节育、人工流产及其服务状况的影响因素、变化状况进行分析。采用卡方检验、趋势性检验、相关性检验等方法对应变量的影响因素及变化状况初步分析；通过分层分析控制影响<WP=6>因素的作用，对应变量的变化进一步分析；通过拟合多因素模型对变化情况做更深入的分析。多因素模型包括：二分类反应变量的LOGISTIC回归模型，多分类有序反应变量的LOGISTIC模型，多分类无序反应变量的LOGIT（MNL）模型。本研究重点对两次调查前三年的服务状况进行比较，以分析近年来育龄妇女生殖健康服务的变化、发展。统计分析软件为SAS 8.02。[研究结果]：1、 我国育龄妇女的低生育率水平稳定，呈略下降趋势。一般生育率呈现下降趋势，由1993年的59.08‰降为2000年的40.61‰，农村、西部地区、少数民族育龄妇女的总和生育率下降明显；1993-2000年间中部地区的总和生育率略有波动；城镇育龄妇女总和生育率稳定在1左右。15-19岁育龄妇女生育率下降到较低水平，但西部地区仍有一定的高度。生育年龄在城镇有后移趋势。2、 出生性别比偏高，仍有攀升。两次调查比较，调查前四年平均出生性别比由124.50增加到126.69。农村、中部地区、汉族出生性别比较高。城镇、中、西部地区、少数民族的出生性别比增加明显。孕产期保健服务状况在改善，但发展极不平衡。西部地区农村的孕产期保健服务急待提高。（1）与1997年调查前三年相比，2001年调查前三年育龄妇女的入院分娩率、由医生接生比例明显增加，在家中分娩的比例明显减少。但产前检查率没有明显变化，由家人接生的比例变化不明显。（2）农村妇女在家分娩比例明显降低，由1997年调查时的61.41%降为2001年调查时的40.78%；城乡孕产期保健服务不平衡现象在减弱。1998-2000年间，90%以上城镇妇女接受孕产期保健服务。76%农村妇女接受产前检查，在家分娩比例高出城镇7.4倍，约为41%，由家人接生的比例超过13%。（3）孕产期保健服务在各地区发展不平衡，东部和中部地区发展快，西部地区，尤其是西南地区发展相对较慢。1998-2000年间，西部地区妇女中，超过1/3不做产前检查，一半以上妇女在家分娩，约30%由家人接生，由医生接生者所占比例（42%）仅为东部地区的一半。西部地区以农村、少数民族、文化程度低的妇女孕产期保健最为薄弱。西部地区农村产前检查率远低于全国农村的平均水平，在家分娩妇女一半以上由家人接生，约为东部和中部地区的6倍。（4）少数民族产前检查率（51%）明显低于汉族妇女（84%），在家分娩和由家人接生的比例明显高于汉族妇女。（5）随着文化程度和经济收入的增加育龄妇<WP=7>3、 女对孕产期保健服务的利用增加。文盲妇女、经济收入低的妇女产前检查率极低，在家分娩比例和由家人接生的比例非常高。4、 人工流产率下降，避孕失败致人工流产比例增加；城镇人工流产服务的可及性和可获得性在改善，农村变化不明显。（1）我国已婚育龄妇女的人工流产率呈现下降趋势。人工流产率由1997年调查时的28.02‰降为2001年调查时的18.15‰。（2）与1997年调查前三年比较，2001年调查前三年人工流产者中避孕失败比例增加，但人群中避孕失败率没有改变。（3）2001年调查前三年更多还原

【Abstract】 [BACKGROUND]: China has effectively slowed down its too rapid population growth. The focus of its family planning program is shifting to maintaining a stable and low birth rate, raising the quality of the population in terms of health and education, enhancing happiness of families and bringing population into balance with resources, environment and sustainable social development. the Chinese government pays great attention to reproductive health services，and efforts have been made to initiate a reorientation of guiding-ideology and approaches of its family planning programme. A client-oriented comprehensive quality of care has been emphasized in the provision of reproductive health services. During the Ninth Five-Year Plan period, China has engaged in means of exploring a new way of thinking and approaches for family planning/reproductive health services by implementing a series of projects on quality of care. Therefore, it is of great significance to study the progress and problems in the very field that highlights fertility and contraception of women at childbearing age and family planning / reproductive health services.[OBJECTIVES]:General Objective: To assess the progress made and problems exist in family planning/ reproductive health(FP/RH) services in recent years, and try to provide strategic recommendations for further improving the quality of care in FP/RH services with the purpose of promoting the sustainable development of national reproductive health programme in China.Specific Objectives:--To study the characteristics and development of fertility of childbearing women; --To study the progress and problems in the provision of maternity care services;--To find out the changes of induced abortion rate and services provided; --To analyze the trends of the patterns of contraceptive-mix and the provision of services; --To study the status of and difficulties in reproductive health services in western<WP=11>China. [METHODS]:STUDY DESIGN: "the National Demographic and Reproductive Health Survey in 2001" was conducted by using the same design and same sample points for "the National Demographic and Reproductive Health Survey in 1997". The sampling process was based on a three-stage design with a proportional allocation in stratified random sample. Altogether 337 counties from 31 provinces (autonomous regions or municipalities) were selected, in each of which 3 or 4 towns were further selected, and the final sample unit was one village group from each town. The total number of village groups was 1041. Women aged from 15 to 49 years old who met the sample selection criteria were enrolled in the study. A total of 39,586 women at childbearing age were personally interviewed with a structured questionnaire. The response rate was 98.27%. The questionnaire contained eight parts, including the information of women’s general demographic characteristics, fertility, contraception, induced abortion and reproductive health services received, etc. The survey was conducted in June 2001. Critical quality control was carried out throughout the designing, implementing and analyzing process ANALYSIS STRATEGY: The status, changes and influencing factors of women’s fertility, contraception, induced abortion and relevant services received were analyzed with combined univariate and multivariate analysis. Changes of dependent variables and influencing factors were preliminarily analyzed by using Chi-square test, trend test and correlation analysis method. More detailed analyses were conducted by using stratified analysis and multivariate models. The current study focused on the comparisons of service utilization between the periods of 1994 -- 1996 and 1998 -- 2000. Data were analyzed by using SAS software 8.02, in which multivariate analysis was conducted by using GLM, LOGISTIC and CATMOD procedure.[RESULTS]： After a slight decline, the fertility rate has been stabilized at a low level. General fertility rate (GFR) dropped from 59.08‰ in 1993 to 40.61‰ in 2000. Ther更多还原