Firmly Push Forward Comprehensive Management of Sex Ratio at Birth

正To further implement the spirit of the Third Plenary Session of the Eighteenth Party Central Committee,conscientiously sum up comprehensive management of sex ratio at birth in 2013 and fully arrange the tasks in 2014,on December 20,2013,National Meeting on Comprehensive Management of Sex Ratio at Birth was held in Fuzhou     

In-Depth Reflection on the Comprehensive Control of High Sex Ratio at Birth in China

Since 1980 s,the SRB has been longlasting high in China,despite a 6-year continual drop from 2008.Moreover,high SRB is deteriorating with the broadening in geographic distribution,expansion in the cumulative difference between both sexes and the increasing difficulties in the combat againsfillegal fetal sex identification and sex-selective abortion.Given these challenging facts,the Central Government has been guiding all provinces to carry out comprehensive control and implement programs led by party and government leaders,such as advanced gender culture construction program,lady priority and preferential program,medical and health market purification program,appraisal & assessment system construction program,and full-course maternal service program,which have well contributed to the comprehensive control of high SRB.Still,these practices are faced with such problems as comprehensive control initiatives remaining in the transition stage from action level to institutional level and statistical data being inadequate to assess the objective situations.Experience shows that the comprehensive control of high SRB requires the development of a sophisticated institutional mechanism seeking both temporary and permanent solutions and the cardinal rules of ruling by law,resolving the current problems and eliminating the root causes,and carrying out scientific and prognostic control.By putting into implementation the organizational leadership,appraisal& assessment and family services,we would be able to put high SRB under control.     

综合治理出生性别比偏高的深层思考

自20世纪80年代以来,我国出生性别比长期持续偏高,虽然2008年以来连续6年下降,但偏高形势依然严峻,面临出生性别比偏高的空间范围扩大、男女差数累积数量大、整治两非难度加大等问题。国家予以高度重视,指导各地开展综合治理活动,实施党政一把手负总责工程、先进性别文化建设工程、女性优先优惠升温工程、医疗卫生市场净化工程、考核评估体系构建工程、孕产期全程服务工程,对综合治理出生性别比偏高起到了积极的促进作用,但综合治理工作尚处于由活动层面向制度层面过渡阶段、统计数据难以准确研究判断客观形势。实践表明,综合治理出生性别比偏高问题需要构建标本兼治、体系完备的体制机制,确立依法治理、标本兼治、科学治理、预后治理的基本原则,通过组织领导落实、考核评估落实、家庭服务落实把综合治理出生性别比偏高各项工作落到实处。     

我国人口重心、就业重心与经济重心空间演变轨迹分析

近20年来我国人口重心、就业重心、经济重心的空间演变轨迹表明,我国区域经济差距的主要原因是东部沿海地区不断集聚生产的同时,没有更有效地吸纳中西部地区的人口,从而造成我国东部沿海地区与中西部地区的生产与人口、就业分布高度失衡。目前,建立完善的分享机制、进一步促进西部落后地区的人口向东部沿海发达地区流动、建立健全的流动人口管理体制是促进我国区域协调发展的有效策略。     

出生性别比综合治理:有所为,有所不为

从1980年我国出生性别比越过正常值域至今,党和各级政府制订了种种措施进行综合治理,但取得的成效甚微。这一时期我国治理工作的特点有:重视禁止性法律法规的制定,但与之相配套的规章制度比较缺乏;重视目标任务的提出,但落实目标的措施比较缺乏;部门性、专项性规章制度较多,综合性规章制度比较缺乏。今后一段时期内综合治理工作,可以按照避实就虚、避难就易的原则,在大力发展社会经济、建立健全社会养老制度、相关法律法规的制定与完善、加大对两非行为的打击力度等方面有所作为;而在人口生育政策的调整、传统文化的改变等方面有所不为。     

Nepal: Integrated health services project

The Integrated Health Services Project, part of Nepal's current 5-year development plan, will aim at minimal health services to the maximum number of people. The project plans to provide for basic health needs through home visits by village health workers. The object is to stem high mortality particularly of mothers and infants through home nutrition, immunization, and teaching oral rehydration techniques, and induce a decline in fertility with conventional devices and ad hoc sterilization camps. The health aides will number 1/3000-5000 people who will visit villages with materials and a 12-point health message. 1 implement is an armband to measure the circumference of children's arms to diagnose nutritional status.     

Financing rural health services in Kenya

The paper analyzes household expenditure on medical care and the willingness to contribute towards service improvements at government health facilities. The analysis is based on survey data from two rural districts in Kenya situated approximately four hundred miles apart. The main finding is that medical care expenditure rises as household income increases, but the probability of willingness to pay fees for service improvement at government clinics declines with income. Income is an important determinant of the willingness to participate in a hypothetical government insurance scheme, with the probability of participation falling as income rises. These results should be interpreted with caution because of the potential for incorrect reporting of the willingness to pay for services that have an element of a social good. The policy implications of the results are briefly discussed.     

Unmet needs for developmental disabilities services

Data collected from a representative sample of persons who are developmentally disabled living in three counties in Florida in 1989 were analyzed to determine the number of services these persons receive, the extent to which they do not receive services they need, the reasons these services are not received, and the factors which are related to satisfaction with services. A battery of 90 services which can be grouped into 8 general categories was used, and the data were collected in face-to-face interviews with 312 persons.     

Client satisfaction with developmental disabilities services

Data from a representative sample of 312 developmentally disabled clients of Florida's Department of Health and Rehabilitative Services are analyzed to discover the characteristics of the clients and to determine the extent to which the clients are satisfied with various services, reasons for any dissatisfaction that exists, and the factors which are related to satisfaction with services. Clients are least likely to be satisfied with the caregiver support services and the vocational and rehabilitative services they receive. Across all categories, reasons most often given for dissatisfaction with services are inappropriateness and insufficient amount. The factors most strongly related to client satisfaction with services are age, living arrangements, and number of services received. Adolescents are less likely than persons at other ages to be satisfied with the services they receive, persons living in a family setting are less likely than persons in nonfamily settings to be satisfied with services, and the greater the number of services received the lower the likelihood of client satisfaction. Combined with information showing that most of the clients have multiple disabilities, these data suggest that the service delivery system does a better job of delivering some services than others. A slot oriented program such as that in Florida may pay insufficient attention to the existence of multiple needs among persons who are developmentally disabled and to providing services to the networks which form the client's economic and social support system.     

Family planning services and Population Research Act

The Senate Human Resources Subcommittee under the chairmanship of Senator Alan Cranston has completed its work on the Family Planning Services and Population Research Amendments of 1973 (S. 1708) and has referred the bill to the Senate Labor and Public Welfare Committee. Right-to-Life activists are zeroing in on committee members in hopes of amending the bill to prohibit federal funds for sterilization and continued research on abortifacient drugs. If such provisions were to be approved, it would prohibit men from obtaining vasectomies with federal assistance and eliminate what has become a most popular birth control method for couples who have reached their desired family size. Such a prohibition would be especially discriminatory of low income males who cannot afford to finance a vasectomy through the private health care system. Banning use of IUDs by federal family planning agencies could also interfere with valuable cancer research and the treatment of such ailments as asthma and duodenal ulcers. The Senate Labor Committee needs to be fully advised as to the dangerous implications of these provisions and of the public opposition to their enactment. Vocalize your opposition today by urging the committee to exclude such amendments from the legislation they send to the Senate. The committee members are: Chairman: Williams, New Jersy; Randolph, West Virginia; Pell, Rhode Island; Kennedy, Massachusetts; Nelson, Vermont; Mondale, Minnesota; Eagleton, Missouri; Cranston, California; Hughes, Iowa; Hathaway, Maine; Javits, New York; Dominick, Colorado; Schweiker, Pennsylvania; Taft, Ohio; Beall, Maryland; and Stafford, Vermont.     

Use of maternal health services in rural China

We use data from the nationally representative 1997 Demographic and Reproductive Health Survey to examine use of maternity services in rural China. The data indicate that roughly 60 per cent of women had at least one prenatal visit, while 40 per cent had a professionally assisted birth over the period 1988-97. Despite China's shift from a more socialist to a more privatized health care system, use of maternity services increased over this period. These increases are consistent with the push toward integration of reproductive health into family planning that emerged after the 1994 International Conference on Population and Development and the 1995 Fourth World Women's Conference held in Beijing. At the same time, we find indirect evidence that the target-based population policy may well have exerted downward pressure on use of maternity services; differences by parity are marked and multilevel models predicting use of maternity services indicate underdispersion at the individual level.     

Measurement of the quality of family planning services

The quality of health services is a subject of increasing interest to health care providers and organizations responsible for financing and promoting health services. The importance of the client's perspective (and by inference, the perspective of potential clients, as well) is now well established, but efforts to define and measure quality have thus far been limited to the perspective of experts even when the experts claim to speak for the clients. In this paper we utilize family planning programs to explore issues of the quality of health services. We propose that a better understanding of the view of quality actually held by family planning program clients will clarify the influence of quality on the use of services, a clarity that has not been possible by looking at quality only as defined by providers, managers or experts. We review the literature on quality of services and identify the gaps in research that must be filled if a better understanding of what quality is and how it relates to service outcomes is to be obtained. A first step must be the research required to develop a set of measures of quality that reflects the multi-dimensional nature of quality, includes the clients' view of services in the definition of quality, and incorporates methodologies required to ascertain the true view of clients. Finally, we suggest that dimensions of quality identified as important for clients as a group will be more predictive of use of services than dimensions identified as important to providers.     

Respondent characteristics in citizen evaluation of municipal services

Research on citizen surveys tend to focus on how to conduct a survey and how to best utilize the survey data. How respondent characteristics affect responses to a survey has received only cursory treatment in the literature. The present study investigated the role of demographics and generalized attitude, two types of respondent characteristics, in citizen evaluations of municipal services. Of particular interest was the pattern of respondent-responses interaction across time. The Automatic Interaction Detector (AID) was used to analyze survey data collected annually from 1974 through 1979 by a University-affiliated Urban Studies Center in a mid-size metropolitan area. Results indicated that these respondent characteristics could account for a substantial portion of the variance associated with service evaluation. However, the relationship between respondent characteristics and service evaluations is nonlinear, interactively complex and lacking in consistency across time. This widely varying pattern of respondent-responses interactions across time was explained in terms of the effect of a third exposure-experiential factor. Implications for future research and for using citizen survey data in public policy analysis and program development were discussed.     

Integrating reproductive health services into family planning programs

A recent Population Council publication, Reproductive Health Approach to Family Planning, discusses integration of reproductive health into family planning programs in a series of edited presentations that Council staff and colleagues gave at a 1994 meeting of the US Agency for International Development (USAID) cooperating agencies. The presentations reflect the Council's view that family planning programs ought to help individuals achieve their own reproductive goals in a healthful manner. The report discusses four areas of reproductive health: reproductive tract infections (RTIs), including sexually transmitted diseases; prevention and treatment of unsafe abortion; pregnancy, labor, and delivery care; and postpartum care. Christopher Elias (Senior Associate, Programs Division) argued that family planning programs ought to provide services that target RTIs, given that these illnesses afflict a significant proportion of reproductive-age women. The family planning community has an ethical responsibility to provide services to women who experience an unwanted pregnancy. They must have access to high-quality postabortion care, including family planning services. Professional midwives are ideally suited to serve as integrated reproductive health workers trained to combat the five major maternal killers: hemorrhage, sepsis, pregnancy-induced hypertension, obstructed labor, and unsafe abortion. This was demonstrated in a highly successful Life-Saving Skills for Midwives program undertaken in Ghana, Nigeria, and Uganda, and soon to start in Vietnam in conjunction with the Council's Safe Motherhood research program. Family planning services should be viewed as part of a comprehensive set of health services needed by postpartum women, which include appropriate contraception, maternal health checks, well-baby care, and information about breastfeeding, infant care, and nutrition. Family planning programs should incorporate breastfeeding counseling into their services. When programs aim to help individuals meet their own reproductive goals in a healthful manner, this implies that services will not increase clients' risk of morbidity.     

The spread of health services and fertility Transition

We use detailed measures of social change over time, increased availability of various health services, and couples' fertility behaviors to document the independent effects of health services on fertility limitation. Our investigation focuses on a setting in rural Nepal that experienced a transition from virtually no use of birth control in 1945 to the widespread use of birth control by 1995 to limit fertility. Changes in the availability of many different dimensions of health services provide the means to evaluate their independent influences on contraceptive use to limit childbearing. Findings show that family planning as well as maternal and child health services have independent effects on the rate of ending childbearing. For example, the provision of child immunization services increases the rate of contraceptive use to limit fertility independently of family planning services. Additionally, new Geographic Information System (GIS)-based measures also allow us to test many alternative models of the spatial distribution of services. These tests reveal that complex, geographically defined measures of all health service providers outperform more simple measures. These results provide new information about the consequences of maternal and child health services and the importance of these services in shaping fertility transitions.     

Long-term care in Spain: Difficulties in professionalizing services

The aim of this article is to analyze the difficulties in professionalizing the long-term care system in Spain. Since 2006, the new Spanish law has recognized care as a subjective right, and regulations are being designed to create a framework for its professionalization. Nowadays, family remains the most important group of providers who care for their elders, and women remain the main informal caregivers. Why do families resist using public long-term care services and professional carers included in the new law? The hypothesis highlights sociocultural factors as an obstacle to professionalization of long-term care services in addition to political and economic factors. The results show qualitative data about expectations, preferences, and discourses that women caregivers have in relation to their responsibility. The empirical material includes 25 interviews with different profiles of caregivers and six focus groups with family caregivers. The article suggests that the Spanish ideal of care is a problem for the professionalization of services because the family remains as the main provider of care—without specific skills, knowledge, and abilities.