家庭计划政策和项目

PFHS-380.665 家庭计划政策和项目 PFHS-380.665 FAMILY PLANNING POLICIES AND PROGRAMS 家庭计划项目分析和未满足的避孕需求的「需求—供给架构」 Demand-Supply Framework for Family Planning Program Analysis and Unmet Need for Contraception W. Henry Mosley A. 社会-经济发展的儿童供给和需求（伊斯特林模式） A. Supply of, and demand for children with socio-economic development （Easterlin model） 1. 需求=假设限制生育是没有成本，父母意欲的存活子女数目 Demand = number of surviving children parents would have if fertility regulations were costless. 2. 供给=假设父母不故意限制家庭成员数目，供给就是存活子女的数目 Supply = number of surviving children couples would have if they made no deliberate attempt to limit family size. 3. 限制生育的成本=取得和使用避孕和堕胎的经济、心理、健康和社会成本 Cost of fertility regulation = economic, psychic, health and social costs of acquiring and using contraception and abortion. B. 需求—供给架构的人口指标 B. Demographic indicators of the demand-supply framework 1. 避孕普及率 计量「已满足」的限制生育需求。 Contraceptive prevalence as a measure of “met” demand for fertility limitation . 2. 未满足的家庭计划需求，是指有性结合的妇女，有部份希望限制或相隔生育，但 没有采用避孕。 Unmet need for family planning measured as proportion of women in a sexual union desiring to space or limit childbearing and not using contraception 3. 限制家庭的总潜在需求，是计量避孕的使用和未满足需求。 Total potential demand for family limitation measured by contraceptive use plus unmet need. 4. （控制育儿的）潜在需求，是计量实际生育和意欲生育的差距，或是非意愿的 或 非意欲的 育儿水平。 Latent demand （for controlling childbearing） measured as difference between achieved fertility and desired fertility, or as level of unintended, or unwanted childbearing. 5. （控制育儿的）明显需求，是计量 总堕胎率。 Overt demand for controlling childbearing as measured by the total abortion rate C. 未满足的家庭计划需求 C. Unmet need for family planning 有未满足需求的群体，包括全部有生育力的已婚或同居的妇女—因此可假定为性活 跃—她们没有采用任何避孕方法，但又不想多生孩子，或是希望把下一胎推迟到起 码两年之后。 The unmet need group includes all fecund women who are married or living in union - and thus presumed to be sexually active - who are not using any method of contraception and who either do not want to have any more children or who want to postpone their next birth for at least two more years. 有未满足需求的群体，也包括因为没有避孕，所以意外怀孕或是怀孕得不合时的全 部怀孕已婚妇女，和最近分娩而仍然停经的妇女。 The unmet need group also includes all pregnant married women, and women who have recently given birth and are still amenorrheaic if their pregnancies／ births are unwanted or mistimed because they were not using contraception. D. 未满足需求的水平和趋势 D. Levels and trends in unmet need 趋势在改变：生孩子的意欲下降，而避孕普及率上升。产后初期的未满足需求最高， 而随着上一胎的分娩时间相隔越长，需求降低。 Changing patterns with declines in desire for children and with increasing levels of contraceptive prevalence. Unmet need is highest in the early post-partum period and falls as the time since last birth gets longer. E. 未满足需求的扩大达 E. Expanded formulations of unmet need 1. 和避孕方法有关：As it relates to contraceptive methods: —使用无效的方法 using ineffective methods —不正确使用有效的方法using an effective method incorrectly —使用的方法对她们不安全或不适合using a method that is unsafe or unsuitable for them 2. 和风险组群有关：As it relates to risk groups: —未结婚的妇女unmarried women —性活跃的青年人sexually active youth —分居，离婚，鳏寡 separated, divorced, widowed F. 未满足需求的理由 F. Reasons for unmet need 1. 供应者的局限 Provider constraints —限制取得服务 Limited access to services —医学障碍 Medical barriers —照护质量Quality of care 2. 使用者的局限 Client constraints —缺乏信息 Lack of information —健康的问 Health concerns —家庭和小区反对 Opposition from family and community —矛盾心理 Ambivalence G. 采用避孕方法的意欲 G. Intention to Use a Method 《人口与卫生调查》的基础是妇女的自我声明，也有计量她们将来采用避孕方法的 意欲。不是全部有「未满足需求」的妇女都表示将来会避孕（理由见上述），而许 多没有未满足需求的妇女反而表达将来会避孕。事实上，在许多国家，没有未满足 需求但将来会避孕的妇女，数目多过那些有未满足需求但将来不会避孕的妇女 （Ross 与 Heaton, 1997）。这「差异」和如何定义「未满足需求」的程序有关。 Intention to use a contraceptive method in the future is also measured in the DHS surveys based on women's own statements. Not all women with an "unmet need" express and intention to use in the future （for reasons given above）, while many women who do not have an unmet need will express and intention to use in the future. In fact, the women without an unmet need who intend to use outnumber the women with an unmet need who intend to use in many countries. （Ross and Heaton, 1997）. This "discrepancy" relates to the procedure for defining unmet need. H. 未满足的家庭计划需求的含意 H. Implications of unmet need for family planning 参考References 必读参考Required Reference: Stash, S.〈解释尼泊尔Chitwan区的未满足避孕需求〉《家庭计划研究》1999年，第 30（4）期，267-287 页 Stash, S. Explanations for unmet need for contraception in Chitwan, Nepal. Studies in Family Planning 30（4）: 267-287, 1999. Westoff, CF与Bankole, A.〈开发中国家对限制家庭的需求趋势〉《国际家庭计划透 视》2000年，第26（2）期，56-62 页 Westoff, CF and Bankole, A. Trends in the demand for family limitation in developing countries. International Family Planning Perspectives 26（2）: 56-62, 2000. Casterline, JB与Sinding, S.〈开发中国家的未满足避孕需求对人口政策的含意〉《人 口与发展评论》2000年，第26期，691-723 页 Casterline, JB and Sinding, S. Unmet need for family planning in developing countries and implications for population policy. Population and Development Review 26: 691-723, 2000. 推荐阅读 Recommended Reading: Bongaarts, J.，〈生育决定因素的供给—需求架构：另类执行〉《人口研究》1993年， 第47期，437-456 页 Bongaarts, J. The supply-demand framework for the determinants of fertility: an alternative implementation, Population Studies 47:437-456, 1993. Bongaarts, J与Bruce, J.〈未满足的避孕需求的成因和服务的社会内容〉《家庭计划研 究》1995年，第26（2）期，57-75 页 Bongaarts, J and Bruce, J . The causes of unmet need for contraception and the social content of services. Studies in Family Planning 26（2）:57-75, 1995. Bongaarts, J,与Bruce, J.〈取得途径的问题：响应〉《家庭计划研究》1995年，第26 （4）期，243-244 页 Bongaarts, J, and Bruce, J. Question of access: Response. Studies in Family Planning 26（4）:243-244, 1995. Casterline, JB, El-Zanaty, F,与El-Zeini, LO.〈未满足的需求和意外生育：上埃及的纵 向实证〉《国际家庭计划透视》2003年，第29（4）期，158-166 页 Casterline, JB, El-Zanaty, F, and El-Zeini, LO. Unmet need and unintended fertility: longitudinal evidence from upper Egypt. International Family Planning Perspectives 29 （4）: 158-166, 2003. Casterline, JB, Sathar, ZA,与Haque, M ul.〈巴基斯坦采用避孕的障碍：旁遮普省的研 究〉《家庭计划研究》2001年，第32（2）期，95-110 页 Casterline, JB, Sathar, ZA, and Haque, M ul. Obstacles to contraceptive use in Pakistan: a study in Punjab. Studies in Family Planning 32（2）:95-110, 2001. Casterline, J, Perez, AE,与Biddlecom, AE.〈菲律宾的未满足家庭计划需求的基本因 素〉《家庭计划研究》1997年，第28（3）期，173-191页 Casterline, J, Perez, AE, and Biddlecom, AE. Factors underlying unmet need for family planning in the Philippines. Studies in Family Planning 28（3）:173-191, 1997. Donaldson PJ与Tsui AO.〈国际家庭计划运动〉《人口简报》1990年11月，第45（3） 期 Donaldson PJ and Tsui AO. The international family planning movement. Population Bulletin 45（3）, November 1990. Feyisetan, B与Casterline, JB.〈开发中国家的生育偏好和避孕的改变〉《国际家庭计 划透视》2000年，第26（3）期，100-108 页 Feyisetan, B and Casterline, JB. Fertility preferences and contraceptive change in developing countries. International Family Planning Perspectives 26 （3）:100-108, 2000. Hakim, C.〈解释生育模式的新方法：偏好理论〉《人口与发展评论》2003年，第29 （3）期，349-374 页 Hakim, C. A new approach to explaining fertility patterns: preference theory. Population and Development Review 29 （3）: 349-374, 2003. Jain, A.〈消除未满足需求应否是优先项目？〉《国际家庭计划透视》1999年，第25 期附刊，539-543 页 Jain, A. Should eliminating unmet need be a program priority? International Family Planning Perspectives 25 （Supplement）: 539-543, 1999. Lapham Robert J与Simmons George B. 〈总览和架构〉第一章（3-34页） 于 RJ Lapham 与GB Simmons（编辑）《为有效的家庭计划项目而组织》第一章（3-34页），国家 学院出版社，华盛顿市， 1987年 Lapham Robert J and Simmons George B. Overview and Framework. Chapter 1 （pp.3-34） in RJ Lapham and GB Simmons （eds） Organizing for Effective Family Planning Programs. Washington, D.C.: National Academy Press, 1987. Legrand, T, Koppenhaver, T, Mandain, N,与Randall, S.〈重估保险效应：定性分析塞内 加尔和津巴布韦的生育行为〉《人口与发展评论》2003年，第29（3）期，375-403 页 Legrand, T, Koppenhaver, T, Mandain, N, and Randall, S. Reassessing the insurance effect: a qualitative analysis of fertility behavior in Senegal and Zimbabwe. Population and Development Review 29 （3） 375-403, 2003. Lesthaeghe, R与Vanderhoeft, C. 〈准备，愿意，能够：转换到新行为形态的概念〉 于 John B Casterline（编辑）《扩散过程和生育过渡：观点选辑》第8章，Washington, DC, National Academy Press, 2001年 http://books.nap.edu/books/0309076102/html/240.html#pagetop（购买英语版本） Lesthaeghe, R and Vanderhoeft, C. Ready, willing, and able: a conceptualization of transitions to new behavioral forms. Chapter 8 in: John B Casterline, ed: Diffusion Process and Fertility Transition. Selected Perspectives. Washington, DC, National Academy Press, 2001. http://books.nap.edu/books/0309076102/html/240.html#pagetop Lindstrom DP.，〈墨西哥生育率下降中的避孕用品的供求作用：微型人口调查的实 证〉《人口研究》1998年，第52期，255-274页 Lindstrom DP. The role of contraceptive supply and demand in Mexican fertility decline: evidence from a microdemographic study. Population Studies 52: 255-274, 1998. Phillips JF与Ross JA.〈：总览家庭计划项目和生育效应〉于 JF Phillips 与JA Ross 编辑《庭计划项目与生育》第十六章（325-331页）Oxford: Clarendon Press，1992 年. Phillips JF, Ross JA. Family Planning Programs and Fertility Effects: An Overview. Chapter 16, pages 325-331 in JF Phillips and JA Ross （eds） Family Planning Programs and Fertility. Oxford: Clarendon Press, 1992. Robey, B, Ross, J,与Bushan, I.，〈满足未满足的需求：新策略〉《人口报告》1996 年9月，J系列43号，巴的摩市，约翰霍普金斯公共卫生学院，人口信息项目 Robey, B, Ross, J, and Bushan, I. Meeting Unmet Need: New Strategies. Population Reports, Series J, No.43, Baltimore, Johns Hopkins School of Public Health, Population Information Program, September, 1996. Robinson, W与Cleland, J. 〈避孕成本对孩童需求的影响〉于 JF Phillips与JA Ross编 辑《家庭计划项目与生育》（106-22页），Clarendon Press, Oxford, 1992年. Robinson, W and Cleland, J. The influence of contraceptive costs on the demand for children. Pages 106-22, in: JF Phillips and JA Ross （eds）, Family Planning Programs and Fertility, New York,: Clarendon Press, Oxford, 1992. Ross, J.〈评论：取得途径的问题〉《家庭计划研究》1995年，第26（4）期，241-2 页 Ross, J. Commentary. The question of access. Studies in Family Planning 26（4）:241-2, 1995. Ross, JA与Heaton, L.〈没有未满足需求的妇女采用避孕的意欲〉《人口与发展评论》 1997年，第23（4）期，149-154 页 Ross, JA and Heaton, L. Intended contraceptive use among women without an unmet need. International Family Planning Perspectives 23 （4）:149-154, 1997 Ross, J, Stover, J与Willard, A. 《116个国家的家庭计划和生殖健康项目面面观》 ， 国际前景集团，美国康乃狄克州，1996年 Ross, J, Stover, J and Willard, A. Profiles for Family Planning and Reproductive Health Programs. 116 Countries. The Futures Group International, Glaxtonbury, Connecticut, 1999. Ross, JA与Winfrey, WL.〈产后长期采用避孕、使用意欲和未满足的需求〉《国际家 庭计划透视》2001年，第27（1）期，20-27页 Ross, JA and Winfrey, WL. Contraceptive use, intention to use and unmet need during the extended postpartum period. International Family Planning Perspectives 27 （1）:20-27, 2001 Ross, JA与Winfrey, WL.〈开发中国家和前苏联的未满足需求：更新的估算〉《国际 家庭计划透视》2002年，第28期，138—143页 Ross, JA and Winfrey, WL. Unmet need for contraception in the developing world and the former Soviet Union: an updated estimate. International Family Planning Perspectives 28: 138 – 143, 2002. Roy, TK, Nangla, P, Saha, U,与Khan, N.〈妇女的育儿和避孕意欲能否预测避孕需求？ 印度中部纵向研究的结论〉《国际家庭计划透视》2003年，第29（1）期，25-31页 Roy, TK, Nangla, P, Saha, U, and Khan, N. Can women’s childbearing and contraceptive intentions predict contraceptive demand? Findings from a longitudinal study in central India. International Family Planning Perspectives 29 （1）: 25-31, 2003 Shelton, JD, Bradshaw L, Hussein, B, Zubair Z, Drexler T,与McKenna, MR.〈测试未满 足的需求：巴基斯坦的以小区为基础的家庭计划发放〉《国际家庭计划透视》1999 年，第25（4）期，191-195页 Shelton, JD, Bradshaw L, Hussein, B, Zubair Z, Drexler T, and McKenna, MR. Putting unmet need to the test: community-based distribution of family planning in Pakistan. International Family Planning Perspectives 25（4）: 191-195, 1999. Sinding, SW, Ross, JA,与Rosenfield, AG.〈寻求共同点：未满足需求与人口目标〉《国 际家庭计划透视》1994年，第20（1）期，23-27页 Sinding, SW, Ross, JA, Rosenfield, AG. Seeking common ground: Unmet need and demographic goals. International Family Planning Perspectives 20（1）: 23-27, 1994. Westoff, CE,与Bankole, A.〈未满足需求的潜在人口重要性〉《国际家庭计划透视》 1996年，第22（1）期，16-20页 Westoff, CE, and Bankole, A. The potential demographic significance of unmet need. International Family Planning Perspectives 22（1）:16-20, 1996. Westoff, CF与Bankole, A.〈未满足需求的时间动态：和摩洛哥的例子〉《国际家庭 计划透视》1998年，第24（1）期，12-14页 Westoff, CF and Bankole, A. The time dynamics of unmet need: and example from Morocco. International Family Planning Perspectives 24（1）: 12-14, 1998.