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玑耶储
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1 政策变化与流动人口健康 : 以妇幼健康为例 Policy change and migrants health: with a focus on maternal and child health 郑真真中国社会科学院人口与劳动经济研究所 Zheng, Zhenzhen Institute of Population and Labor Economics, CASS 2012 年 3 月 28 日

2 主要内容 Contents 人口流动的不同阶段 migration Different periods of 不同阶段人口流动对妇幼健康的影响 Impacts on maternal and child health in different periods 相关研究与数据 Research findings and facts 讨论 : 变化与研究需求 Discussion: policy change and research demand

3 中国人口流动的不同阶段 Different periods of migration 第一阶段 :20 世纪年代 Period I: 1950s-70s 控制迁移的行政手段 Administrative control of migration 第二阶段 :20 世纪 80 年代 Period II: 1980s 1984 年国务院关于农民进入集镇落户问题的通知,1985 年公安部关于城镇暂住人口管理的暂行规定 The sign of relaxed control, temporary residence registration 第三阶段 : 年代末 Period III: s 更多管制政策出台, 不过从初期的劝阻改变为后来的鼓励 More managerial policies, but changed from discourage in early years to encourage later 第四阶段 :2000 至今 Period IV: 21st century 以服务为主体的社会政策 : 消除歧视, 纳入城市公共服务体系 Service oriented social policy: eliminate discrimination, responsibility and coverage of urban public service system (26 related documents in 10 years)

4 不同阶段妇女儿童流动特征 Women and child migrants in different periods 20 世纪 90 年代以前, 妇女迁移以婚姻和随迁为主 Women migrates mainly because of marriage or follow her husband before 1990s 90 年代中期, 打工妹数量逐渐上升, 迁移妇女以单身为主 More single women migrate workers during mid-1990s 90 年代后期, 更多已婚妇女加入劳动力流动, 部分带子女, 2000 年 46% 流动人口与家庭同住在流入地 (1990:7%) More married women joined labor migration in later-1990s, some with their children, 46% migrants live with their family in 2000 (it was 7% in 1990) 2005 年女性占流动人口 50%, 规模超过 7 千万 Women made 50% of migrants with a size of million

5 不同阶段人口流动对妇幼健康的影响 Impacts to MCH in different periods 第三阶段 : 年代末 Period III: s 早期对打工妹的心理和生理健康的忽视 : 仅有零星报道 The needs of psychological and physical health care of working girls were neglected in early years: scattered cases reported 90 年代后期开始关注流动妇女的健康问题, 主要集中于生殖健康 Attentions to issues of women migrants health started later 1990s, mainly focused on reproductive health 90 年代末以来出现更多有关流动人口健康的调查研究 More researches about MCH of migrants since end of 1990s 第四阶段 :2000 至今 Period IV: 21st century 连续两个 10 年妇女儿童发展纲要中强调流动妇女和儿童的健康问题 MCH issues of migrants mentioned in national development plan of women and children ( , ) 更多地方政策 ( 如专项财政拨款 ), 更多服务 More local policies (local gov. special budget), more health services

6 孕产妇死亡率 ( 每十万新生儿 ) 中国妇幼健康指标的城乡差距和地区差距 Gaps between urban-rural and areas 全国东部中部西部年份 Maternal mortality rate, The coverage of maternal health care in urban>90%, in less developed rural <30%. Mortality rate in children (<5 years) during (Rudan, et al, Lancet, 2010)

7 乡城流动对妇幼健康的影响 : 差距缩小还是扩大 Impact of rural-urban migration: gaps eliminated or enlarged 早期研究 : 迁移对妇幼健康的双面影响 Findings from earlier studies: the duel effects of migration 知识 Knowledge 态度 Attitude 观念 Opinion 行为 Behavior 研究的局限 limitations of earlier studies 设计 Design 比较 Comparison 参照组 Reference group 对历史数据的挖掘和回顾性调查 Further analysis of existing data and retrospective surveys

8 人口流动对妇幼健康的影响 : 近 10 年的研究 Impacts to MCH: more recent research findings 孕产保健 : 两种差距 Maternal health care: two gaps 城市居民与流动人口之间 Urban residence vs. migrants MMR, Shanghai average: Improvement in the 10 years is not as much as urban residence 流动人口与农村人口之间 Migrants vs. counterparts in origin Women migrants are often found having a better health status and use health service more, but it may also due to the selectivity of migration 孕产保健状况随时间变化 Changes over time 住院分娩率, 北京和成都流动妇女调查 Rates of hospital delivery, Beijing and Chengdu women migrants survey, 2006 before Giving birth in destination 81% 96% Giving birth in origin 59% 82%

9 人口流动对妇幼健康的影响 : 研究与数据 Impacts to MCH: research findings and facts 婴幼儿死亡 Infant and child mortality, Hangzhou, ( ) Urban residence vs. migrants 婴儿死亡率 Infant mortality: 岁以下儿童死亡率 Child <5 mortality: 死因差距 : 流动人口中的婴幼儿更可能死于早产 / 低出生体重和意外事故 Cause of death: more migrant children died from low birth weight and accident 婴幼儿和儿童保健 Infant and child health care 北京上海广州杭州四城市调查 Four cities survey, 2003 Having service card 45.3% Had health check-up 52.9% Having immunization record 95.2% Had any immunization 98.8% Had 4 immunization 67.6% 杭州 3 岁以下儿童保健管理情况 (%), Hangzhou, Health care coverage for <3 years Urban residence vs. migrants

10 更多统计数据 Impacts to MCH: more facts 政策变化与服务提供 : 努力缩小差距 Policy changes and service available: efforts to eliminate the gaps 上海市早期新生儿死亡率, Neonatal mortality rates of Shanghai, Non-residence Residence

11 影响流动妇女儿童服务利用的因素 Determinants of service use of migrants 直接影响因素 : 缺信息, 少意识, 怕花钱 Measurable determinants: lacks of information, awareness, and money 社会经济因素 : 受教育程度, 收入, 就业类型 Social-economic factors: education, income, employment 影响流动儿童保健服务的因素 : 父母文化程度家庭收入母亲的工作状态与母亲的年龄 Related factors to child health care: parents education, family income, mother s employment, and mother s age 社会经济地位作用比流动身份起到更为重要的作用 Social-economic status plays a more important role than the residence status 体制和医疗保险约束是根本原因 The key constrain is institutional and health insurance system

12 近年变化 : 政策改善流动人口结构改变 Most recent changes in policy and migrants 近年来的变化有利于缩小差距 : 流入地的政府关注政策变化投入增加 The recent changes to eliminate the gaps: much more attentions from the local government on health issues, changes or new policies, more inputs 不过, 政策转变和服务改善过程中, 最弱势人群最迟受益 ( 流动人口中的不同人群之间差距极大 ) However, during the process of policy change and service reform, the most disadvantaged group enjoyed the benefit of latest 不仅要有政策和投入, 还需要针对不同人群转变服务方式 The need for more appropriate approaches to meet the needs of clients with different social-economic status 特别需要关注 : 新一代农民工的特点 Special attention to: the new generation

13 例如 : 新生代务工人员的身体和心理健康 (2010 深圳调查 ) Example: physical and mental health of new generation 60 男女新生代非新生代新生代非新生代新生代非新生代新生代非新生代自评一般健康状况较差有肠胃疾病贫血有慢性病

14 讨论 : 变化中的研究需求 Discussion: research demand during change Problems entangled with different systems and on-going reforms, as well as changes of migrants: many changes at the same time Not only understand the problems, but the strategies and policies to address them Policy related researches: monitor and evaluate the changes and impact of the new policies Floating vs. settlement the dilemma of large cities and the way to urbanization Learn experience of other countries: looking at similar issues and learn successful (and not so successful) strategies, policies, and interventions, and implementations More communication and collaboration within and cross boundaries

15 谢谢 T h a n k s

中国女性的婚姻与生育状况一婚姻状况的总体特征婚姻状况是我们探知人们生活的一扇窗户, 婚姻状况的变化在一定程度上反映了一个社会的现代化和工业化水平社会转型和

中国女性的婚姻与生育状况一婚姻状况的总体特征婚姻状况是我们探知人们生活的一扇窗户, 婚姻状况的变化在一定程度上反映了一个社会的现代化和工业化水平社会转型和妇女绿皮书. 5 中国女性的婚姻与生育状况杨玉静摘要 : 进入 21 世纪, 中国女性的婚姻与生育状况出现了新的特征六普数据显示, 2010 年女性有偶率为 72. 3%, 普遍结婚仍是女性婚姻状况的一个特点 ; 未婚率和离婚率分别为 18. 5%