中国未婚流动青少年生殖健康服务利用研究进展

<正>青少年在生命周期中处于一个特定的时期,其生殖健康有许多特点,享有生殖健康服务是青少年的基本权利。继1994年开罗国际人口与发展大会首次在《行动纲领》~([1])中明确提出青少年所面临的生殖健康挑战,并要求各国为青少年提供必要的生殖健康教育和服务后,世界各国各地区相继出台一些生殖健康政策和服务支持框架。在中国,15~24岁     

我国青少年生殖健康现状

<正> 随着社会的发展和思想观念的改变,青少年的性与生殖健康问题已越来越受到国际社会的广泛关注和重视,并被WHO生殖健康与研究部确定为优先的研究领域。在我国,生殖健康教育相对滞后,越来越多的青少年面临与性相关的健康危险,该人群的婚前性行为、妊娠、人工流产和性病发生率呈明显的上升趋势。由于目前在我国,计划生育和性与生殖健康教育和服务的对象仅局限在已婚夫妇,因此,在婚前性行为普遍存在及社会对性行为持较开放态度的客观现实下,应尽快将青少年的性与生殖健康教育和服务纳入到健康教育的规划中。有关青少年性与生殖健康状况主要表现在以下几方面。     

残障青少年获取性教育与生殖健康服务的定性研究

了解学校老师对残障青少年获取性教育与生殖健康服务的态度、认识和建议以及学校开展残障青少年性教育面临的困难,为更好地满足残障青少年需求提供科学依据.方法 在上海、北京和陕西农村地区对视力、听力、肢体和智力障碍青少年的性教育相关老师、班主任/生活老师以及校医进行个别深入访谈,共完成个人深访29人.结果 多数受访老师认为有必要对残障青少年进行性教育,性教育相关老师对性教育内容的理解更全面.城市访谈涉及8所特殊学校,其性教育开展状况明显好于农村访谈涉及的4所普通学校和1所特殊学校,但缺乏统一的教学标准,内容也不全面.绝大多数受访老师认为残障青少年也需要生殖健康服务,但他们几乎都没听说过社会上有特别考虑残障青少年需求的生殖健康服务.结论 残障青少年获取性教育和生殖健康服务面临较多障碍.应提高相关政府部门及教育和服务机构对残障青少年性教育与生殖健康服务必要性和重要性的认识,推动学校性教育的开展,消除残障青少年获取生殖健康服务的障碍.     

我国青少年生殖健康现状

随着社会的发展和思想观念的改变,青少年的性与生殖健康问题已越来越受到国际社会的广泛关注和重视,并被WHO生殖健康与研究部确定为优先的研究领域.在我国,生殖健康教育相对滞后,越来越多的青少年面临与性相关的健康危险,该人群的婚前性行为、妊娠、人工流产和性病发生率呈明显的上升趋势.由于目前在我国,计划生育和性与生殖健康教育和服务的对象仅局限在已婚夫妇,因此,在婚前性行为普遍存在及社会对性行为持较开放态度的客观现实下,应尽快将青少年的性与生殖健康教育和服务纳入到健康教育的规划中.有关青少年性与生殖健康状况主要表现在以下几方面.     

青少年性与生殖健康干预效果评价及启示

全球青少年生殖健康问题日益严重。在研究青少年性与生殖健康需求的基础上,评价青少年生殖健康干预项目的效果,确定为其提供信息和保健服务的最佳途径,应成为世界各国尤其是发展中国家的一个优先研究领域。该文就近年来青少年生殖健康干预效果评价做一综述,以对我国青少年性教育与生殖健康服务工作提出借鉴性建议。     

临夏青少年性与生殖健康服务普及与评价

目的:了解临夏青少年对性与生殖健康知晓情况及服务利用情况,以便进一步为青少年提供性与生殖健康适宜的服务方式和途径。方法:在临夏各地区运用整群抽样法,选取校内外15~22岁男女青少年共210名接受问卷调查。结果:青少年性与生殖健康知识缺乏,生殖健康服务及利用不足。结论:应通过多种途径积极开展青少年性与生殖健康服务,青少年性与生殖健康知识水平有待进一步提高。     

我国青少年性与生殖健康研究进展

青少年性与生殖健康问题已成为一个不容忽视的严峻问题,通过对青少年性与生殖健康知识、态度及行为等现状,性与生殖健康相关问题,性与生殖健康服务的研究,探讨适合中国传统文化和国情的青春期健康教育模式,利用现有资源向青少年提供性与生殖健康教育和服务.     

未婚流动青少年生殖健康教育现状、挑战及发展

从未婚流动青少年生殖健康教育需求的视角探讨当前面向未婚流动青少年性与生殖健康教育的现状、挑战及发展方向。中国流动青少年对性与生殖健康教育的需求表现为：内容的广泛性、途径多样性和教育/咨询环境的私密性。当前的挑战主要包括：家庭性与生殖健康观念和知识传输基本功能缺失;农村学校性与生殖健康教育阵地沦陷;社会环境从“谈性色变”到“性开放”的强烈冲击。需从加大政策保障执行力度,在青少年学前和在学期间发挥家庭和父母在性与生殖健康教育中的积极作用,确保青少年在义务教育阶段获得以生活技能为基础的综合化性教育,青年人的性与生殖健康促进要同就业、保健、教育及反暴力等干预相结合4个方面积极应对挑战。     

亲青服务在社区

社区开展青少年性与生殖健康教育服务，是青少年健康成长的需要，也是计划生育协会工作以人为本满足群众对生殖健康的需要的体现。黄浦区以学校、家庭和社区互动开展青春健康教育，提高社会对青少年接受性与生殖健康教育的认同感；以亲青服务增强青少年人口意识、人生观和价值观，努力营造青少年生殖健康的良好氛围。     

江苏省沛县高级中学青春期健康现状调查分析

2000年10月,中国计生协与美国适宜卫生组织达成为期五年的合作协议,在全国12个城市和2个县开展"促进中国青少年性与生殖健康"国际合作项目(简称"青春健康"项目),江苏省沛县青少年是两个农村试点县之一.在当前青少年性与生殖健康问题突出的形势下,社会对其相关研究,教育和服务却相对空白.     

我国青少年生殖健康政策回顾和发展趋势分析

目的：回顾我国青少年生殖健康政策,分析其发展趋势,为完善相关政策体系提供依据。方法：采用社会学内容分析法,对政策内容进行比较分析。对决策者进行定性访谈,采用主体框架方法对资料进行分析。结果：解放后,我国共颁布了青少年生殖健康相关政策140条,其中包括相关权利政策9条、教育政策116条、服务政策8条和未婚青年流动人口政策7条。1996年之前性与生殖健康教育相关政策的发文数量波动在1-3条／年,其他3类政策的发文数量为0。此后青少年生殖健康相关政策的发文数量呈平稳上升趋势。国际环境、决策层的主流观念及社会变迁等因素都影响了政策的内容和数量。结论：我国青少年生殖健康政策体系建设需要出台专项政策,完善现有的相关教育政策体系,通过政策和财政支持促进青少年对性与生殖健康服务的可及性,关注未婚青年流动人口的权益保障,倡导长效的多部门合作机制。     

中国青年的性与生殖健康问题亟待纳入政策议程

自20 世纪90年代中叶以来,中国促进和保护青年性与生殖健康的社会支持性环境已大 为改观,但生活在社会经济加速转型期的“80 后”和“90 后”青年,却面临越来越多的性生理、性心理及社 会适应的困扰。由于缺乏来自学校、家庭和社会的正规教育与正确引导,未婚青年性和生殖健康知识的匮 乏与性观念开放及性行为的普遍化之间形成了鲜明的反差,性活跃的男女青年因而不可避免面临诸多前 所未有的威胁和挑战。更令人忧虑的是,现有的性与生殖信息、教育及服务的供给远远滞后于青年特别是 青少年日益多元化及复杂化的需求。这一切都呼唤中国政府直面现实,不失时机地将青年的性与生殖健 康问题列为公共卫生的优先领域并列入国家公共政策的重要议程。     

北京市某区高中生性与生殖健康知识、态度与行为调查研究

目的了解高中生关于性与生殖健康的知识、态度和行为状况,及知识来源和服务需求．为卫生服务机构制定相应的青少年性与生殖健康服务内容及健康教育形式提供依据。方法对636名高中生进行不记名自填式问卷调查。结果被调查高中生时青春期性发育及艾滋病相关知识知晓度较高;男生对边缘性行为及性行为袁示赞同者的比例高于女生．且性行为发生率明显高于女生;有关性与生殖健康知识来源依次为纸质媒体、学校和网络。被调查高中生对心理咨询、青春期疾病的检查与治疗以及青春期生殖健康保健咨询服务需求程度较高。结论应重视学生生殖健康知识教育,对目前部分高中生存在性行为给予正确的引导,卫生服务机构应提供专业服务及咨询工作,使青少年能够得到更专业、更适合的服务。     

中学生家长对青春期性与生殖健康服务的需求调查

目的:了解家长对青春期性与生殖健康服务的需求,为探索适宜的青春期保健服务提供建议和依据。方法:采用随机整群抽样的方法选取中学生家长进行匿名问卷调查。结果:①自我评价:57.85%的家长认为自身的性教育能力欠缺,包括教育技巧缺乏(52.17%)、性相关知识缺乏(36.68%)和缺乏沟通和信任(31.30%);②服务需求:母亲对青春期性与生殖健康服务的需求(50.7%)比父亲(42.3%)更高;56.57%的家长希望通过影像资料学习性教育的知识和技巧,其次为讲座(48.27%)和书本(46.94%);75.99%的家长支持建立专门为青少年提供性教育服务的咨询和服务点。结论:加强宣传,及早开展家长对青春期性教育能力培训;促进多部门合作,开展针对青少年的综合性友好服务,保障青少年健康。     

Reproductive and sexual health education for adolescents in Bangladesh: parents' view and opinion

This study attempted to find out whether parents in Bangladesh considered it important to provide reproductive and sexual health education to their adolescent children. It investigated possibilities of making parents play effective role models in educating their children on reproductive and sexual health. Findings suggest considerable positive attitude of parents toward adolescent reproductive health education, including a positive environment for introducing reproductive and sexual health education in schools. Nevertheless, findings also revealed a serious lack of knowledge among parents on basic understanding of reproductive and sexual health matters. Some parents also had reservations about educating their children on these matters. Making parents more aware of reproductive and sexual health matters and developing their communication skill to talk to their children along with in-school education for adolescents should be given high priority in Bangladesh.     

Adolescent girls, illegal abortions and "sugar-daddies" in Dar es Salaam: vulnerable victims and active social agents

Adolescent girls' early sexual activity, early pregnancy, induced abortions and the increase in HIV infections have become major concerns in Sub-Saharan Africa. Efforts, though, to understand their sexual behaviour and to prevent reproductive health problems are almost non-existent. Adolescent girls are normally seen as victims and easy preys of (often older and married) men's sexual exploitation. This article, which is based on a qualitative study of 51 adolescent girls who had just had an illegal abortion in Dar es Salaam, Tanzania, reveals that these girls are not only victims but also willing preys and active social agents engaging in high-risk sexual behaviour. In order to get material benefits they expose themselves to serious health risks, including induced abortion - without realising their own vulnerability. In our study, one out of four girls had more than one partner at the time they became pregnant, and many counted on an illegally induced abortion if they got pregnant. Even if adolescents are now allowed free access to family planning information, education and services, our study shows that this remains in the realm of theory rather than practice. Moreover, most adolescent girls are not aware about their right to such services. The paper concludes that the vulnerability of adolescent girls increases without the recognition that sexuality education and contraceptive services do not constitute a licence to practice illicit sex - but rather a means to create more mature and responsible attitudes and to increase sexual and reproductive health.     

Adolescent girls, illegal abortions and “sugar-daddies” in Dar es Salaam: vulnerable victims and active social agents

Adolescent girls’ early sexual activity, early pregnancy, induced abortions and the increase in HIV infections have become major concerns in Sub-Saharan Africa. Efforts, though, to understand their sexual behaviour and to prevent reproductive health problems are almost non-existent. Adolescent girls are normally seen as victims and easy preys of (often older and married) men's sexual exploitation. This article, which is based on a qualitative study of 51 adolescent girls who had just had an illegal abortion in Dar es Salaam, Tanzania, reveals that these girls are not only victims but also willing preys and active social agents engaging in high-risk sexual behaviour. In order to get material benefits they expose themselves to serious health risks, including induced abortion — without realising their own vulnerability. In our study, one out of four girls had more than one partner at the time they became pregnant, and many counted on an illegally induced abortion if they got pregnant. Even if adolescents are now allowed free access to family planning information, education and services, our study shows that this remains in the realm of theory rather than practice. Moreover, most adolescent girls are not aware about their right to such services. The paper concludes that the vulnerability of adolescent girls increases without the recognition that sexuality education and contraceptive services do not constitute a licence to practice illicit sex — but rather a means to create more mature and responsible attitudes and to increase sexual and reproductive health.     

Sexual and reproductive health in HIV-related proposals supported by the Global Fund to Fight AIDS, Tuberculosis and Malaria

Objective

To assess the sexual and reproductive health interventions included by countries in HIV-related proposals approved by the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund).

Methods

We examined the Global Fund database for elements and indicators of sexual and reproductive health in all approved HIV-related proposals (214) submitted by 134 countries, from rounds 1 to 7, and in an illustrative sample of 35 grant agreements.

Findings

At least 70% of the HIV-related proposals included one or more of the four broad elements: sexual and reproductive health information, education and communication; condom promotion/distribution; diagnosis and treatment of sexually transmitted infections; and prevention of mother-to-child transmission of HIV. Between 20% and 30% included sexual health counselling, gender-based violence, and the linking of voluntary counselling and testing for HIV with sexual and reproductive health services. Less than 20% focused on adolescent sexual and reproductive health, the rights and needs of people living with HIV, or safe abortion services. All these elements were rarely featured, if at all, in the grant agreements reviewed. Overall, however, sexual and reproductive health indicators did appear in most HIV-related proposals and in more than 80% of the grant agreements.

Conclusion

Country coordinating mechanisms and national-level stakeholders see in funding for sexual and reproductive health a means to address the problem of HIV infection in their respective national settings. However, we highlight some missed opportunities for linking HIV and sexual and reproductive health services.     

Sexual and reproductive health and rights of adolescent girls: Evidence from low- and middle-income countries

This paper reviews the evidence on sexual and reproductive health and rights (SRHR) of adolescent girls in low-income and middle-income countries (LMIC) in light of the policy and programme commitments made at the International Conference on Population and Development (ICPD), analyses progress since 1994, and maps challenges in and opportunities for protecting their health and human rights. Findings indicate that many countries have yet to make significant progress in delaying marriage and childbearing, reducing unintended childbearing, narrowing gender disparities that put girls at risk of poor SRH outcomes, expanding health awareness or enabling access to SRH services. While governments have reaffirmed many commitments, policy development and programme implementation fall far short of realising these commitments. Future success requires increased political will and engagement of young people in the formulation and implementation of policies and programmes, along with increased investments to deliver at scale comprehensive sexuality education, health services that are approachable and not judgemental, safe spaces programmes, especially for vulnerable girls, and programmes that engage families and communities. Stronger policy-making and programming also require expanding the evidence on adolescent health and rights in LMICs for both younger and older adolescents, boys and girls, and relating to a range of key health matters affecting adolescents.