加强母婴保健监督全面实施卫生监督综合执法

  目的  分析京沪妇女保健法律体系的强制力及其变迁情况，阐明法律体系强制力对妇女保健工作的作用，并探索对其进行量化评价的方法。  方法  系统收集京沪两地所有涉及妇女保健工作的法律文件，根据法律责任条款覆盖主要部门（机构）的情况和其明确情况，综合计算妇女保健法律体系刚性约束程度，并运用Spearman相关、线性回归等分析其与孕产妇死亡率之间的关系。  结果  两地妇女保健法律体系的刚性约束程度逐渐提升，均从1990年的0提升至2017年的44.4 %，但对关键支撑部门的强制力不足;两地法律体系的刚性约束程度与孕产妇死亡率呈负相关（相关系数分别为 – 0.640和 – 0.788）。上海法律体系的刚性约束程度的提升对孕产妇死亡率变化的解释程度高于北京（上海64.4 %，北京44.6 %）。  结论  法律体系应当对妇女保健工作各方有刚性的约束作用；京沪妇女保健法律体系的强制力正逐步提升；上海法律体系的强制力对妇女保健工作的规范作用强于北京，但两地均需明确关键支撑部门的法律责任，并在执法中落实法律的强制力；本研究对法律体系强制力的量化方法科学可行。

Public health law: power,duty, restraint

  Objective  To analyze the enforceability of maternal health care-related law system and its variation in Beijing and Shanghai municipality and to explore the effect of the enforceability on maternal health care services and quantitative method to evaluate the enforceability.  Methods  We systematically collected all normative legal documents related to maternal health care issued by municipal administrations of the two cities. The rigid constraint of the legal documents was quantitatively assessed by identifying responsible governmental agencies designated by the documents and penalty for illegal acts specified in the documents. Spearman correlation and linear regression were used to analyze the relationship between the enforceability of the legal documents and the maternal mortality in the two cities.  Results  The overall proportion of the legal documents with enforceability increased gradually from 0 in 1990 to 44.4% in 2017 but the enforceability to key responsible departments was not strong enough in the two cities. Significant correlations between the degree of the legal documents′ enforceability and the vairations in maternal mortality were observed, with the correlation coefficients of – 0.640 for Beijing and – 0.788 for Shanghai, respectively. The ratio of variation in maternal mortality which could be explained by the enforceability of the legal documents was higher in Shanghai than that in Beijing (64.4% vs. 44.6%).  Conclusion  The law system should have a rigid constraint on all aspects of maternal health care. The enforceability of legal documents related to maternal health care have been gradually improved in Beijing and Shanghai the effect of the improvement in the enforceability is greater in Shanghai than that in Beijing. The study result indicates that the quantitative evaluation method is feasible in assessing the enforceability of maternal health care-related law system.