摘要：
目的 描述中国住院分娩率的变化趋势,并探讨国家相关政策对住院分娩率的影响.方法 总活产数和住院分娩活产数来自全国妇幼卫生年报,相关政策来自官方网站.根据政策调整,将年份分为降消项目实施前(1996至1999年)、降消项目实施期(2000至2008年)和后降消项目期(2009至2015年).结果 20年间纳入分析的总活产数为244 398 010,住院分娩活产数211 605 727.住院分娩率由1996年58.7%(6 309 255/10 739 816)升至2015年99.7%(13 583 658/13 626 948),年均增长率2.8%.期间,经济地区别和城乡别住院分娩率也同步上升且差距逐年缩小至近于消失.在降消项目实施期和后降消项目期,农村住院分娩率上升速度均快于城市,中、西部快于东部.到2015年所有省份住院分娩率均接近或达到100%,仅西藏和青海略低;然而,从区县来看尚有112个区县不足96%,其中39个不足80% 的区县分布在4个西部省份(西藏、四川、青海和新疆).结论 中国住院分娩率20年来逐年上升,提前达到2020年目标(98%),地区和城乡差别近于消失.在全面放开二孩政策背景下,宜巩固成绩、关注复杂妊娠,着重提升住院分娩服务能力和质量;对于住院分娩率依旧偏低的少数西部区县,宜继续强化倾斜政策,探索精准卫生帮扶模式,以共享社会发展成果.%Objective To describe the secular trends of institutional delivery (ID) rate in China from 1996 to 2015,and to assess the impacts of national health policies on the ID rate.Methods Data on the number of live births and IDs for districts/counties in 31 provinces of China was annually collected by the Office for National Maternal & Child Health Statistics of China.Information concerning the relevant policies was from official governmental websites,including the programme to reduce maternal mortality and eliminate neonatal tetanus (2000 to 2008),and ID subsidy programme in rural China (2009 to present).According to the programme to reduce maternal mortality and eliminate neonatal tetanus,the calendar years were categorized into three periods: pre-programme period (1996 to 1999),programme implementation period (2000 to 2008) and post-programme period (2009 to 2015).Results A total of 244 398 010 live births were included in the analysis,in which 211 605 727 were delivered in institutions.During the 20 years,the ID rate steadily increased from 58.7% (6 309 255/10 739 816) in 1996 to 99.7% (13 583 658/13 626 948) in 2015,with a compound annual growth rate of 2.8%.Analyses stratified by economic regions or urban-rural areas showed notably consistent increases in ID rates,and the regional and urban-rural differences became nearly disappeared by 2015.The largest regional difference between East (71.6%,2 540 896/3 547 423) and West (44.6%,1 675 305/3 752 873) was 27% in 1996 and <1% in 2015 (East 99.9%[5 177 865/5 180 636]and West 99.0%[3 925 766/3 964 622]).The urban-rural difference was 22.7% in 1996 (urban 73.5%[2 756 531/3 748 703],rural 50.8%[3 552 724/6 991 113]) and 0.4% in 2015(urban 99.9%[6 257 853/6 262 763],rural 99.5%[7 325 805/7 364 185]).During the programme implementation period and the post-programme period,the ID rates in rural area increased faster than those in urban area,and the corresponding compound annual growth rates in rural area were 2.4 and 2.8 times of those in urban area;the ID rates in Middle and West regions increased faster than those in East region,and the corresponding compound annual growth rates in West region were 3.6 and 6.3 times of those in East region.By 2015,the ID rates in all provinces other than Tibet (90.5%[48 445/53 505]) and Qinghai (97.2%[60 836/62 600]) reached or were close to 100%.However,there were still 112 districts/counties with ID rates <96%,of which 39 with ID rates <80%;the 39 districts/counties were all located in four western provinces (Tibet 19,Sichuan 15,Qinghai 3,and Xinjiang 2).Conclusions During the past 20 years,the ID rate in China has steadily increased and achieved the goal of the year 2020 ahead of schedule;the regional and urban-rural inequality in ID has nearly disappeared.Given universal two-child policy,it is of significance to strengthen existing achievements,focus on complicated pregnancies and comprehensively improve the capability and quality of ID services;meanwhile,it is also of significance to develop particular policies and explore the medical-aid model for the minority-inhabited western regions with lower ID rates.
