巴基斯坦国内移民与女性生殖和孕产保健利用情况：来自最近一次全国调查的证据。
Internal migration and utilization of reproductive and maternity care among women in Pakistan: evidence from a recent National Survey.
机构信息
Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
Section Global Health and Rehabilitation, Western Norway University of Applied Sciences, Bergen, Norway.
出版信息
Front Public Health. 2023 Apr 21;11:1138898. doi: 10.3389/fpubh.2023.1138898. eCollection 2023.
BACKGROUND
During the last decades, migratory behavior has had a key role in population growth and redistribution in Pakistan. Migration has far-reaching socioeconomic implications for individuals and society at large that could influence the health integrity of Pakistani women. This study aimed to describe the migration patterns and drivers as well as their association with adequate access to reproductive and maternal care among married Pakistani women aged 15-49.
METHODS
The data from the 2017-18 Pakistan Demographic Health Survey (PDHS) was used to extract the information on the explanatory (sociodemographic and migration backgrounds) and outcome variables (unmet needs for family planning, adequate antenatal care, and delivery at health facilities). Bivariate and multivariate logistic regression analyses were employed to examine the relationship between these explanatory and outcome variables before and after adjustment for sociodemographic inequalities.
RESULTS
In unadjusted models, the odds of having adequate ANC and delivery at health facilities were approximately 2 to 4 times higher in those living (urban non-migrant), moving to (urban to urban, rural to urban), or leaving the urban areas (rural to urban) as compared to rural non-migrants; likewise, the odds of the unmet needs for family planning was about 20-50% lower in the same migration streams compared to rural non-migrant. However, after adjustment for sociodemographic inequalities, most of these associations attenuated and only the association of urban to urban migration with unmet needs for family planning and the association of urban non-migrant with delivery at health facilities remained significant.
CONCLUSION
Although the findings suggest that Internal migration flows, particularly those to urban areas (urban to urban and rural to urban), could be associated with better access to reproductive and maternity care among married Pakistani women aged 15-49 years; adjustment for sociodemographic inequalities, particularly education and wealth, nullified this association to a great extent. This has important implications for current policies and interventions in Pakistan and calls for policy reform and women's rights advocacy to enhance the literacy level of young Pakistani girls through well-tailored interventions, maintaining them at school.
背景
在过去几十年中，迁移行为在巴基斯坦的人口增长和重新分布中发挥了关键作用。迁移对个人和整个社会都有着深远的社会经济影响，可能会影响巴基斯坦妇女的健康状况。本研究旨在描述迁移模式和驱动因素，以及它们与已婚 15-49 岁巴基斯坦妇女获得适当生殖和孕产妇保健之间的关联。
方法
本研究使用 2017-18 年巴基斯坦人口与健康调查（PDHS）的数据，提取有关解释变量（社会人口学和迁移背景）和结果变量（计划生育需求未得到满足、充分的产前保健和在卫生机构分娩）的信息。采用单变量和多变量逻辑回归分析，在调整社会人口学不平等因素之前和之后，检查这些解释变量与结果变量之间的关系。
结果
在未调整的模型中，与农村非移民相比，居住在（城市非移民）、迁移到（城市到城市、农村到城市）或离开城市地区（农村到城市）的人获得充分的 ANC 和在卫生机构分娩的几率大约高出 2 到 4 倍；同样，在同一迁移流中，计划生育需求未得到满足的几率比农村非移民低 20-50%。然而，在调整社会人口学不平等因素后，这些关联大多减弱，只有城市到城市迁移与计划生育需求未得到满足之间的关联以及城市非移民与在卫生机构分娩之间的关联仍然显著。
结论
尽管调查结果表明，内部迁移流动，特别是流向城市地区（城市到城市和农村到城市），可能与已婚 15-49 岁巴基斯坦妇女获得更好的生殖和孕产妇保健有关；但社会人口学不平等因素（特别是教育和财富）的调整在很大程度上消除了这种关联。这对巴基斯坦当前的政策和干预措施具有重要意义，并呼吁政策改革和妇女权利倡导，通过量身定制的干预措施提高年轻巴基斯坦女孩的识字水平，让她们留在学校。
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