• Journal of Preventive Medicine and Public Health
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• 제20권1호
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• pp.165-203
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• 1987

This project was a service-cum-research effort with a quasi-experimental study design to examine the health benefits of an integrated Family Planning (FP)/Maternal & Child health (MCH) Service approach that provides crucial factors missing in the present on-going programs. The specific objectives were: 1) To test the effectiveness of trained nurse/midwives (MW) assigned as change agents in the Health Sub-Center (HSC) to bring about the changes in the eight FP/MCH indicators, namely; (i)FP/MCH contacts between field workers and their clients (ii) the use of effective FP methods, (iii) the inter-birth interval and/or open interval, (iv) prenatal care by medically qualified personnel, (v) medically supervised deliveries, (vi) the rate of induced abortion, (vii) maternal and infant morbidity, and (viii) preinatal & infant mortality. 2) To measure the integrative linkage (contacts) between MW & HSC workers and between HSC and clients. 3) To examine the organizational or administrative factors influencing integrative linkage between health workers. Study design; The above objectives called for quasi-experimental design setting up a study and control area with and without a midwife. An active intervention program (FP/MCH minimum 'package' program) was conducted for a 2 year period from June 1982-July 1984 in Seosan County and 'before and after' surveys were conducted to measure the change. Service input; This study was undertaken by the Soonchunhyang University in collaboration with WHO. After a baseline survery in 1981, trained nurses/midwives were introduced into two health sub-centers in a rural setting (Seosan county) for a 2 year period from 1982 to 1984. A major service input was the establishment of midwifery services in the existing health delivery system with emphasis on nurse/midwife's role as the link between health workers (nurse aids) and village health workers, and the referral of risk patients to the private physician (OBGY specialist). An evaluation survey was made in August 1984 to assess the effectiveness of this alternative integrated approach in the study areas in comparison with the control area which had normal government services. Method of evaluation; a. In this study, the primary objective was first to examine to what extent the FP/MCH package program brought about changes in the pre-determined eight indicators (outcome and impact measures) and the following relationship was first analyzed; b. Nevertheless, this project did not automatically accept the assumption that if two or more activities were integrated, the results would automatically be better than a non-integrated or categorical program. There is a need to assess the 'integration process' itself within the package program. The process of integration was measured in terms of interactive linkages, or the quantity & quality of contacts between workers & clients and among workers. Intergrative linkages were hypothesized to be influenced by organizational factors at the HSC clinic level including HSC goals, sltrurture, authority, leadership style, resources, and personal characteristics of HSC staff. The extent or degree of integration, as measured by the intensity of integrative linkages, was in turn presumed to influence programme performance. Thus as indicated diagrammatically below, organizational factors constituted the independent variables, integration as the intervening variable and programme performance with respect to family planning and health services as the dependent variable: Concerning organizational factors, however, due to the limited number of HSCs (2 in the study area and 3 in the control area), they were studied by participatory observation of an anthropologist who was independent of the project. In this observation, we examined whether the assumed integration process actually occurred or not. If not, what were the constraints in producing an effective integration process. Summary of Findings; A) Program effects and impact 1. Effects on FP use: During this 2 year action period, FP acceptance increased from 58% in 1981 to 78% in 1984 in both the study and control areas. This increase in both areas was mainly due to the new family planning campaign driven by the Government for the same study period. Therefore, there was no increment of FP acceptance rate due to additional input of MW to the on-going FP program. But in the study area, quality aspects of FP were somewhat improved, having a better continuation rate of IUDs & pills and more use of effective Contraceptive methods in comparison with the control area. 2. Effects of use of MCH services: Between the study and control areas, however, there was a significant difference in maternal and child health care. For example, the coverage of prenatal care was increased from 53% for 1981 birth cohort to 75% for 1984 birth cohort in the study area. In the control area, the same increased from 41% (1981) to 65% (1984). It is noteworthy that almost two thirds of the recent birth cohort received prenatal care even in the control area, indicating that there is a growing demand of MCH care as the size of family norm becomes smaller 3. There has been a substantive increase in delivery care by medical professions in the study area, with an annual increase rate of 10% due to midwives input in the study areas. The project had about two times greater effect on postnatal care (68% vs. 33%) at delivery care(45.2% vs. 26.1%). 4. The study area had better reproductive efficiency (wanted pregancies with FP practice & healthy live births survived by one year old) than the control area, especially among women under 30 (14.1% vs. 9.6%). The proportion of women who preferred the 1st trimester for their first prenatal care rose significantly in the study area as compared to the control area (24% vs 13%). B) Effects on Interactive Linkage 1. This project made a contribution in making several useful steps in the direction of service integration, namely; i) The health workers have become familiar with procedures on how to work together with each other (especially with a midwife) in carrying out their work in FP/MCH and, ii) The health workers have gotten a feeling of the usefulness of family health records (statistical integration) in identifying targets in their own work and their usefulness in caring for family health. 2. On the other hand, because of a lack of required organizational factors, complete linkage was not obtained as the project intended. i) In regards to the government health worker's activities in terms of home visiting there was not much difference between the study & control areas though the MW did more home visiting than Government health workers. ii) In assessing the service performance of MW & health workers, the midwives balanced their workload between 40% FP, 40% MCH & 20% other activities (mainly immunization). However, $85{\sim}90%$ of the services provided by the health workers were other than FP/MCH, mainly for immunizations such as the encephalitis campaign. In the control area, a similar pattern was observed. Over 75% of their service was other than FP/MCH. Therefore, the pattern shows the health workers are a long way from becoming multipurpose workers even though the government is pushing in this direction. 3. Villagers were much more likely to visit the health sub-center clinic in the study area than in the control area (58% vs.31%) and for more combined care (45% vs.23%). C) Organization factors (admistrative integrative issues) 1. When MW (new workers with higher qualification) were introduced to HSC, it was noted that there were conflicts between the existing HSC workers (Nurse aids with less qualification than MW) and the MW for the beginning period of the project. The cause of the conflict was studied by an anthropologist and it was pointed out that these functional integration problems stemmed from the structural inadequacies of the health subcenter organization as indicated below; i) There is still no general consensus about the objectives and goals of the project between the project staff and the existing health workers. ii) There is no formal linkage between the responsibility of each member's job in the health sub-center. iii) There is still little chance for midwives to play a catalytic role or to establish communicative networks between workers in order to link various knowledge and skills to provide better FP/MCH services in the health sub-center. 2. Based on the above findings the project recommended to the County Chief (who has power to control the administrative staff and the technical staff in his county) the following ; i) In order to solve the conflicts between the individual roles and functions in performing health care activities, there must be goals agreed upon by both. ii) The health sub·center must function as an autonomous organization to undertake the integration health project. In order to do that, it is necessary to support administrative considerations, and to establish a communication system for supervision and to control of the health sub-centers. iii) The administrative organization, tentatively, must be organized to bind the health worker's midwive's and director's jobs by an organic relationship in order to achieve the integrative system under the leadership of health sub-center director. After submitting this observation report, there has been better understanding from frequent meetings & communication between HW/MW in FP/MCH work as the program developed. Lessons learned from the Seosan Project (on issues of FP/MCH integration in Korea); 1) A majority or about 80% of the couples are now practicing FP. As indicated by the study, there is a growing demand from clients for the health system to provide more MCH services than FP in order to maintain the achieved small size of family through FP practice. It is fortunate to see that the government is now formulating a MCH policy for the year 2,000 and revising MCH laws and regulations to emphasize more MCH care for achieving a small size family through family planning practice. 2) Goal consensus in FP/MCH shouBd be made among the health workers It administrators, especially to emphasize the need of care of 'wanted' child. But there is a long way to go to realize the 'real' integration of FP into MCH in Korea, unless there is a structural integration FP/MCH because a categorical FP is still first priority to reduce the rate of population growth for economic reasons but not yet for health/welfare reasons in practice. 3) There should be more financial allocation: (i) a midwife should be made available to help to promote the MCH program and coordinate services, (in) there should be a health sub·center director who can provide leadership training for managing the integrated program. There is a need for 'organizational support', if the decision of integration is made to obtain benefit from both FP & MCH. In other words, costs should be paid equally to both FP/MCH. The integration slogan itself, without the commitment of paying such costs, is powerless to advocate it. 4) Need of management training for middle level health personnel is more acute as the Government has already constructed 90 MCH centers attached to the County Health Center but without adequate manpower, facilities, and guidelines for integrating the work of both FP and MCH. 5) The local government still considers these MCH centers only as delivery centers to take care only of those visiting maternity cases. The MCH center should be a center for the managment of all pregnancies occurring in the community and the promotion of FP with a systematic and effective linkage of resources available in the county such as i.e. Village Health Worker, Community Health Practitioner, Health Sub-center Physicians & Health workers, Doctors and Midwives in MCH center, OBGY Specialists in clinics & hospitals as practiced by the Seosan project at primary health care level.

• 국제지역연구
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• 제22권1호
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• pp.215-235
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• 2018

출산율 제고에 대한 정책적 고민은 OECD국가들의 공통된 관심사일 뿐 아니라 세계 최하위인 출산율을 기록하고 있는 한국의 최대 관심사이기도 하다. 많은 국가 예산을 투입해왔고 출산율 관련 여러 연구들이 진행되어 왔음에도 불구하고 한국의 출산율은 계속 감소 추세이다. 따라서 본 연구는 기존 출산율 연구에서 다루어져 왔던 출산율에 영향을 주는 세부적 요인들의 영향력 및 효과성 검증과 유럽 선진국가들의 사례를 통한 정책적 접근의 문제점을 인지하고 출산율과 삶의 질에 관한 거시적이고 구조적 접근을 통해 전체적 흐름을 다시 파악하고자 함에 그 목적이 있다. 즉 선진국의 높은 삶의 질은 출산율을 높이는지, 삶의 질과 출산율이 모두 높은 국가 모델은 어느 나라이며 그 나라의 출산에 대한 사회 및 정책적 흐름은 어떠한지를 살펴보았다. OECD국가들의 삶의 질 요인(BLI)와 CIA출산율 자료를 이용하여 분석한 결과, 삶의 질 수준이 높은 국가 중에도 출산율이 낮은 국가가 많다는 사실을 확인할 수 있었다. 그러나 삶의 질 수준과 출산율이 모두 높은 국가가 한국이 지향해야 할 국가 모델임을 인지하고 본 연구에서 새로 도출된 아이슬란드, 아일랜드, 뉴질랜드의 사례와 삶의 질 수준은 높지만 출산율이 낮은 독일의 사회적 특성을 비교해 본 결과 앞의 세 나라는 양성평등에 대한 인식 수준이 높게 나타났고 그 결과로 성별에 따른 임금 차이는 낮게 나타났음을 확인하였다. 반면에 독일의 경우는 성별에 따른 임금 불평등이 비교적 더 크게, 출산율은 더 낮게 나타남으로써 양성평등을 위한 인식전환이 출산율에 주요한 영향을 미치고 있음을 확인했다. 부모- 자식 간의 '상승관계(synergy)' 에 기초하여 가정 및 노동시장에서 양성평등 의식을 고양하는 것이 정책의 최우선 순위가 되고, 여타의 삶의 질을 높이는 요소를 적극 활용하여야 한다는 결론을 도출하였다. 즉 출산율 정책의 우선순위와 인프라적 지원을 동시에 추진하기 위해 국가의 출산율 목표를 '임신 가용한 여성의 출산율 제고'에서 '국민이 행복한 사회를 만드는 것' 으로 재설정하여 행복한 사회가 되어가는 과정에서 스스로 출산을 결정할 수 있는 시스템을 만들어야 할 것이다.

• Journal of Nutrition and Health
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• 제49권3호
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• pp.179-188
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• 2016

본 연구는 광주광역시에 거주하는 결혼이주여성 92명을 대상으로 하여 사회경제적 특징과 건강, 식생활 실태를 조사하여 결혼이주 여성의 식생활과 이에 영향을 미치는 요인을 분석하기 위해 수행되었다. 본 조사에 응한 결혼이주여성의 평균 연령은 31.3세, 한국에서의 평균 거주기간은 5.5년이었으며, 출신국은 베트남 56%, 중국 26%, 필리핀 12%, 기타 국가 12% 등이었다. 가장 많이 앓고 있는 질병은 소화기계 질환, 빈혈, 신경계 질환 순이었고, 만성 성인병 유병률은 낮은 편이었다. 조사대상자의 체위를 살펴보면, 현재 평균 체중은 54 kg으로서, 한국으로 이주할 때 체중과 비교하면 평균 3.8 kg 증가하였으며, BMI $25kg/m^2$를 기준으로 비만한 조사대상자는 17%였다. 식품을 구입할 때 가장 중요하게 생각하는 것은 영양적 가치, 건강, 식품에 대한 기호도 순으로 건강에 관심이 높았으며, 식품에 대한 정보는 인터넷 37.0%, 가족 28.3%, TV 또는 라디오 27.2% 순으로 스마트폰 사용이 일반화되어 인터넷을 통한 정보습득이 가장 많았다. Mini dietary assessment로 판정한 식습관점수는 5점 만점 기준에 3.45이었으며, 유제품 섭취, 단백질 섭취, 규칙적 식사, 골고루 섭취하기 등에서 점수가 낮은 경향을 나타냈으나, 지방이 많은 음식이나 동물성 지방, 튀긴 음식, 당이나 탄산음료도 적게 섭취하였다. 조사대상자의 식습관 변화정도를 살펴보면, 한국으로 이주 후 식습관이 많이 변했다고 응답한 조사대상자는 33.7%였으며, 식습관 변화 내용으로는 식품섭취 증가와 관련되었으며, 특히 과일과 채소의 섭취가 증가하였다고 응답하였다. 조사대상자의 거주 기간이 BMI, 허리둘레와 유의적으로 양의 상관관계 있었으며, 거주 기간별로 비만, 질병 유병, 식습관 변화 정도를 살펴본 결과, 유의적인 차이는 없었으나, 거주기간이 5년 이상인 그룹이 5년 미만인 그룹에 비해 식습관이 많이 변하고 비만율이 증가하였으나 질병은 감소하는 경향을 나타냈다. 본 연구 결과에서는 거주기간과 질병 유병률이 역의 관계가 있는 것으로 보고되었으나, 이는 본 조사대상자의 한국 평균 거주기간이 비교적 짧아 한국 문화에 대한 적응단계가 이행단계와 관계되는 것으로 생각된다. 결혼이주 여성의 식생활 적응 및 바람직한 식습관 형성은 결혼이주 여성 뿐 만 아니라 이들이 속하고 책임지고 있는 다문화 가정의 건강에도 중요한 영향을 미칠 것으로 사료되어 결혼이주 여성에 대한 장기적이고 다양한 연구와 교육이 필요할 것이다.