출산조절정책의 현황과 전망 (Current Status and Future Prospects of the Population Control Policy in Korea)
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- 한국인구학
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- 제11권1호
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- pp.14-31
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- 1988
The national family planning program in Korea, which was instituted as an integral part of the nation's economic development plans since 1962, has contributed greatly to a reduction in the fertility and population growth rate. The total fertility rate dipped from 6.0 births per women in 1960 to 2.0 in 1985, and the population growth rate rom 2.84 percent per year to 1.25 percent during the same period, while the contraceptive practice rate for the 15-44 married women increased from 9 percent in 1965 to 70 percent in 1985. Study findings indicate that the fertility reduction in the past 26 years is largely attributed to the virgorous implementation of the national family planning program, rising age at marriage, wide-spread use of induced abortion, and the changes in attitude regarding the value of children that came into being in the wake of the rapid socio-economic development over the period. Among the strengths of the national family planning program are the following : 1) a pluralistic system of program manageent with active participation of various government and voluntary organizations, 2) utilization of a large corps of family planning field workers to conduct face-to-face communication and motivation activities, 3) use of private physicians with government support to provide contraceptive services, 4) a systematic program management system including program planning of traget allocation, evaluation, and supervision with a broad MIS and award system, 5) numerous incentive and disincentive schemes for stimulating the small family norm and contraceptive use, and 6) strong commitments to the family planning program by political leaders. The new demographic targets during the Sixth Five-Year Economic and Social Development plan period(1987-91) have been set for a further reduction in the population growth rate to 1.0 percent by 1993, assuming that the TFR will decline to 1.75 level in 1995. This target is, however, not easy to achieve due to anticipated unfavorable factors like the strong boy preference, high discontinuation rates of reversible contraceptive methods, fertility termination-oriented contraceptive use, a plateau level of contraceptive practice rate that has mostly accounted for a sterilization, shortened length of birth intervals, and the changing patterns of contraceptive mix. The recent changes in contraceptive and fertility behaviors clearly indicate that the past quantity-oriented management system of the national program should be redirected toward a quality-oriented approach. Particularly, program efforts should be expanded to recruit new contraceptive users in the 20s of younger age groups, both for birth spacing and controlling their fertility since the women aged 20 to 29 account for more than 80 percent of the total annual births in recent years. In addition, the current contraceptive fee system of the national family planning program should be gradually shifted from free contraceptive services to a acceptor's charge system, and the provision of contraceptive services through the medical insurance system, which will cover the entire population by 1989, should be accelerated as a means of integration of family planning program with other health programs.
This study aimed at developing a desirable family planning policy and strategy by examining the current status of family planning practice in rural Korea and by indentifying the crucial factors which affect fertility control behavior. For this purpose, an analytical study was conducted, using the survey data collected in July 1985, on an interview basis, on 1, 440 married women living in the Soyi, Wonnam and Maingdong townships of Eumseong County(in North Chungcheong Province). This study population has the typical characteristics of rural areas, and the results of the analysis can be summarized as follows: 1. In regard to the demographic characteristics of the study population : their average age at marriage was 23.7, they had an average of 2.6 children( 1.3 boys, 1.3 girls) :10% experienced the death of their child (ren) :14% had spontaneous abortion(s) :4% weathered stillbirth(s) :35% went through induced abortion (s) : and 5.5% were currently pregnant. The average of their ideal numbers of children was 2.2, while 44% felt that they must have a son. 2. Looking at the contact rate with medical & health institutions, over the past 1 year, the visit rate to health subcenters was 43.7%, while 26.9% visited the (county) health center :59.6% had been to private clinics : and 41.5% went to the Soonchunhyang - Eumsung hospital : thus showing a relatively high rate of accessibility. 3. The utilization rate of family planning services was 76.5%, with tubectomy being the most prominent method at 52.3%, while the informants were health workers in 54.2% of the acceptors. Of the 8.4% who discontinued the use of contraceptive methods, only 26% did so due to want for pregnancy, natural infertility (meno - pause), or other reasons, while the remaining 74% stopped usage on account of side effects, failure in the methods themselves, and inconvenience of use, thus pointing to a situation where the proper choice of family planning methods have not yet been made. It can be noted that there is a strong motivation for early birth stopping as 35.3% practice family planning even with only one child, of which 38.3% have had sterilization operations. According to results of a multiple regression analysis, among the variables affecting contraception usage the most significant variable was the number of sons. 4. 34.8% experienced induced abortions. It was shown as a result of multiple regression analysis that the number of children and attitudes toward induced abortions extensively affected their frequency of abortions conducted. 5. In the regard to the relation between family planning and induced abortions, 33.7% of the women used both, while 52.0% of them used only the former(family planning), with only 1.4 % utilizing solely the latter(abortion), and 12.9% totally abstaining from fertility regulation : again, the discriminant analysis indicated that the choice of family planning and/or induced abortion was determined by the number of children and attitudes toward induced abortion. In view of the above mentioned results, the following are some comments and suggestions concerning problems related to the current family planning policies, in Korea : 1. It is difficult to expect a further quantitative expansion in family planning program operations, as there has been an excessive supply of target-oriented sterilization operations on women. From a maternal and child health care point of view, it will be desirable to have a diversification of service points in the future where family planning methods may be properly chosen, so that choices of methods which suit the mothers' characteristics and tastes may be made by the individuals themselves by strengthening their quality of family planning information services. 2. Along with the strengthening of the qualitative improvement of family planning services policies must be implemented to effectively promote the moral (ethical) deterrents to induced abortions and to preference for sons. From a maternal care standpoint, the social permissive norm toward induced abortion must be modified, and the bias towards son must be analyzed as the women with more daughters have a lower rate of family planning acceptance. Such changes in attitudes, however, can not be hoped to be accomplished with ad hoc policies, but will only be possible when an enhancement of the women's status(within the society) is brought about in a long - term perspective.
본 연구는 노인들의 여가활동 제약요인들을 살피고, 특정 제약요인을 가진 노인들의 여가만족도를 높이기 위해서 실천적 측면에서 노인의 특성과 욕구에 기반 한 여가활동을 제안하고 정책적 지원 방안을 마련 할 목적으로 수행되었다. 노후보장패널 6차 부가조사자료를 활용하여 65세 이상 노인들 가운데 경제적 부담과 건강문제로 여가활동에 제약을 경험한다고 응답한 3167케이스를 분석하였다. 여가활동의 제약요인 집단별 여가만족도의 영향요인을 분석하기 위하여 인구사회적 특성(나이, 성별, 교육, 혼인상태, 독거여부, 지역, 적정생활비수준, 건강상태), 여가관련 변인(여가시간, 여가동기), 여가활동 변인(선호 활동, 비선호 활동)을 단계적으로 위계선형 회귀 모형에 입력하였다. 연구 결과는 다음과 같다. 첫째, 노인 여가활동의 주요한 제약원인으로는 경제적 부담과 건강 문제가 압도적으로 높았다. 둘째, 세 집단(재정취약집단, 건강취약집단, 재정+건강취약집단) 간의 여가관련 변인에서 차이가 나타났다. 여가활동 만족 수준은 재정취약집단이 가장 높게, 다음으로 건강취약집단, 재정+건강취약집단의 순서로 나타났다. 여가시간은 재정취약집단에서 가장 짧았으며, 여가동기에서는 재정취약집단에서 가족 및 주변 관계 때문이라는 응답은 높았으며, 건강유지라는 응답은 상대적으로 낮게 나타났다. 건강취약집단에서 휴식활동을, 재정취약집단에서는 오락취미 활동을, 그리고 재정+건강취약집단에서 사회활동을 선호 한다는 응답이 상대적으로 높게 나타났다. 셋째, 재정취약집단의 경우, 애완동물 돌보기 및 정원손질 같은 활동들을 선호 한다고 응답할수록 여가만족도가 높게 나타난 반면, 국내여행을 선호 한다고 대답할수록 여가만족도가 낮게 나타났다. 건강취약집단의 경우, TV 시청 및 라디오 듣기 등의 휴식활동을 선호 한다고 응답할수록 그리고, 비선호 한다고 응답할수록 모두의 경우에서 여가만족도가 낮게 나타났다. 이밖에도 종교활동 혹은 친목단체 활동과 같은 사회참여 활동을 선호 한다고 응답할수록 여가만족도가 높게 나타났다. 재정+건강취약집단의 경우, 집근처 산책 혹은 TV 시청, 국내여행 등의 활동을 여가활동으로 선호 한다고 응답한 노인일수록 여가만족도가 낮게 나타난 반면, 바둑, 장기, 체스 등의 오락 활동과 등산과 같은 취미활동, 그리고 친목단체 활동 등을 선호 한다고 응답한 노인일수록 여가만족도가 높게 나타났다. 본 연구는 노인 여가활동에 대한 전국단위의 데이터를 실증적으로 분석한 결과를 바탕으로 맞춤형 여가활동을 제안하고 정책적 지원 방안에 대한 논의를 포함하고 있다.
The levels of health knowledge, attitude and practice of housewives considerably effect to the health of households, communities and the nation. This study was designed to grasp the levels of health knowledge, attitude and practice of houswives and analyse the various factors effecting to health in order to provide health education services as well as materials for effective formulation and implementation of health policy to improve the health of the nation. This study has been conducted through interviews by trained surveyers for 4,281 housewives selected from 4,500 households throughout the country for 40 days during July 11-August 20, 1983. The results of survey were analysed by stepwise multiple regression and path analysis are summarized as follows; 1. Based on the measurement instrument applied to this study, the levels of health knowledge, attitude and practice of housewives were extremely low with 54.5 points out of 100 points in full. Higher level with 72 points and above was approximately 21 percent and lower level with 39 points and below was approx. 24 percent. The middle level was approx. 55 percent. In order to implement health programs successively, health education should be more strengthened and to improve the level of health knowledge, attitude and practice (KAP) of the nation, political consideration as a part of spiritual reformation must be concentrated on health. 2. The level of health knowledge indicated the highest points with 57.3 the level of attitude was the second with 55.0 points and the practice level was the lowest with 50.0 point. Therefore, planning and implementation of health education program must be based on the persuasion and motivation that health knowledge turn into practice. 3. Housewives who had higher level of health knowledge, showed their practice level was relatively lower and those who had middle or low level of it practice level was the reverse. 4. Correlations among health knowledge, attitude and practice (KAP) were generally higher and statistically significant at 0.1 percent level. Correlation between total health KAP level and health knowledge was the highest with r=.8092. 5. Health KAP levels showed significant differences according to the age, number of children, marital status, self-assessed health status and concern on health of the housewives interviewed (p<0.001) 6. Health KAP levels also showed significant differences according to the education level, economic status, employment before marriage and grown-up area of the housewives interviewed. (p<0.001) 7. Heath KAP levels showed significant differences according to health insurance benificiary and the existence of patients in the family. (p<0.001). 8. Health KAP levels showed significant differences according to distance to government organizations, schools, distance to health facilities, telephone possession rate, television possession rate, newspaper reading rate and activities of Ban meeting and Women's club. (p<0.001) 9. Health KAP levels showed significant differences according to electric mass communication media such as television, radio and village broadcasting etc. and printed media such as newspaper, magazine and booklets etc., IEC variables such as individual consultation and husband-wife communication, however, there was no significance with group training. 10. Health KAP of the housewives showed close correlation with personal characteristics variables, i.e., education level (r=.5302), age (r=-.3694) grown-up area (r=.3357) and employment before marriage. In general, correlation of health knowledge level was higher than the levels of attitude or practice. In case of health concern and health insurance, correlation of practice level was higher than health knowledge level. 11. Health KAP levels showed higher correlation with community environmental characteristics, Ban meeting and activity of Women's club, however, no correlation with New-village movement. 12. Among IEC variables, husband-wife communication showed the highest correlation with health KAP levels and printed media, electric mas communication media and health consultation in order. Therefore, encouragement of husband-wife communication and development of training program for men should be included in health education program. 13. Mass media such as electric mass com. and printed media were effective for knowledge transmission and husband-wife communication and individual consultation were effective for health practice. Group training was significant for knowledge transmission, however, but not significant for attitude formation or turning to health practice. To improve health KAP levels, health knowledge should be transmitted via mass media and health consultation with health professionals and field health workers should be strengthened. 14. Correlation of health KAP levels showed that knowledge level was generally higher than that of practice and recognized that knowledge was not linked with attitude or practice. 15. The twenty-five variables effecting health KAP levels of housewives had 41 per cent explanation variances among which education level had great contribution (β=.2309) and electric mass com. media (β=.1778), husband-wife communication (β=.1482), printed media, grown-up area, and distance to government organizations in order. Variances explained (R²) of health KAP were 31%, 15%, and 30% respectively. 16. Principal variables contributed to health KAP were education level (β=.12320, β=.1465), electric mass comm. media (β=.1762, β=.1839), printed media, (β=.1383, β=.1420) husband-wife communication (β=.1004, β=.1067), grown-up area and distance to government organizations, in order. Since education level contributes greatly to health KAP of the housewives, health education including curriculum development in primary, middle and high schools must be emphasized and health science must be selected as one of the basic liberal arts subject in universities. 17. Variences explained of IEC variables to health KAP were 19% in total, 14% in knowledge, 9% in attitude, and 10% in health practice. Contributions of IEC variables to health KAP levels were printed media (β=.3882), electric mass comm media (β=.3165), husb-band wife com. (β=.2095,) and consultation on health (β=.0841) in order, however, group training showed negative effect (β=-.0402). National fund must be invested for the development of Health Program through mass media such as TV and radio etc. and for printed materials such as newspaper, magazines, phamplet etc. needed for transmission of health knowledge. 18. Variables contributed to health KAP levels through IEC variables with indirect effects were education level (Ind E=0.0410), health concern (Ind E=.0161), newspaper reading rate (Ind E=.0137), TV possession rate and activity of Ban meeting in order, however, health facility showed negative effect (Ind E=-.0232) and other variables showed direct effect but not indirect effect. 19. Among the variables effecting health KAP level, education level showed the highest in total effect (TE=.2693) then IEC (TE=.1972), grown-up city (TE=.1237), newspaper reading rate (TE=.1020), distance to government organization (TE=.095) in order. 20. Variables indicating indirect effects to health KAP levels were; at knowledge level with R²=30%, education level (Ind E=.0344), newspaper reading rate (Ind E=.0112), TV possession rate (Ind E=.0689), activity of Ban meeting (Ind E=.0079) in order and at attitude level with R²=13%, education level (Ind E=. 0338), activity of Ban meeting (Ind E=.0079), and at practice level with R²=29%. education level (Ind E=.0268), health facility (Ind E=.0830) and concern on health (Ind E=.0105). 21. Total effect to health KAP levels and IEC by variable characteristics, personal characteristics variables indicated larger than community characteristics variables. 22. Multiple Correlation Coefficient (MCC) expressed by the Personal Characteristic Variable was .5049 and explained approximately 25% of variances. MCC expressed by total Community environment variable was .4283 and explained approx. 18% of variances. MCC expressed by IEC Variables was .4380 and explained approx. 19% of variances. The most important variable effected to health KAP levels was personal characteristic and then IEC variable, Community Environment variable in order. When the IEC effected with personal characteristic or community characteristic, the MCC or the variances were relatively higher than effecting alone. Therefore it was identified that the IEC was one of the important intermediate variable.