1996年至2013年中国婚前医学检查率变化情况

Secular trends of premarital medical examination in China during 1996 and 2013

目的：描述中国婚前医学检查（简称婚检）率长期变化情况，探讨国家相关政策调整对婚检率的影响。方法：婚姻登记与婚检资料来自全国妇幼卫生年报，相关政策文件来自政府官方网站。根据政策调整情况，年份分强制婚检期（1996年至2003年）、鼓励自愿婚检期（2004年至2008年）和免费自愿婚检期（2009年至2013年）。结果：18年间全国婚姻登记284242719人，婚检107198795人，平均婚检率37.7%。强制婚检期婚检率在52.7%～67.7%，平均60.9%（城市71.5%，农村51.7%）；取消强制婚检过渡至鼓励自愿婚检的2004年，婚检率骤降至2.6%，后缓慢升至2008年11.5%；免费自愿婚检政策出台后，婚检率较快回升至2013年52.3%（城市49.8%，农村54.6%）。分层分析显示，城乡别和地区别婚检率在大幅下降后也逐年回升，但省份间差异悬殊。2013年，广西（97.5%）、福建（96.0%）、宁夏（95.4%）、浙江（93.4%）和安徽（90.1%）5省婚检率已逾90%，然而经济较发达的上海（27.4%）和广东（25.5%）仅约为全国水平的一半，重庆（12.4%）、北京（5.8%）和天津（4.6%）更低。此外，经济欠发达的贵州（6.4%）和青海（1.8%）也处低点。结论：在系列自愿婚检政策导向下，中国婚检率骤降后大幅回升，但省份间差异显著。有的省份已处历史高点，宜适时评估其健康收益；有的省份却持续低迷，其原因也值探究，尤其是探索符合成本效益的自愿婚检或与孕前保健统筹考虑的服务模式有重要现实意义。

Objective：To describe the secular trends of premarital medical examination （ PME ） in China during 1996 and 2013 and to assess the impacts of national health policies on the PME rate. Methods：The information on marriage and PME for districts and counties in 31 provinces of China was annually collected by the Office for National Maternal ＆amp; Child Health Statistics of China, and the infor-mation on the health policies was from official governmental websites. According to the main health poli-cies, the calendar years were categorized into 3 periods：1996 to 2003 was mandatory PME period;2004 to 2008 was encouraged voluntary PME period; and 2009 to 2013 was free-paid voluntary PME period. Results： During the 18-year period, 284 242 719 people were registered for a marriage in which 107 198 795 were examined, giving the PME rate of 37. 7%. During the mandatory PME period, the rate ranged 52 . 7% -67 . 7% with an average of 60 . 9% （ urban 71 . 5%, and rural 51 . 7%） . In 2004 , the first year when the PME became voluntary, the rate was abruptly dropped to 2. 6%, and thereafter gradually increased to 11 . 5% in 2008 . As the policies of the free-paid voluntary PME were subsequently issued, the rate was quickly increased to 52. 3% （urban 49. 8%, and rural 54. 6%） in 2013. The in-creasing trend was consistently observed both in urban and rural areas, and across East, Middle, West, and Northeast economical regions. However, the rates differed greatly among provinces. In 2013, 5 pro-vinces had rates of ＆gt;90% （ Guangxi 97 . 5%, Fujian 96 . 0%, Ningxia 95 . 4%, Zhejiang 93 . 4% and Anhui 90. 1%）, whereas some provinces were stuck at a low rate, including developed and underdeve-loped provinces/cities. The PME rate in 2013 was 27. 4% for Shanghai, 25. 5% for Guangdong, 12. 4%for Chongqing, 5. 8% for Beijing and 4. 6% for Tianjin. Underdeveloped provinces were Guizhou （6. 4%） and Qinghai （1. 8%）. Conclusion：As various national policies to promote voluntary PME were issued, the PME rate was significantly increased after a sharp decline, though it varied greatly by provinces. For provinces with high PME rate, PME-related health benefits need to be evaluated;for provinces with low rate, it is of important practical significance to explore a cost-effective health service model that is likely incorporated with pre-pregnancy examination.