Comments by opponents on the British Medical Association’s guidance on non-therapeutic male circumcision of children seem one-sided and may undermine public health

The British Medical Association(BMA)guidance on non-therapeutic circumcision(NTMC)of male children is limited to ethical,legal and religious issues.Here we evaluate criticisms of the BMA’s guidance by Lempert et al.While their arguments promoting autonomy and consent might be superficially appealing,their claim of high procedural risks and negligible benefits seem one-sided and contrast with high quality evidence of low risk and lifelong benefits.Extensive literature reviews by the American Academy of Pediatrics and the United States Centers for Disease Control and Prevention in developing evidence-based policies,as well as risk-benefit analyses,have found that the medical benefits of infant NTMC greatly exceed the risks,and there is no reduction in sexual function and pleasure.The BMA’s failure to consider the medical benefits of early childhood NTMC may partly explain why this prophylactic intervention is discouraged in the United Kingdom.The consequence is higher prevalence of preventable infections,adverse medical conditions,suffering and net costs to the UK’s National Health Service for treatment of these.Many of the issues and contradictions in the BMA guidance identified by Lempert et al stem from the BMA’s guidance not being sufficiently evidence-based.Indeed,that document called for a review by others of the medical issues surrounding NTMC.While societal factors apply,ultimately,NTMC can only be justified rationally on scientific,evidence-based grounds.Parents are entitled to an accurate presentation of the medical evidence so that they can make an informed decision.Their decision either for or against NTMC should then be respected.

One Couple, No Child: The Non-Nuclear Family in China

A CCORDING TO the trad-itional Chinese concept of what makes a family,there must be a husband,wife and at least one child.Recently a new challenge to this ancient concept has been quietly taking root in major cities throughout the country--a family in which the husband and wife,both working put off indefinitely the idea of having a child.Such a life-style,not uncommon in the West,fies in the face of the Chinese"more kids,more happiness"tradi-tion of family life.

Are school uniforms associated with gender inequalities in physical activity? A pooled analysis of population-level data from 135 countries/regions

Purpose:It is aimed to assess whether school uniforms are associated with population-level gender inequalities in physical activity,and whether associations differ by school level,country/region income,and assessment method.Methods:An ecological study design was employed.We collected data about global uniform practices using an online survey.We searched for country/region-level estimates of school-aged youth meeting physical activity guidelines from international surveillance studies.Study selection was conducted in duplicate using a systematic process,and a random sample of all data was checked to ensure extraction and pooling processes were accurate.We calculated absolute and relative gender inequalities in physical activity for each country.Linear regression examined associations between country/region-level uniform practices(binary yes/no exposure variable) and country/region-level gender inequalities in physical activity guideline compliance(absolute and relative inequalities).We investigated moderation by school level,stratified analyses by income group,and repeated primary analyses using device-measured data.Results:Pooling data from 135 countries/regions(n=1,089,852),we found no association between population-level uniform practices and gender inequalities in physical activity across all ages(absolute:β=-0.2;95% confidence interval(95%CI):-1.7 to 1.3,p=0.74;relative:β=0.1;95%CI:-0.1 to 0.2,p=0.51).Subgroup analysis suggested a positive association in primary school settings(absolute:β=4.3;95%CI:-0.0 to 8.6,p=0.05).Among high-income countries,absolute inequalities were significantly greater in countries/regions with uniform practices(N=37) compared to those without(N=48)(9.1(SD=3.6) vs.7.8 percentage points(SD=4.3)).Repeating analyses using device-measured data(n=32,130;N=24) did not alter our primary finding.From initial descriptive statistics,we found that in countries/regions where a maj ority of schools(>50%) reportedly use uniforms,there was lower compliance with physical activity guidelines among all genders(median:16.0%,interquartile range:13.2%-19.9%,N=103) compared to generally non-uniform countries/regions(median:19.5%,interquartile range:16.4%-23.5 %,N=32)(z=3.04,p=0.002).(N=countries,regions and studies repre sented;n=sample size or participants included).Conclusion:School uniforms are associated with greater gender inequalities in physical activity in primary school settings and in high-income countries.Our population-level findings warrant testing using individual-level data across contexts.

Improving the Use of Insecticide-Treated Nets among Children under Five Years Old in Benin, West Africa

Background: In Benin, malaria represents the first cause of consultation and hospitalization (48% for children under 5 years old) in health units. It also accounts for 23.1% of deaths recorded in health facilities (MoH, 2019). Between the two main components of vector control adopted by Benin government, the mass distribution campaigns of Insecticide-Treated Nets (ITNs) remained the only proven cost-effective way to rapidly achieve high and equitable coverage (WHO, 2017). After the fourth mass distribution campaign conducted in 2017, the Demographic and Health Survey (DHS) data indicated that the percentage of children who slept under an ITN has increased from 20% in 2006 to 70% in 2011-2012 and to 76% in 2017-2018 while the incidence of malaria (tested positive) is increasing rapidly among children under 5 years old, growing from 36.5% in 2009 to 28.8% in 2012 and then to 51.4% in 2019. This study aims to understand this contrast by identifying the origin of the increase in ITN use over time among children under five years old and the factors which determine this use. Methods: Data from the Demographic and Health Survey (DHS) conducted in Benin respectively in 2006 and in 20018 were used during the analysis, which covered 13,445 children under five years old from 2006 DHS and 12,255 children from 2017-2018 DHS. Firstly, the data were analyzed using decomposition method to highlight the origin of the increase of ITN use over time among children under five years old. Secondly, the chi-square test analysis estimated the association between ITN use and some characteristics (wealth index, maternal or caregiver education level and child age). Finally, the logistic regression model was used to identify the main factors, which influence the net use over the study period. Results: This study shows that the improvement of basic conditions is the main origin of behavior change in the use of ITNs among children under five years old. This improvement of the basic conditions consists of making ITNs available in households and informing household members about the benefits of ITN use. So, the free ITN distribution campaigns, routine distribution, awareness campaigns about the benefits of ITN use are the strategies, which increase the household capacities and knowledge, allowing household members to make their children sleep under net. The analysis also shows that region of residence, wealth index of household, household size, religion, and child age continue to determine the ITN use among children under age 5 years old and MNCP will integrate the factors in malaria prevention strategies in order to achieve universal use of ITNs. Conclusions: Although, sleeping under ITN behavior has indeed spread among children under 5 years old, policymakers and other stakeholders should design strategies to maintain and improve the current level of ITN use to reach the collective protection threshold (80% according to WHO). Therefore, to address the challenges of universal use of ITN, the study recommends expanding the routine distribution system to private sector health centers;discussing issues related to health service utilization (particularly ITN use) within a consultation framework at the communal level. In addition, collecting qualitative and quantitative data in the Oueme region will allow better understanding of all aspects of the ITN use gap among children under 5 years.

Comparison of nutrition education policies and programs for children in China and other selected developed countries

A double burden of overweight/obesity and malnutrition during childhood is a major concern in China.Dietary intakes in this critical period affect children’s physical and cognitive development,and also have health consequences in later life.Therefore,establishing healthy eating habits that will endure is crucial for children.Nutrition education is an effective way in improving nutrition knowledge and attitudes,and healthy eating behaviors.Diverse forms of nutrition improvement programs that targeting children,family,teachers,and school settings have been conducted in many developed countries.However,due to the differences of genetic background,household environment as well as dietary patterns between Chinese children and children from other countries,the existing nutrition education programs for children abroad might not be appropriate for children in China.Thus,nutrition education programs that consider Chinese nutrition-related policies and food supply as well as the local educational resources are required for Chinese children.This review summarized nutrition-related policies and legislations in China and developed countries.A series of evidence-based nutrition education programs that combined educational strategies and environmental supports conducted in the Southwest China Childhood Nutrition and Growth Study were presented.These programs can serve as example models for adopting nutrition interventions to improve nutrition and health status of children in different regions of China.

Tackling China’s Pension Fund Payment Crisis:Will the “Two-Child Policy” Be the Answer?——An example with the basic pension insurance program for urban employees

Based on the reality that 29 Chinese provinces have already implemented the policy allowing a couple to raise a second child if either parent is an only child, this paper provides an empirical study on the effect of this policy on the financial status of the social pooling fund of basic pension insurance for urban employees. Our study suggests the followings. First, under the previous unchanged family planning policy, current deficits and cumulative deficits will occur in the social pooling fund in the year 2047 and 2063 respectively. Second, if lO% to 50% of qualified couples choose to raise a second child, the financial status of the social pooling fund will improve; relative to the previous unchanged family planning policy, the contribution ratio can decrease from 20% to the range between 18.06% and 19.57% without causing any changes to the original financial status of income and expenditure. Third, if the percentage of couples choosing to raise a second child rises to 60% to 100%, the contribution ratio can even decrease to the range between 16.55% and 17. 7% without causing any changes to the financial status as under the previous unchanged family planning policy. The above conclusions have all passed the sensitivity test. Therefore, the ＂two-child policy＂ for qualified couples is favorable to alleviating the payment pressures of pension insurance but the policy effectiveness is subject to fertility desire and the intensity of government implementation.

The influence of Chinese population policy change on resources and the environment

Universal two-child policy has been implemented since the end of 2015 in China.This policy is anticipated to bring a significant increase in the total population,with profound influences on the resources and environment in the future.This paper analyzes the changing dynamics of urban and rural population,and forecasts urban and rural population from 2016 to 2030 at national and provincial scale using a double log linear regression model.Drawing upon the results of these two predictions,the impact of the population policy change on Chinese resources consumption and environmental pollution are predicted quantitatively.Given the future total population maintains current levels on resources consumption and environmental emission,the additional demand of resources and environment demand for the new population is forecasted and compared against the capacity on supply side.The findings are as follows:after implementing the universal two-child policy,China's grain,energy consumption,domestic water demand,and pollutant emissions are projected to increase at different rates across provinces.To meet the needs arising from future population growth,food and energy self-sufficiency rate will be significantly reduced in the future,while relying more on imports.Stability of the water supply needs to be improved,especially in Beijing,Henan,Jiangsu,Qinghai,and Sichuan where the gap in future domestic water demand is comparatively larger.Environmental protection and associated governing capability are in urgent need of upgrade not least due to the increasing pressure of pollution.

Fertility Values among Women of Childbearing Age in Hunan Province, China: A Cross-Sectional Study

Background: China is facing with a crisis of the aging population. After the implementation of the latest fertility policy, the research on fertility related issues is urgent. Objective: The objective of this study is to explore the fertility values among women of childbearing age and the socio-demographic factors associated with it under the background of three-child policy, which is helpful to cope with the aging of the population. Methods: This study was conducted among 383 women of childbearing age who met the inclusion criteria using a general information questionnaire and the fertility values questionnaire from May to August 2021 in Hunan Province, China. Data were collected on the women’s socio-demographic characteristics and fertility values. The descriptive statistics, t-test and analysis of variance were used for data analysis. Results: The total mean score of the positive values was 43.55 ± 10.10, and that of the negative values was 50.87 ± 13.85. There were significant differences in the scores of the overall positive and negative values, as well as scores of each dimension (p The item mean score of the overall negative values (3.38 ± 0.93) was higher than that of the overall positive values (2.90 ± 0.67). Among the positive values, “emotional value” (4.26 ± 0.93) scored the highest, while “worrying about life changes” (3.88 ± 1.10) scored the highest among the negative values. There were significant differences in both the positive and negative values in terms of age, marital status, and “only-child” women or not (p Conclusion: The fertility values among women of childbearing age in Hunan Province were relatively negative, especially, excessive worries about life change since having a child, which may lead to further declines in fertility levels. Relevant support measures are urgently needed from the government to adapt to the three-child policy.

China's Universal Second-Child Policy: Grounds, Effects and Strategies

The 13 th Five-Year Plan(2016─2020), with the balanced development of population being the core element, is crucial for China. The superimposed effect of an aging population and low birthrate leading to a reduction in the labor supply would have a fundamental influence on the long term balanced development of China's population, implying that China's population policy must be adjusted. This paper argues that a gradual relaxation of the family-planning policy adjustments accords with the original intention of the population policy design and development direction. The universal second-child policy is the logical results of the adjustment and improvement of China's family-planning policy, and is designed to bring about positive effects on future demographic and economic development, particularly in sustaining the long term balanced development of China's population, easing the marriage squeeze, extending the demographic dividend, and delaying the population aging process. China needs to develop and improve support and governance systems for fully implementing the universal second-child policy, realizing the policy transition from rewarding one-child families to population security and the modern transition of governance systems and capacity to a universal second-child policy.

Should China Allow Couples to Have a Second Child?

China’s family planning policy is back in the spotlight.Guangdong, the country’s most populous province according to the latest population census,has officially applied to the Central Government for permission for it lifting family planning restrictions.If the application is approved,couples in which either the husband or wife is an only child will be allowed to have a second child,according to Zhang Feng, family planning chief in Guangdong.

生育文化、生育制度与生育率——兼论三孩生育政策及其配套支持措施的可能效果

随着中国少子老龄化程度的不断加深,如何促使生育率回升至适度水平成为政府和学界重点关注的议题,其中以三孩生育政策及其配套支持措施为代表的鼓励型生育制度和以“多子多福”为核心的传统生育文化被寄予厚望,希望借此帮助中国摆脱“低生育率陷阱”。然而,研究发现:中华文化圈国家或地区的生育率远低于其他国家与地区,而海外华人则是所在国生育率最低的族群之一,传统生育文化在现代社会已然发生了嬗变,对促使低生育率回升的作用已十分有限,取而代之的是“晚婚晚育少生优生甚至不婚不育”的现代生育文化,并形塑起一种内生性的低生育率机制。与此同时,欧洲和东亚国家通过构建鼓励型生育制度后依然深陷低生育率陷阱,无法有效刺激低生育率回升至适度水平。中国三孩生育政策及其配套支持措施的预期效果同样不容乐观,而生育文化、生育制度和生育率之间存在着十分复杂的互构关系,亟需从结构性和内生性的“文化—制度”视角去重新审视我国生育率转变的形成机制。

高学历育龄人群三孩生育意愿研究

文章基于2021年中国综合社会调查(CGSS)数据,采用二元Logit回归模型、门槛效应模型和倾向值匹配(PSM)等方法实证分析高学历育龄人群的三孩生育意愿以及生育支持条件对其的影响。研究结果表明:高学历育龄人群的三孩生育意愿相对较低,平均只有14.1%的高学历育龄人群愿意生育三孩,而低学历育龄人群有18.4%愿意生育三孩。高学历育龄人群愿意生育三孩的比例与已育二孩的性别结构有关。已有两个儿子、两个女儿和一儿一女的高学历育龄人群愿意生育三孩的比例分别为12.3%、16.0%和13.9%。家庭收入水平对高学历育龄人群的三孩生育意愿有显著的正向影响,且存在显著的收入门槛效应。随着家庭收入水平的提高,家庭收入对高学历育龄人群三孩生育意愿的边际影响效应呈现出先增大后减小的倒“U”型关系,家庭收入水平对家庭收入为11万元-36万元的高学历育龄人群三孩生育意愿的影响效应最大,对家庭收入为11万元以下和36万元以上高学历育龄人群三孩生育意愿的影响效应较小。相对于没有托育服务的高学历育龄人群而言,政府而非市场提供低价优质的托育服务能够显著增强高学历育龄人群的三孩生育意愿。政策启示在于:一是提高中国育龄人群的三孩生育水平,不能把过高的期望寄托在高学历育龄人群,尤其是已育有两个孩子的高学历育龄人群;二是提高已育两个孩子高学历育龄人群的三孩生育水平,重点关注已育两个女儿且家庭收入为11万元-36万元的高学历育龄人群;三是降低高学历育龄人群三孩生育的直接成本和机会成本,加强生育支持政策评估,进一步完善高学历育龄人群的生育休假政策和生育三孩家庭的收入补贴政策,优化高学历人群的延迟退休政策,消除高学历育龄女性的就业歧视,仍然是激励高学历人群生育三孩的重要举措;四是政府主动承担婴幼儿的托育服务,为育龄人群提供低价优质的托育服务,能够达到事半功倍的三孩生育激励效应。

“双碳”背景下中国绿色金融政策协同有效性研究——基于多维文本量化分析

绿色金融政策的协同性研究对实现碳达峰碳中和,推进绿色金融可持续发展具有重要意义。通过政策协同理论,构建绿色金融政策“协同—属性—工具”分析框架,采用基于机器学习的文本相似度算法与系统耦合协同模型,从政策纵向协同、横向协同和耦合协同多个维度对2016—2022年中央及地方绿色金融政策进行文本量化分析。研究发现:我国绿色金融政策纵向协同、横向协同和耦合协同水平逐渐提升,但总体强度仍较低;在区域上,我国绿色金融政策三维协同具有区域差异性;在政策类型维度上,央地绿色金融政策类型呈现多样化特征;在政策工具维度上,央地绿色金融政策工具结构失衡,使用供给型和环境型政策工具较多而需求型工具略少。因此,为提高我国绿色金融政策有效性,应进一步优化绿色金融政策多维协同机制。

“三孩”政策背景下婴幼儿家庭养育压力的影响因素探究

为了解“三孩”政策背景下0~6岁婴幼儿家庭养育压力的现状及其影响因素,采用基本信息问卷、简式养育压力量表(PSI-SF)对我国东、中、西部六省3982个婴幼儿家庭所面临的养育压力展开调查,并从个体家庭因素、经济因素和社会区域因素三个方面分析0~6岁婴幼儿家庭养育压力产生的原因。结果显示,在0~6岁婴幼儿家庭中,近五成家庭养育压力超出正常范围,且从养育压力的各个维度来看,育儿愁苦得分高于困难儿童得分高于亲子互动失调得分;家庭结构、社会经济地位以及城乡地区对0~6岁婴幼儿家庭的养育压力有显著影响。基于此,建议关注父亲的养育压力,政府社区家庭合作共育;明确家庭压力来源,缓解家庭养育压力;加大政府投入,降低家庭养育成本;完善社会服务支持,提高家庭养育知识与技能。

育龄夫妻三孩生育意愿分析及对策研究——基于福建龙岩的实地调查

为积极落实三孩生育政策,主动适应人口和计划生育工作转型发展的新要求,调研组基于龙岩市育龄夫妻三孩生育意愿的调查问卷数据及实地调研,得出结论:三孩生育意愿的影响因素主要表现在经济成本、制度保障和生育观念三个方面。为进一步优化生育政策,提高三孩生育政策及配套支持措施的针对性、可操作性,切实减轻群众生育、养育、教育负担,助力生育友好城市建设,建议加强顶层设计提供政策支持,着力提升系统保障功能,多管齐下降低家庭养育成本,营造良好的生育氛围。

Optimizing data visualization for reproductive,maternal,newborn,child health,and nutrition(RMNCH&N)policymaking:data visualization preferences and interpretation capacity among decision-makers in Tanzania

Background:Reproductive,maternal,newborn,child health,and nutrition(RMNCH&N)data is an indispensable tool for program and policy decisions in low-and middle-income countries.However,being equipped with evidence doesn’t necessarily translate to program and policy changes.This study aimed to characterize data visualization interpretation capacity and preferences among RMNCH&N Tanzanian program implementers and policymakers(“decision-makers”)to design more effective approaches towards promoting evidence-based RMNCH&N decisions in Tanzania.Methods:We conducted 25 semi-structured interviews in Kiswahili with junior,mid-level,and senior RMNCH&N decision-makers working in Tanzanian government institutions.We used snowball sampling to recruit participants with different rank and roles in RMNCH&N decision-making.Using semi-structured interviews,we probed participants on their statistical skills and data use,and asked participants to identify key messages and rank prepared RMNCH&N visualizations.We used a grounded theory approach to organize themes and identify findings.Results:The findings suggest that data literacy and statistical skills among RMNCH&N decision-makers in Tanzania varies.Most participants demonstrated awareness of many critical factors that should influence a visualization choice—audience,key message,simplicity—but assessments of data interpretation and preferences suggest that there may be weak knowledge of basic statistics.A majority of decision-makers have not had any statistical training since attending university.There appeared to be some discomfort with interpreting and using visualizations that are not bar charts,pie charts,and maps.Conclusions:Decision-makers must be able to understand and interpret RMNCH&N data they receive to be empowered to act.Addressing inadequate data literacy and presentation skills among decision-makers is vital to bridging gaps between evidence and policymaking.It would be beneficial to host basic data literacy and visualization training for RMNCH&N decision-makers at all levels in Tanzania,and to expand skills on developing key messages from visualizations.

“三孩”政策背景下我国乡村生育政策的创新与完善研究

进入新世纪以来,受长期计划生育政策惯性、生育观念转变和大范围人口流动的影响,我国乡村人口呈现出总量快速下降、人口结构恶化、总和生育率下降、新生儿性别比失调等问题。2021年“三孩”政策推出,提出应对我国生育政策进行综合性设计,以顺应我国乡村人口发展的需求。我国现有生育支持政策对于化解乡村生育问题还存在较多不足,需要秉持科学化和统筹城乡理念,抛弃历史包袱和政策惯性,遵循推进政策普惠化和系统化的思路进行政策调整,并不断完善政策执行体系。

农村夫妻就业分化对生育意愿的影响

生育属于夫妻共同决策,探究农村夫妻就业分化引致的生育意愿变动及其内在机理,可能为中国低生育率的破解提供新视角。基于2014年和2018年中国家庭追踪调查(CFPS)数据,实证检验农村夫妻就业分化对生育意愿的影响。结果表明,农村夫妻就业分化会降低其生育意愿,与务农型夫妻相比,兼业型夫妻和非农型夫妻的平均生育意愿分别减少0.037个和0.054个。使用CMP模型和Tobit模型进行稳健性检验后,结论依旧成立。就业分化对35岁以下、村庄宗族氛围不浓厚的农村夫妻生育意愿的抑制作用更强。机制检验表明,抚育能力削弱和传统生育观念弱化是农村夫妻就业分化导致生育意愿下降的重要原因。农村夫妻就业分化对其生育二孩和生育三孩的行为亦存在显著负向影响。因此,包容性生育政策改革需着重关注农村夫妻的抚育成本和时间顾虑,并通过营造新型生育文化,以激发农村夫妻的生育动力和情感需求。

2024—2035年学前教育学龄人口及其对资源需求的预测——基于“三孩”政策的研究

在“三孩”政策全面实施背景下,本文基于第七次全国人口普查数据,使用CPPS2020软件分高、低两种总和生育率方案预测2024—2035年学前教育出生人口、学龄人口和在园幼儿数,进而测算各年份幼儿园机构、专任教师和财政投入需求。结果发现:2035年我国出生人口在高、低方案下较2024年提升99万人、减少6万人;学龄人口和在园幼儿总量整体减少,向城市集聚,到2035年在园幼儿规模为2498—2752万人,其中71%—72%就读于城镇幼儿园。从教育资源现有供给水平来看,城乡学前机构与城镇专任教师可以满足未来需求,乡村专任教师和教育经费存在大量短缺。基于此,需统筹城乡幼儿园的配置;促进城乡教师资源流动;建立各级财政分项目按比例承担学前教育经费的分担机制,加大学前的教育财政投入;财政投入更多用于人员经费和公用经费。

Analysis of the Characteristics of Pregnancy and Delivery before and after Implementation of the Two-child Policy

Background： After the two-child policy is frilly implemented, new challenges regarding pregnancy management and the treatment of pregnancy complications will arise. The aim of this study was to analyze the characteristics of pregnancy and delivery before and after the implementation of the two-child policy to make suggestions on the quality assurance of the new era of obstetrics. Methods： In total, 5895 cases of pregnant women who delivered from April 2016 to March 2017 in Peking University Third Hospital served as the study group and 5103 cases of pregnant women who delivered from January to December 2015 served as the control group. The characteristics of pregnancy and delivery were retrospectively analyzed. Results： In the study group, the percentage of pregnant women who were older （over 40 years） （3.6% vs. 2.2%）, were multipara （30.3% vs. 17.0%）, received irregular prenatal care （ 1.5% vs. 0.9%）, were transferred for treatment from a subordinate hospital （4.4% vs. 2.8%）, and were not residents of Beijing （3.8% vs. 2.2%）, were significantly increased compared with the control group （P 〈 0.05）. In the study group, the rate of a hypertensive disorder complicating pregnancy （6.4% vs. 5.0%）, gestational diabetes mellitus （25.3% vs. 23.1%）, dangerous placenta previa （3.0% vs. 2.3%）, placental implantation （2.4% vs. 1.8%）, and severe postpartum hemorrhage （2.8% vs. 1.9%） was significantly increased compared with the control group （P 〈 0.05）. In the study group, the cesarean section rate during primipara was significantly reduced compared with the control group （42.0% vs. 44.2%）. However, the rate during inultipara was significantly increased compared with the control group （P 〈 0.05）. Indications for cesarean section in the study group as well as the percentages of scared uterus and placenta previa were significantly increased compared with the control group （P 〈 0.05）. Conclusions： According to the current situation, better methods are needed to strengthen pregnancy and delivery management, reduce the rate of cesarean section, and ensure a positive outcome for mothers and babies.