| 总结: | Reproductive health is a crucial part of general health and a central feature of human
development. Since gaining global attention at the 1994 International Conference on
Population and Development (ICPD), the importance of reproductive was reaffirmed as
one of the eight goals of Millennium Development Goals (MDGs), and in the post-2015
development agenda. This thesis addresses the key issues of public health affecting
childbearing women and the older people. Universal access to reproductive health,
reducing maternal deaths and non-communicable diseases (NCDs) are among the main
targets of the new agenda for the global Sustainable Development Goals (SDGs) 2015-
2030. The objectives of the thesis are:
1. To investigate problems relating to reproductive health and NCDs,
2. To examine the correlates and risk factors of reproductive health outcomes and NCDs
that are of public health concerns,
3. To evaluate the barriers to the utilization of health services in the developing countries,
and
4. To put forth recommendations for policy and research.
The objectives are partially achieved through the writing of five essays listed below. A
comprehensive review of the literature was carried out to complete the thesis.
1. Proximate Determinants of Fertility in Peninsular Malaysia
2. Medical Students’ Attitudes toward Abortion Education: Malaysian Perspectives
3. Correlates of and Barriers to the Utilization of Health Services for Delivery in South
Asia and sub-Saharan Africa
4. Ethnic and Gender Differentials in Non-communicable Diseases and Self-rated
Health in Malaysia
5. The Debilitating Effects of Chronic Diseases among the Oldest Old in China An analysis of the proximate determinants of fertility indicate that marriage
postponement and contraceptive use are the two most important factors affecting fertility,
but breastfeeding and abortion also play a role in fertility reduction. Abortion is a serious
public health issue, and it poses high risks to the health and life of women. A survey on
medical students in Malaysia showed that 9 out of 10 students wanted more training on
the general knowledge and legal aspects of abortion, and pre- and post-abortion
counseling. Hence, there is a need to incorporate abortion education in the curriculum of
medical schools. Unmet need for contraception remains at a high level in some
developing countries. The reproductive health needs of couples and adolescents need to
be given more attention. The national family planning program needs to be revitalized to
provide services beyond family planning such as infertility treatment and bio-medical
research. A family policy is also needed to foster family development and to advocate for
family friendly work environment for work-life balance. Chronic diseases are rising
rapidly, affecting people of all ages, especially the older people. Preventive, protective
and rehabilitative measures must be taken to reduce these diseases. The root cause of the
chronic diseases, including modifiable factors such as unhealthy life style and diet must
be addressed. There exists wide gaps in the utilization of health services. Efforts must be
made to overcome supply-side and demand-side barriers. The thesis concludes by putting
forth some recommendations for policy and future research.
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