张开宁

20世纪后半期，全球妇女运动的蓬勃开展以及妇女、性别、发展方面的研究及行动使妇女健康作为一个与人类社会可持续发展，特别是妇女全面发展密切相关的领域得到了前所未有的关注。这一点，在联合国人口与发展大会（1994年，开罗）、世界第四届妇女大会（1995年，北京）、人口发展大会后五年及世妇会后五年一系列举世瞩目的国际性会议及重要文件中得到了明确的体现。另一方面，性传播疾病（特别是包括于其中的艾滋病）在世界范围内的蔓延及肆虐，以及全球经济一体化的加速给人类健康、特别是妇女健康带来了新的严峻挑战。毫无疑问，妇女健康在21世纪将继续作为一个重要领域而备受重视。

云南省工青妇干校妇联教研室的教师们在校领导的支持以及原河南省郑州大学妇女研究中心主任李小江教授的带领和具体指导下，积极参加了福特基金会资助的“妇女生育与健康”项目。其后，该校一批教师和科研人员参加并完成了云南生育健康研究会的“生育健康调查与教育”课题。在锻炼了队伍、积累了经验的基础上，为了更好地为贫困社区妇女健康服务，在云南生育健康研究会若干专家、学者的支持下，该校发挥自己在教育、培训方面的专长以及同县、乡妇联组织联系密切的优势，向福特基金会申请并实施了“贫困社区妇女健康教育倡导培训”项目。通过专家指导，自主操作，顺利实施了项目。

通过不断的实践和总结，该课题组已经形成了一套广大少数民族妇女群众能够理解和接受的、可以真正了解广大妇女真实需要的实用的调研方法，包括人类学的田野调查与社会学的问卷调查相结合的方法等。基于这些方法，云南省工青妇干校课题组历时数年，在贫困农村地区开展了“贫困社区妇女健康教育倡导培训”，本书其主要部分就是这样一个项目的回顾与总结。

本书不仅向作者展现了云南省工青妇干校在“贫困社区妇女健康教育倡导培训”项目的设计、实施以及跟踪评估方面的实践与思考、体验与成果，而且收录了云南生育健康研究会一些学者的论文，包括：人口学者以“健康促进与权益保障”为题，就当代云南妇女的身体素质状况所做的实证性研究；民族学及妇女研究专家从田野考察的实际出发，通过分析云南少数民族地区贫困妇女的现状，探讨少数民族妇女在扶贫开发中的作用，以及扶贫开发与少数民族妇女健康及发展关系的理论思索；以云南藏族和佤族为案例所进行的传统文化“双刃剑”与妇女生育健康关系的研究；等等。此外，若干作者论证了妇联组织的特点及其在妇女健康促进方面的优势，对妇联组织为主导的妇女健康教育、倡导及促进活动的开展提出了自己的见解。

贫困社区妇女健康的研究及行动离不开赋权妇女的网络活动，改善信息和资源可及性的行动，特别是提高贫困农村妇女创收能力及自主意识、健康意识的活动。同时，促使农村妇女积极参与社区活动，以及更主动地表达自己在发展与健康方面需求的心声的考虑，营造有利氛围以促进男性在上述各方面的理解、支持和参与的理论与实践，都具有十分重要的价值。细读本书，读者不难发现作者们在这些方面的宝贵体验与思索。相信这本论文集能够从很多方面使读者受益。希望正在实施妇女健康项目的机构和人士能够从中发现可借鉴的体验和思路。

展望21世纪，妇女健康的促进尚任重而道远。衷心希望本书既是一个贫困地区妇女健康项目的总结，更是又一个更宏伟的系统工程的前奏。感谢本书的组织者及作者群以自己的辛勤劳动及探索精神为贫困农村妇女健康的促进指明了一个具体的切入点，希望有更多的朋友和同道参与21世纪妇女促进健康的新长征。

Preface

Globally，there had been a lack of attention to women's well-being and health. Narrowness of vision characterized early women's health all over the world. However，the last 5 decades of the 20 Century witnessed a significant change throughout the world，developing and developed. In the 1990s，a series of global conferences of governments organized by the United Nations has produced an action agenda for socially equitable，sustainable development for the 21 century. Specially，the International Conference on Population and development （Cairo，1994，known as ICPD） and the Fourth World Conference on Women （Beijing，1995，known as FWCW ） established sexual and reproductive health and rights as fundamental to human rights and development. Reproductive health refers to a spectrum of conditions，events and processes through life，ranging from healthy sexual development，comfort and closeness and joys of childbearing，to abuse，disability and death. Profoundly，life-affirming and life-threatening conditions make up reproductive health. Reproductive health is also an approach. When we use the language of ICPD，we talk about health needs，but we also talk about rights，equity，dignity，empowerment，self-determination and responsibility in relationship. Reproductive health is an approach to analyzing and then responding comprehensively to the needs of women and men in their sexual relationships and reproduction. Effective reproductive health services have been defined. However，those services do not always reach everyone in need，and do not always with the optimal quality of care. Against these already large challenges loom world economic trends that are creating greater disparities between people，and，in some places，forcing governments to radically alter their spending away from health and social services. Being aware about it，improvement of reproductive health services has been given an increasing attention throughout the world.

Significant progress has been achieved since ICPD and FWCW.

With a support from the leaders of their school，Yunnan Training School for Cadres of the Women's Federation，Youth League and Workers' Union （YTSWYU） has been involved in women's project since early l990s，when a group of teachers of YTSWYU actively participated in a Ford Foundation supported project in women's reproductive health. This project was led by and with a technical support from Professor Li Xiaojiang，who worked at the Center for Women's Studies，Zhengzhou University that time. Later，more tutors and staff of YTSWYU became members of Yunnan Reproductive Health Research Association （YRHRA） and they participated in more reproductive health programs. Based on the experiences in YRHRA，and took the advantage that the school staff are skillful in training for women's cadres and the close linkage with Women's Federation at County and Township levels，a team of YTSWYU staff applied to Ford Foundation for a separated program entitled “ Education，advocacy and training in women's health in poor communities"，in order to better meet women's needs in health in general and reproductive health in particular in poor rural areas. For years，the YTSWYU Team implemented the above-mentioned program，with technical support of several experts from various institutions including YRHRA. This book is a reviewing and a summary of their program implementation to a large extent.

In implementation of the reproductive health programs，a set of study methods，which was easy understood by the local women in poor rural Yunnan，was developed and used by YTSWYU Team.

This book not only describes designing，implementation and assessment of the YTSWYU program，but also includes several papers written by non-YTSWYU staff YRHRA members. These authors include experts in population and development studies，gender and women's studies. They shared their experiences，case studies and re-thinking about reproductive health of the ethnic minority women in poorest rural communities，poverty alleviation and its connection with women's health ，traditional culture as a “double-edged sword" to reproductive health，women's federation and its role in women's health promotion. For me as an individual，and for the Yunnan Reproductive Health Research Association as an institute，it has been an honor to be part of the YTSWYU partnership.

It is well known that networking，empowerment of women，and improvement of women's access to information and other resources are core issues in women's health promotion. Therefore，in poorest rural communities activities aimed at promoting networking and getting a stronger voice of the local women play a critical role. This book in your hand share experiences of YTSWYU Team in improvement of women's access to information and other resources，promoting networking and getting a stronger voice of the local women，as well as encouraging male's responsibility & participation in reproductive health. It is hoped that the experiences shared will be useful for individuals and institutions who are interested in health promotion in poor rural areas of China. Like all beginnings，women's health promotion is truly a work-in-progress. By the time the book is published，our understanding will have deepened and perhaps changed，so that our work can be more informed and effective.

In the 21 Century，more attention will be paid to Women's health and well-being. This book is an early milestone for YTSWYU on their path toward the goal of better health for women. We celebrate it for the important step it presents and look forward to future steps. Thanks for the editors and authors of this book for their efforts，which made it possible that experiences of the YTSWYU shared to a wider range of audience. It is hoped that this will make a contribution to the “Long March" of the women's health promotion in 21 Century.