生育健康这个名称意味着什么？在中国及中国之外，人们正较少地谈及计划生育和妇幼保健，而开始较多地谈论“生育健康”，其含义究竟何在？读者手中的这本书是上述现象的又一佐证，它针对如下问题给出了种种答案：什么是生育健康？人们应如何更新自己的研究，使其更切合这些新的定义？毫无疑问的是，生育健康这个名称含义丰富而深刻。

过去，计划生育并未考虑人类的性；而在妇幼保健中，母亲的需求由于过分地强调儿童而被忽略。在任何地方，妇女的健康和幸福被忽视，存在于家庭、社区及人们的物质环境及文化环境中的种种因素未得到应有的重视，而这些因素决定着妇女能否获得真正的健康。若对这些因素偶有注重，则往往是将妇女视为生育及种族繁衍、延续的工具，至于妇女的生活本身如何，则很少引起人们的关注，除非而且直到它已经影响到了妇女的生殖功能。在全球，包括发达国家及发展中国家，这种狭隘的观点造成了早些时候妇女健康及计划生育工作中不如人意的状况。

在过去的十年中，情况开始发生变化。若干因素的协同作用，促成了这些变革。这些因素包括：日益壮大且呼声日盛的为妇女的健康及权益而斗争的各种组织；改善卫生服务方面的需求；改进研究方法方面的需要；关于将环境科学、社会科学及医学科学相互联系的认识，由于这种联系，诸如健康这样一类复杂的问题得以在一种广阔的背景下获得最好的认识及更佳的解决。在这个世界上，男性和女性都有着千丝万缕的联系，然而，妇女绝不仅仅是作为一种生育的工具而存在。

云南生育健康研究会（YRHRA）在拓宽这些认识方面属先驱者之一。该研究会是一个以中青年研究者为主体的朝气蓬勃且富有奉献精神的群体，会员来自医学、自然科学、社会科学、艺术及人文科学、法学等领域，会员也包括妇女活动家及医务工作者。这些会员每个月在昆明有一次学术活动。该研究会出版《生育健康与社会科学通讯》，组织学术讲座，为项目提供设计及指导，将有关资料译为中文，积极交流，并在云南省就生育健康的有关话题进行研讨，寻找问题并力图解决。该研究会的历史只有两年，然而，这个独创性的群体在当地、中国乃至国际学术界都引起了相当的重视，并得到了有力的支持。

早些时候，该组织的发起人张开宁副教授在崇高使命的激励下倡导了关于生育健康意义的研讨。我本人也参与了其中的一些讨论。这些研讨富有生气且意义深远，它们包括：在门诊如何与一位第二次前来就诊的性病患者交谈；不同民族的生育习俗；法律中的权利；环境的恶化等等。这些热忱的研究会成员通过讨论确信，生育健康对于云南省来说确实是一个极其重要的问题；同时，生育健康需要比过去任何时候都更具有针对性的研究。

本书是一部论文集，它体现了该研究会会员集体研讨的过程，表达了不同的观点，代表着会员们来自的不同学科。全书集中地论述了以妇女为中心的生育健康，包括概念、定义、理论、研究报告、分层次生育健康教育模式及其评价的构想，以及未来研究的设想等。本书开篇的综论，是我所见到过的最富有思想性及最透彻的论述之一。本书中的若干见解，不仅对于中国而言相当新颖，而且我相信对于在全球正努力加深对生育健康的认识，并致力于解决生育健康问题的人们来说，也有着相当重要的参考价值。

正如一切新的事物一样，本书确实有不少地方尚待完善。待本书正式出版之日，人们的认识应当已更加深刻，甚至有的观点已发生变化。我们所意识到的关于女性主义理论与女性主义发展过程之间的联系，关于男性的认识，以及男子作为男人对于生育健康有其特殊需求和关注的见解，我们所建立的跨学科的合作，关于对社区的注重以及对家庭的关注，所有这些，都将超出本书文字所表述出的深度。那个时候，我们的认识将已经更加深刻，因而，我们的工作将基于更全面的信息之上且更加有效。

我作为个人，福特基金会作为一个组织，均对与云南生育健康研究会的合作关系引以为荣。我们感谢昆明医学院及张开宁副教授，以及云南生育健康研究会的成员们，感谢他（她）们的勤奋工作及活动。

本书对于中国和云南而言都是一块早期的里程碑，它树立在一条通向未来目标的道路上，这个目标就是在生育健康领域内实现明智而积极的变化。我们祝贺本书出版所代表着的人们业已迈出的这一重要的一步，并期待着将来更多的成果。

福特基金会项目官员 白梅博士

1995年6月

PREFACE

What's in a name?What does it mean that inside China and outside China people are talking less about family planning and maternal and child health,and are beginning to talk more about“reproductive health”?The book in your hands is evidence of this fact,providing myriad answers to the question of what reproductive health means and how we might fashion research so that it is more responsive to these new definitions.The truth is that there is much to a name.

It used to be said that family planning left out all consideration of sex and that in maternal and child health（MCH）the mother's needs were overshadowed by an unbalanced focus on the child.Everywhere there was a lack of attention to women's wellbeing or to the complex factors in the family,the community,the material and cultural surroundings that shaped her possibility of achieving genuine health.When such attention was shown,it was often on the woman as a vessel for birth,as the channel through which the species was continued.What her life was like did not account for much unless and until it impinged on her reproductive function.This narrowness of vision characterized early women's health and family planning work throughout the world,developing and developed.

Over the past decade,this has begun to change.A consonance of events has propelled these changes,including increasingly strong and vocal women's health and right organizations，demands for improvements to health services and to the ways in which research is carried out,and an understanding bridging environmental science,social science,and medical science that issues as complicated as health can best understood and addressed in context.If no man is an island,no woman is merely a uterus.

The Yunnan Reproductive Health Research Association（YRHRA）is a testament to this broader understanding.With members from the medical,natural,and social sciences,the arts and humanities,and law,as well as activists and practitioners,YRHRA is a lively and engaged group of（mostly）young researchers.They meet once a month in Kunming,produce a newsletter,organize lectures and press briefings,translate articles into Chinese,share their work,and discuss and probe issues related to reproductive health in their province.Only two years old,this first—of—its—kind group has attracted considerable attention and support from a local,national,and international community of peers.

Early on,the inspired mentor of the organization,Dr.Zhang Kaining,began discussions of the meaning of reproductive health.These conversations,a few of which I was able to witness,were lively and far-reaching.They ranged from how to talk to a person in your clinic who was back for the second time with a sexually—transmitted disease,to birthing practices of different ethnic groups,to legal rights and environmental degradation.The enthusiastic membership believed that reproductive health was an issue of pressing importance in their province and one that required more sensitive research than had heretofore existed.This edited volume is one collection of their work,demonstrating their group process and the differing views and disciplines of the YRHRA members.Focused on the concept of women—centered reproductive health,this book includes conceptual pieces,definitional pieces,reports of research,evaluations of educational approaches,and propositions for future work.The mission statement which opens the book is one of the most thoughtful and thorough postulations I have seen anywhere.Not only is some of this work a first for China,but I believe it has much to offer the larger community of people who are working to understand and address reproductive health concerns around the world.

Like all beginnings,this is truly a work—in—progress.By the time the book is published,our understandings will have deepened and perhaps even changed.The connections we draw to feminist theory and feminist process,the understanding we have of men and their special reproductive health needs and concerns as men,the partnerships we form across disciplines,our engagement with community and attention to the family,will all have grown beyond what you read here.Our understanding will have deepened so that our work can be more informed and effective.

For me as an individual,and for the Ford Foundation as an organization,it has been an honor to have been part of the YRHRA partnership.We are grateful to Kunming Medical College and to Prof.Zhang Kaining and the members of YRHRA for their hard work and commitment.

This book is an early milestone for China and for Yunnan on the path toward this goal of wisdom and positive change in the field of reproductive health.We celebrate it for the important step which it represents and look forward to future steps.

Mary Ann Burris,Ph.D.

Ford Foundation

June 1995