Achieving SDG related sexual and reproductive health targets in China: what are appropriate indicators and how we interpret them?

Background: Sexual and Reproductive Health (SRH) targets have been included as part of the United Nations Sustainable Development Goals and thus indictors are important to monitor the progress towards these targets. SRH indicators are recommended for setting norms and measuring progress at global level. However, given the diverse political, socioeconomic and cultural contexts in different countries, and lack of global agreement on broad indicators, it is important to select appropriate indicators for specific countries. Based on internationally recommended indicators and data availability in China, this paper selected four indictors to reflect SRH in China and interpreted these indictors by analyzing the underlying factors.

Methods: we employed secondary data analysis and key informant interview. The major secondary data were obtained from the China Health Statistical Year Book (2005-2017), China Statistical Year Book (2005-2017), and the sub-national estimates of the Global Burden Diseases Study 2016. We also interviewed 36 key informants at national and sub-national levels.

Results: the four selected SRH indicators are contraceptive prevalence rate (CPR), adolescent birth rate, abortion rate, and availability of school sex education. CPR of married women has remained above 75% over the last three decades, indicating a high level of access to family planning (FP) services; however, unmarried but sexually active women have significant unmet needs for FP services. Although adolescent birth rates in China remain low, the abortion rate, abortion numbers, and the ratio of abortions to births increased from 2014-2016 while FP policy was relaxed in China. This suggests that abortion among unmarried women is a significant contributor to the overall figures. Qualitative analysis of the availability of school sex education reveals a situation of policy absence and the conservative attitude of key stakeholders.

Conclusion: Since SRH challenges vary significantly between socio-economic, political and cultural contexts, indicators for measuring progress towards SRH targets of SDGs should be selected based on country context. The CPR and abortion rate are currently available and important indicators to monitor the most basic part of SRH in China, but require modification to ensure they can reflect universal access to quality reproductive healthcare by all reproductive age women, regardless their marriage status. Indicators on sex education need to be carefully developed to fit the context in China.