新移民女性健康照顧政策之性別檢視

Examine the Healthcare Policy for Marriage Immigrant Women with a Gender Perspective

蔡佩君(Pei-Chun Tsai)

指導教授 ： 張菊惠

長榮大學/健康科學學院/醫務管理學研究所/碩士(2008年)

https://doi.org/10.6833/CJCU.2008.00059

摘要

東南亞婚姻移民女性來到台灣，決定在這陌生的地方紮根生存，此人生階段走來艱難重重。在主流強勢文化同化之洪流，與夫家父權意識型態壓迫下，又因本身語言、經濟能力和生活適應等因素，致使其成為台灣健康弱勢族群之一。近年來政府與民間團體陸續推出多種服務方案，但是她們的聲音卻往往不被聽見，服務方案的內涵與輸送方式，是否符合當事人群體的健康需求，是否考量其母國文化的特殊性，是否提升其在夫家的自主性並縮小性別不平等，是過去研究較少關注的。故本研究先彙整分析台灣既有之新移民女性健康服務方案和新移民女性健康需求，並從中檢視其性別意涵。
本研究採用多元方法，使用文件內容分析、深入訪談與焦點團體訪談進行資料收集與分析。文件內容收集官方與民間針對新移民女性所提供之健康相關服務，包括衛教資料、識字/生活輔導班課程表、醫療與健康協助方案等。深入訪談對象為新移民女性密集地區中提供協助方案之政府與民間社團，以瞭解其服務方案內涵、運作模式與成效。最後再進行一場新移民女性焦點團體，探究其健康需求為何。資料先以WinMax98進行資料處理與主軸編碼，再以婦權基金會發展之「性別影響評估工具」進行政策之性別檢視。
研究結果分為四部分。首先，目前針對新移民女性提供之健康相關服務方案，學習者卻不知為何而學，為誰而學，輔導課程內容以「融」入台灣生活為主，其課程設計非以學習者需求為導向，健康供需不對口，只著重於生育健康，婦女本身的疾病預防與健康篩檢則毫不重視。其次是消失的主體性，新移民女性身體不但被夫家操控，甚至不被珍視，身體自主權部份則是缺席的，而與自身相關的避孕方法與選擇權也被掠奪。結紮本身不是問題，有問題的是結紮的決策過程與施行過程，邊緣化新移民女性，且以福利之名的結紮補助政策，係透過國家政策正當化地對新移民女性進行生育控制，卻也反映出政策制訂者下意識或無意識之種族歧視。再者新移民女性健康照顧服務不具文化適切性，看病必須配合通譯員時間，況且並非有通譯員就能解決就醫障礙。徒具形式的健康服務毫無文化敏感性，新移民女性無法得到該有的健康照顧服務與品質保障，而未瞭解新移民女性母國文化背景，健康資訊直接翻譯導致不可理解、不尊重和不具可近性。
最後以性別影響評估工具之參與、資源、價值、權益四大面向，進行性別檢視。參與部分，家庭計畫決策參與的排除隔離，社區服務方案的參加亦僅達到指派、遵從的教化式參與，缺乏具合作、充權的參與，需求之優先次序界定由專家主導。資源部分，需求與服務提供不對等、不及時、不具文化適切性，未符合家庭生命週期發展之階段性需求。而價值部分，服務輸送傳遞複製傳統父系社會之性別角色迷思，新移民女性成為服務、輔導甚至矯正之標的，更加鞏固其性別弱勢地位。權益方面，新移民女性主體性被剝奪，政策制訂者與醫療人員甚至成為壓迫者之共犯結構。
本文針對現行健康相關服務政策提出，以學習者需求為導向、整合資源，提供新移民女性充權教育，使其能力提升與意識覺醒，而達自主自決的層次。其次提供有效的、可理解的與受尊重的衛教資料，並廢除新移民女性生育調節補助。健康相關服務人員，應需接受多元文化與充權教學者之在職訓練，以提供新移民們具文化適切性之服務。

關鍵字

新移民女性 ； 健康照顧政策 ； 性別影響評估 ； 充權 ； 具文化適切性之健康服務

並列摘要

Female marriage immigrants who resettled from south-eastern Asia to Taiwan are changeable in their life. Under the strength culture assimilation, consciousness of paternity and self factors such as economic ability and living adaptation, female marriage immigrants became disadvantaged minorities. In recently, government and private groups proposed several service projects. Whether the content of service projects and the ways of delivery match their demand, consider the specific culture of mother country, and even elevate their autonomy of marital power and narrow the gap between gender impacts. All of these issues are less discussed in the past research. Therefore, this study would collect relative healthcare service projects and demands focusing on female marriage immigrants to assess gender impact.
This study applies content analysis, in-depth interview and focus group to data collection and analysis. Documental content collections include health relative services offering from government and private groups such as patient education activities, class schedules for literacy and living counsel, medical and health aids, and so on. In-depth interview recruit government and private groups offering projects for high density areas of new female immigrants. Through in-depth interview, we realize the content of service projects, model, and affect. Last, we held a new female immigrants focus group to discuss health demand. Data processed by WinMax98 and axle coding. Then, apply “gender impact assessment tool” developing by female right foundation to detect gender impact.
Research results could separate fourth sections. Firstly, health-relative service projects for female marriage immigrants focus on fusing living as part of Taiwan’s life. The project was designed lack of learner orienting, mismatch supply and demand, and only focus on birthing rather than disease prevention and health screening.
Secondly, dismiss physical autonomy. New female marriage immigrants’ bodies were controlled, not cherished and be absent from physical autonomy. The methods of contraception were plundered. Legation of oviduct itself is not a problem but the process of decision and carry out are the major problems. It borders new female marriage immigrants. Instead of welfare subsidy of birth control for new female marriage immigrants, policy maker regulated race discrimination with or without conscious alert.
Furthermore, healthcare service for new female marriage immigrants was not culture suitable. Seeing a doctor depends on time schedule of interpreters but interpreters could not solve medical obstacles. Healthcare service is a mere formality and lack of culture sensibility. It could not guarantee healthcare and quality for new female marriage immigrants. Health information directly translation became unreasonable, unrespectable and not access without realize new female marriage immigrants’ culture background of mother country.
The last, gender impact assessment tool includes participation, resource, value and right to assess gender impact. For participation, family plan participates and excludes. Community service project merely achieves assignment, obedience but lack of corporation and empowerment. The priority of demand is decided by experts. For resource, demand and service was not consistency, not on time and no culture suitable, and not match the demand of family life cycles. For the value, service delivery duplicates gender confusion of traditional patriarchal society. New female marriage immigrants became servicing, consulting and correcting target. Hence, consolidate gender disadvantage. For the right, main body of new female marriage immigrants was abolished. Policy maker and medical staffs is accomplice with oppressor.
This study proposed relative healthcare service focusing on demand of learning; integrating resource; and empowerment education for female marriage immigrants to elevate self ability and alert of consciousness. Meanwhile, it offers effective, reasonable patient education activities, and abolish subsidy of delivery. Health relative staffs should accept multi-culture and empower learning in order to offer new female marriage immigrants suitable service.

並列關鍵字

new female immigrants ； healthcare policy ； gender impact assessment ； empowerment ； and culture suitable healthcare service

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