台灣少子化問題已被視為國安級挑戰。內政部統計顯示,2024年全國新生兒數跌破 13.5 萬人,創下歷史新低;同時,高齡化加速進展,65 歲以上人口已達總人口 19.64%,預估年底將突破 20%,正式邁入「超高齡社會」。在少子化與高齡化的雙重壓力下,生育政策為我國重要議題。台灣生殖醫學會今(26)日發布《我國少子女化對策——擴大人工生殖補助》建言書,中華民國生育醫學會理事長黃貞瑜、癌症希望基金會副執行長嚴必文、年輕病友協會理事長潘怡伶、台灣凍卵協會理事長曾琬婷及立法委員王正旭、陳菁徽連袂出席,除了感謝政府推出生育補助政策造福民眾外,也期待政府持續擴大人工生殖補助、放寬醫療性凍卵條件,守護女性生育力,共同推進少子化對策,邁向完美國家。
國家人工生殖補助見成效 面對少子化與高齡雙重壓力 生殖醫學會九大建言盼與政府攜手努力
根據內政部統計,2024 年全國出生數創歷史新低,且已連續超過 10 年呈現下降趨勢。與此同時,台灣也將邁入「超高齡社會」,人口結構正面臨壓力。生育力保護將成國力重要關鍵,其中不孕症是主要成因之一。為緩解少子化挑戰,政府自 2021 年推動人工生殖補助政策至今,成功迎來 24,653 名新生兒,為兩萬多個家庭帶來希望。中華民國生育醫學會理事長黃貞瑜表示:「試管嬰兒補助是國家級投資,已經實際幫助許多夫妻成家,讓民眾減輕負擔,避免因經濟壓力錯失生育機會。」
台灣生殖醫學會理事長蔡英美表示,學會長期關注國內少子化政策,要特別感謝行政院少子化辦公室、國健署一直以來的支持,陸續推動諸多新政幫助不孕家庭。不過臨床上仍有不少尚未被照顧到族群,為持續協力政府政策優化,學會參照臨床現況及國際政策趨勢提出 9 大建言,包括強化衛教知識宣傳、人工生殖補助方案調整、提高生育保存及凍卵可及性、人工生殖資料庫優化、友善生育環境推動、中央/地方協作、孕產家庭心理支持、人工生殖適用對象擴大、商業保險資源導入等,期待與政府攜手並進。
借鏡「完美國家」放寬醫療性凍卵適用對象 守護卵巢功能退化高風險族群
其中在生育力保存議題上,蔡英美理事長引用歐盟 Fertility Europe 在 2024 年評比歐洲各國生育政策的指標,提出的完美國家(perfect country)評比,其中法國、荷蘭、比利時、以色列被列為完美國家。醫學會也特別跨海向以色列生育司司長 Dr. Geva 請教相關政策規劃。發現政府除癌症患者外,亦將卵巢功能下降、需接受卵巢手術或提前更年期高風險女性,納入補助範圍,確保女性的生育自主權。蔡英美建議,可比照國際趨勢,逐步放寬補助對象,借鏡歐盟生育政策指標,邁向完美國家。台灣生殖醫學會理事賴宗炫醫師也表示,像是卵巢開刀、紅斑性狼瘡,或是兒童癌症的病患,都可視為下一階段的努力目標。
台灣凍卵協會理事長曾琬婷則觀察到,多數選擇凍卵的女性多數經濟自主、生活穩定、也期待未來能夠成家,凍卵對這類族群並非排斥生育,而是保留機會。政策上可思考擴大補助有高度生育意願的凍卵女性,並搭配獎勵配套,提升「轉化率」。另外也可以思考開放單身女性使用人工生殖,納入少子化政策核心。
病友團體:感謝政府關注病友生育需求 期待政策精進
癌症希望基金會副執行長嚴必文表示,感謝政府關注血癌與乳癌患者的生育需求,不過也觀察到癌症病友在就醫時,僅有不到 25% 的癌症病友在接受相關治療前被轉介到生育的科別,在生育力保存的諮詢上,仍有非常大的進步空間。期待未來政策能夠以試辦計畫為基礎,持續擴大推動、充分保障病友知情選擇權益,另外也推動發展「癌症病人生育利保護跨科指引」,讓民眾有底氣、勇氣邁向生育之路。
台灣年輕病友協會理事長潘怡伶則表示,過去常看到許多病友在育齡期得到癌症的問題,人生要做決策的階段就碰上疾病,人生軌跡因此改變,很感謝政府看見病友需求提出凍卵試辦計劃。針對養育問題,潘理事長也表示,補助不只是支出,更是國家級的長遠投資,年輕的病友往往因經濟壓力而生育卻步,「育兒比化療辛苦」,未來的育兒政策若能加強補助支持,更能減輕病友的負擔。
生育補助是國家投資 立委:政策可多元考量
立法委員王正旭表示,從台大醫院的研究的人工生殖投資報酬率研究,每投資1元,可以保障21.87元的投資報酬率。對國家來說是相當高的報酬,政府應加速推動,搭配數據成效作為資源配置依據。王委員也強調,試辦計劃如能順利推展,也期待能夠擴大到非癌症、重大傷病造成的不孕症病友,都能得到國家的支援。
立法委員陳菁徽也強調,醫療補助必須與職場友善並行,包括治療請假、彈性工時與隱私保護,接下來在立法院,除了人工生殖法修法外,接下來也會參考北歐模式,針對職場育兒政策,持續來做跨黨派溝通,讓雙親都有育兒的責任,在職場發展上,民眾都能兼顧育兒也無後顧之憂。
國健署:相關政策陸續落地、滾動更新 盼幫助民眾一起圓夢
最後蔡理事長表示,很肯定政府的努力,政策也已邁出相當重要的一步,不過台灣約三成不孕夫妻與卵巢功能相關,一旦卵巢功能下降即無法逆轉,錯失保存最佳時機將降低治療成功率,補助對象可再考量擴增因自體免疫疾病需接受卵巢毒性治療者、患損害卵巢儲備的良性卵巢疾病患者(如重度子宮內膜異位症、反覆卵巢手術者)、具有遺傳性卵巢早衰風險者三大族群。台灣生殖醫學會強調,將持續以專業協助國健署優化政策,期盼與政府攜手,讓行政院所設定的『2030 年總生育率提升至 1.4』願景逐步落實。
國健署沈靜芬署長樂見民間共同努力推進少子化政策,她也強調,政策上會持續參考各方意見持續滾動性調整,同時她也鼓勵民眾,將生育計劃放到人生規劃,倘諾在規劃上面臨不孕問題,政府也願意陪伴民眾一起走、一起圓夢。國健署會從不同面向給予民眾支持,同時與教育部做跨部會整合,提升國民的健康識能。接下來願意與民間攜手合作創造希望,培育健康的下一代,歡迎大家給予回饋

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