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CRC

Second National Review 2022 Shadow Report

Articles of Treaty or Act involved :

Topic1:

Related Provisions on Convention on the Rights of the Child:

Article 2, Section 1,、Article 3, Section 1、Article 7, Section 1

Topic2:

Article 52 of the Convention-specific Document

Article 53 of the Convention-specific Document

Topic3:

Article 54 of the Convention-specific Document

Topic4:

Article 184 of the Convention-specific Document

Article 205 of the Convention-specific Document

Article 213 of the Convention-specific Document

Quinne Lo 0912902090

twvipcare@gmail.com

2022/3

The report is closed

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 Table of Contents

Topic1…………………….……………………………………………..…………………………2

Articles of Treaty or Act involved ………….……………………………..………….3

Analysis of the Issue..…….……………………………...…………………….………….3

Recommendations…………………………………………..………………………………6

Topic2……………………………….……………………………………..………………..……8

Articles of Treaty or Act involved ……………………………………………….……8

Discussion……………………………………………………………………………………….10

Suggestion……….………………………..………………………………………….……….12

Topic3…………………………………………………………………………….………………18

Articles of Treaty or Act involved ……………………….…………………….……18

Issue status……………………………………………..…..…………………………………18

Analysis of the Issue.……………………………..……………….………………………18

Specific recommendations.…………………..…………………………..………20

Topic4…………………………………….……………..……………………….………………21

Articles of Treaty or Act involved ………………………..…………………….……21

Analysis of the Issue…………….…………………..……….……………………………21

Conclusions and

Recommendations…………………………….………..…………..……………….…26

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 Topic1:

Same-sex adoptions are against the best interests of children

Articles of Treaty or Act involved :

Related Provisions on Convention on the Rights of the Child:

1. Article 2, Section 1, “States Parties shall respect and ensure

the rights set forth in the present Convention to each child

within their jurisdiction without discrimination of any kind,

irrespective of the child's or his or her parent's or legal

guardian's race, colour, sex, language, religion, political or

other opinion, national, ethnic or social origin, property,

disability, birth or other status.”

2. Article 3, Section 1, “In all actions concerning children,

whether undertaken by public or private social welfare

institutions, courts of law, administrative authorities or

legislative bodies, the best interests of the child shall be a

primary consideration.”

3. Article 7, Section 1, “The child shall be registered immediately

after birth and shall have the right from birth to a name, the

right to acquire a nationality and. as far as possible, the right

to know and be cared for by his or her parents.”

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 Issue:

In an extremely controversial ruling, the Taiwan Kaohsiung Juvenile

and Family Court has rule that two males can jointly adopt a baby

girl, making the girl legally to have two dads in Taiwan. Despite the

Taiwan 2018 referendum, Propositions 12, calls upon Government

to establish special “civil partnership-like” laws to protect

Taiwanese gays and lesbians right to pursue a “wife and husband-

like legal union relationship”, the adoption for children is limiting

to “kinship by blood” only. Hence, this ruling is not only without

precedents, but moreover illegit within Taiwanese legal framework

and local customs. The administrative branch of Taiwanese

government’s very passive role, consequence in Child’s best

interest being ignore, i.e., restraining the presence of motherhood

in a girl’s life.

Analysis of the Issue:

1. Taiwan Kaohsiung Juvenile and Family Court’s ruling not only

violated Taiwan democratic process on law amendment

(revising adoption policy) but most importantly, the ruling that

allows “motherhood” to be missing from a child’s life is not

only not in Child’s best interest (a direct violation on Article 3,

Section 1 and the General comment No. 14 point 39.)

A. Taiwan Constitution Court has made it very clear in its

Interpretation No. 748 ruling that it “only address the issues of

whether the provisions of the Marriage Chapter…” and that the

“Interpretation does not deal with any other issues”. (Judicial

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 Interpretation No. 748 paragraph 24) As such, it is not possible

to “extend” Judicial Interpretation No. 748 beyond Taiwan Civil

Code’s Marriage Chapter, and to draw on it inference to

adoption, as it belongs to Taiwan Civil Code’s “Parents and

Children Chapter”.

B. Additionally, Taiwan Constitution Court has also relinquished

the “procreation cultural connection to marriage” as an

argument pro-same sex union, and such that regardless of

same-sex union or opposite-sex union, childbearing is no

longer a legit linkage or the fundamental protection cover by

Taiwan Constitution.

C. Taiwan “Act for Implementation of J.Y. Interpretation No. 748”

Article 20, clear state application of Civil Code regarding to

adoption only apply to genetic child of the other party and that

is the de facto end of Taiwan Civil Code Marriage Chapter.

There is simply no legal ground for a Child to have two fathers

in Taiwan.

2. The sequential order of actions taken by the plaintiffs raise

many eyebrows as to whether or not they are acting in the

best interest of the girl? Adopting the girl first as an individual,

then call for press conference, then file application to court to

have government registry to be amended, and have another

press conference? It seems to many that the baby girl is simply

a drama prop rather than a precious girl.

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 3. The lack of proactive attuite to comply with CRC, from the

Taiwanese government administrative branch has outrage

culturally conservative groups in Taiwan. CRC not only call for

best interest of children in minds, but moreover, proactively

action to protect children’s welfare with in bound of local

social customs. Taiwan government fails to proactively

protect Taiwanese children in the following manners:

A. “Young children are rights holders” is straightforward with the

General comment No. 7, article 3. In conjunction with article 5

and article 6, it is state’s duty, in this case the administrative

branch of Taiwanese government, to provide a child’ parent as

much support as possible, including subsidy economic wise to

ensure a mother can take care her child. (Point 20).

B. With reference to CRC General comment No. 14 point 18, we

would like to remind the committee members, that:

1. With cultural connection between marriage and “procreation”

being relinquished by Taiwan Constitutional Court the only

legit reasoning for allowing an adult to adopt a child is with the

presumption that he or her would one day entering a wife and

husband marriage, in connection toward CHC article 7 section

1 and the General comments No.7 Point 16.

2. The issues of would same-sex couple makes good parents is

not the chief concerns in Taiwan, it is the stability of family

that concerns the public when it comes to adoption. In 2020,

Taiwan has 139 children being adopt locally, and according to

statistics only 3 are being adopted by an un-marriage

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 individual, and that Kaohsiung Juvenile and Family Court’s

ruling simply demonstrate that this is becoming a loophole, for

potential political agenda, which in itself is fundamentally

inconsistent with CRC. The stability of the adopter’s family is a

question that has to be address by taking different family

structure into accounts, then based on scientific fact with

democratic process new revision to Taiwan adoption law

should be proposed, Taiwan Kaohsiung Juvenile and Family

Court has not been grant power by the people to make such

change, and the in response of Taiwan administrivia bench of

government to fails to act proactively in this case is putting

inerasable harm to the girl.

C. Finally, we would like to call Committee’s attention to the

dangers of war, as the Russian-Ukrainian war remind all Taiwan

citizen that the status of Taiwan and China conflict is on-going,

and the war status since 1949 has not come to an official peace

agreement. With current Taiwan constitution requiring all

male to be in service, Taiwan Kaohsiung Juvenile and Family

Court’s ruling has put the baby girl in a clear disadvantage,

where both daddies are requiring to be in service; while all

other babies at least still have a mommy or mommies.

Recommendations:

The research reported that a child raised by biological parents or

family is most suitable. Even though there are many misfortunes

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 nowadays, we society should pursue the best environment for

children in order to meet the best interests of children in Taiwan.

Using a representative sample of 207,007 children, including 512

with same-sex parents, from the U.S. National Health Interview

Survey, prevalence in the two groups was compared. Emotional

problems were over twice as prevalent for children with same-sex

parents than for children with opposite-sex parents. Joint biological

parents are associated with the lowest rate of child emotional

problems relative to step parents, single parents, or same-sex

parents. （ https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2500537 ）

This study is in line with CRC Article 7, a family with biological

parents is best for children, and it is also in the best interests of the

children. The people of Taiwan have not granted judges the ability

to disregard the best interests of children, nor can they endorse

political judgments that only consider groups of same-sex sexual

orientation. The government should not block children from

entering a more favorable environment for their growth and

development, that is, children should be adopted by a family with

parents biologically consistent with their original parents (if they

adopted by a same-sex family, this opportunity will be blocked).

The government should be more cautious in amending the law to

allow same-sex couples to adopt children. In particular, the

necessity of mother for children must not be ignored. The problem

of low birth rate is serious, and every child must be cherished. Let

children have a better future and their best interest.

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 Topic2:

'Gender-self-determination' education and policies harm

children's safety, human rights and health

Articles of Treaty or Act involved :

Article 52 of the Convention-specific Document

Article 53 of the Convention-specific Document

Situation

1. A 7-year-old grade 1 natal male student claimed he was a girl,

and he entered the women's toilet to violate the privacy of

natal female students.

A mother posted on the Plurk: "My daughter, grade 1, said that

there was a male classmate who claimed to be a girl and insisted

on going to the womens' toilet. He just wanted to peek at the

girls to pee.” (Picture 1) (1)

Figure 1 Screenshot of the message “grade 1 male student's

invasion of the female toilet”

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 A psychiatrist and pediatric endocrinologists reported to

prescribe highly controversial "puberty blocker" to a 12 years

old girl with gender dysphoria in a Medical Conference in

Taiwan in 2019 (Figure 2) (2). The vast majority of children on

puberty blockers had lower bone density than their peers,

impaired brain development and 'negative effects on IQ for

gender-dysphoric children', and hypertension. (3)

Figure 2 A psychiatrist and pediatric endocrinologists reported to

prescribe highly controversial "puberty blocker" to the minority.

9

 A natal male without sex-reassigned surgery changed his gender

into woman on the ID card in Taiwan in 2021

The Supreme Administrative Court ruled that “E”, who didn’t do

the sex-reassigned surgery and still possessed penis and testes,

could change the gender into woman on the ID card. Taiwan

produced “the first woman with penis and testes ". “E” has all

the privileges of women (4).

Discussion

1. The definition gender and sex was age-inappropriate (5), and

caused students gender-self-determination (5) with bad behaviors

(such as peeking at the girls to pee in the womens’toilet).

2. Girls were sexually assaulted by transgender rapists in the women

toilets.

Several cases about girls sexually assaulted by transgender

women occurred. An American father revealed that his ninth-

grade daughter was the victim after a male student “wearing a

skirt” allegedly attacked her in the girl’s bathroom.(6)

3. UK and Sweden ended all use of puberty blockers and cross-sex

hormones for minors.

Keira Bell was born female but began puberty blockers at 16

after referral to the Tavistock. She had a double mastectomy,

which she now regrets. She sued NHS. Professor Christopher

Gillberg, an expert in child and adolescent psychiatry, who

believes prescribing drugs to delay puberty – a first step in

gender treatment – is a scandal and tantamount to conducting

'a live experiment' on vulnerable children. 'We have left

10

 established evidence-based clinical practice and are using

powerful life-altering medication for a vulnerable group of

adolescents and children based upon a belief.

High Court judge banned an NHS gender clinic from giving

puberty-blocking drugs to children (7).Sweden’s Karolinska

ended all use of puberty blockers and cross-sex hormones for

minors outside of clinical studies in May, 2021 (8)

4. Gender-self-determination allowed more men into women’s spaces.

The vast majority of reported sexual assaults at public swimming

pools in the UK take place in unisex changing rooms. The data,

obtained through a Freedom of Information request by the

Sunday Times, suggests that unisex changing rooms are more

dangerous for women and girls than single-sex facilities. Just

under 90 per cent of complaints regarding changing room sexual

assaults, voyeurism and harassment are about incidents in unisex

facilities. What’s more, two thirds of all sexual attacks at leisure

centres and public swimming pools take place in unisex changing

rooms.

Of 134 complaints over 2017-2018, 120 reported incidents took

place in gender-neutral changing rooms and just 14 were in single-

sex changing areas.。(9)

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Suggestion

1. There is blur and vague interpretation of the “gender diversity”

in the gender equity education law, and the interpretation is

different from the original meaning in English, which caused

teachers to be confused. It is suggested to amend the

interpretation of Article 2, “Gender diversity" means "diversity

of gender representation", rather than “many different

genders”.（10）

2. Please include professionals in "Child Development",

"Educational Psychology", "Educational Curriculum Design",

"Children's Medicine" and other professionals to design the

framework of gender equity education. The foreign and

aggressive sex and gender education is not proper for

Taiwanese students.

3. It is necessary to re-evaluate the age-inappropriate contents

with " many different genders" in the textbooks, clearly define

"gender", and stop teaching "self-determination of gender

identity" in the elementary and junior high schools.

4. Ministry of Health and Welfare or the Medical Association

should prohibit the use of puberty blockers on minors as

United Kingdom and Sweden did.

5. Groups of "women”, “children” and children's rights" should

be included in the discussion of the “the requirements of

legalization of gender change”, and the impact of the

legalization of gender change on women and children.

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 6. We should be aware of the problems caused by gender-self-

determination in foreign countries. Many children and women

have been sexually assaulted and violently attacked by

transgender women in these countries. Therefore, we should

be very careful about the law of “legalization of self-identified

gender change”.

(1) The website of “grade 1 male student's invasion of the

female toilet”https://www.plurk.com/p/orsz5g

(2) The content a psychiatrist reported using puberty

blockers on a 12 year-old girl in a Medical Conference in

Taiwan in 2019

「…跟家長溝通的過程，需要花非常非常久的時間，那最近

也很幸運的就是我們有遇到一個她哦，那個小孩子很主動，

她是一個小學的女生，小學五年級的一個女生，身體上的女

生，可是她從小就非常明確的知道自己其實是想要成為一個

男性。好，她現在學校裡頭參加是男子足球隊這樣子。哦，

她的家長也非常非常開明，而且也願意讓她說一個男性的性

別角色在學校生活，也特別把她挑了一個學校，其實是相對

比較友善的這樣子。學校環境對於性別這樣發展友善，所以

我們也跟臺大這邊的小兒就是內分泌科這邊合作好，他家長

也充分能夠理解到這件事情，所以我們開始可以使用

blocker (青春期阻斷劑)，好像這樣子的個案，讓他未來能

夠爭取更多的時間，那她有更多時間思考，以及他未來能夠

真正成為自己想要的一個內外合一的人。我相信在未來的十

幾 20 年，這一定會漸漸發展下去，我們會讓我們的青少年

有更多能夠理解自己的機會，有更多的選擇權，那其中對於

兒童青少年。相對是容易的，對於家長的衛教反而是困難

13

 的，那我覺得也是這堂課能夠跟大家分享的一些經驗，這絕

對不是一條容易的路，但是如果大家在臨床過程當中有這樣

的的話，我們至少可以讓我們家長能夠有一些些開啟他們更

多元想像的機會。」

(3) Cheng I (2021) Gender Dysphoria in Children and

Adolescents – Review

https://www.tma.tw/ltk/110640504.pdf

(4) A natal male without sex-reassigned surgery changed

his gender into woman on the ID card

https://udn.com/news/story/7321/5766469

(5) The contents of “many different genders”in the

textbooks.

案由 性別定義（多元多樣）已經造成(性別)不安

(台灣實例),這樣情況下孩子該不該接受這

樣的教育呢?

課本 1

翰林五下綜合

活動 108 年 8

月版本

14

 課本 2

南一五下 藝術

與人文 108 年 2

月出版

課本 3 泰宇高

中護理 108 年

出版

15

 行政院

多元性別之學

校教育

109 年 6 月擷取

https://www.ey.gov.tw/Page/9277F759E41C

CD91/b39986b6-49e6-4b13-8a1e-

d325abbc89ba

(6) Parents demand Virginia superintendent be fired over

alleged sex assault cover-up

https://nypost.com/2021/10/13/parents-demand-superintendent-

be-fired-for-alleged-sex-assault-cover-up/

(7) . Daily mail. 'A live experiment on children': Mail on

Sunday publishes the shocking physicians' testimony that

led a High Court judge to ban NHS's Tavistock clinic from

giving puberty blocking drugs to youngsters as young as

10 who want to change sex, 2021.

https://www.dailymail.co.uk/news/article-9130157/The-physicians-

testimony-led-High-Court-judge-ban-child-puberty-blocker-

drugs.html

(8) Sweden’s Karolinska Ends All Use of Puberty Blockers and

Cross-Sex Hormones for Minors Outside of Clinical

Studies https://segm.org/Sweden_ends_use_of_Dutch_protocol

16

 (9) Unisex changing rooms put women in danger (2018)

https://www.thetimes.co.uk/article/unisex-changing-rooms-pu

t-women-in-danger-8lwbp8kgk?region=global

（10）

There is blur and vague interpretation of the “gender diversity” in

the gender equity education law, and the interpretation is different

from the original meaning in English, which caused teachers to be

confused. It is suggested to amend the interpretation of Article 2,

“Gender diversity" means "diversity of gender representation",

rather than “many different genders”. （10）

Article 2

The terms used in this Act are defined as follows:

1. Gender equality education: It refers to teaching

respect for gender diversity differences through

education, eliminating gender discrimination, and

promoting substantive equality between genders.

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 Topic3: Indefinite of "Sex" and "Gender" and inappropriate use

of "multiple gender", adverse to children's development rights

Article of Treaty or Act involved :

Article 54 of the Convention-specific Document

Issue status:

The Implementation of Taiwan Gender Equity Education Act and

the Gender Mainstreaming Policy has cause great social tension

due to inappropriate and confusing word choice for the translation

of the term “Gender”. The consequence not only results in

educational resources discrimination toward children from

minority groups, moreover, violation in parent’s liberty to chose

education that is in conformity of their religious and moral

convictions, in accordance with the International Covenant on

Economic, Social and Cultural Rights (ICESCR) Article 13, Section 3.

Issue analysis:

1. The child representative has ask government officials on the 2nd

National Report of the Convention on the Rights of the Child on

February 23, 2021: "How many gender(s) are there in total?"

And that the chairperson replied with: A. “I don't know how

many kinds of gender”, and B. “As the times evolve, there may

be more and more genders.”

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 2. The response from the chairperson is in direct contradiction to

UN WHO and UN Women’s definition of “Gender”, as it is clear

define that “Gender refers to the characteristics of women,

men, girls and boys that are socially constructed.” Taiwan is

experiencing the similar confusion between “gender” and “sex”

that happen in western world as well, and that Taiwan

government’s word choice for “gender” happen to be same

term use as biological sex, simply adding fuel to the fire.

3. Worsen an already bad situation, Taiwan Gender Equity

Education Act article 2 has limit all “gender related policy” in

Taiwan to be applicable to two aspects of Gender, i.e., sexual

orientation and gender identity. Other socio-cultural relating

aspect of gender, such as: class, race, poverty level, ethnic

group, sexual orientation, age, etc., according to UN Women,

are inappropriately ignore and disregard by Taiwan government

official.

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 Specific recommendations:

We call on Taiwan government to amend and adopt “社會性別(shè

huì xìng bié)” as the official translation of “gender”, replacing the

existing confusing word choice, in both laws and policy. Moreover,

we ask other gender aspects, specifically the socio-cultural relating

aspect of gender defined by UN Women, such as: class, race,

poverty level, ethnic group, sexual orientation, age, etc., to be all

included in Taiwan Gender Equity Education Act article 2, so that

equal protection can be officially extending to all minority group’s

children.

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 Topic4: Children's right of health is unvalued in remote areas

Articles of Treaty or Act involved :

Article 184 of the Convention-specific Document

Article 205 of the Convention-specific Document

Article 213 of the Convention-specific Document

Analysis:

1. Disparity in the numbers of pediatricians for Taipei and Taitung

2020 Taipei City Taitung County

Number of 18,399 1,350

newborns

Number of 715 17

Pediatricians

Source: Taiwan Ministry of Health and Welfare

The number of newborns was 18,399 in Taipei, and the number of

newborns was 1,350 in Taitung in 2020. There are 715 pediatricians

in Taipei and 17 pediatricians in Taitung. One pediatrician took care

of 25.73 newborns in average in Taipei, and one pediatrician took

care of 79.41 newborns in average in Taitung. The workload of

pediatricians in Taitung is three times that of pediatricians in Taipei,

which means that children in Taitung have only one third of the

resources of medical care in Taipei.

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 There are very few doctors in Taitung, and even fewer pediatric

sub-specialists. There is no pediatric surgeon. For hernia,

cryptorchidism, hypospadias and other surgeries, patients can only

go to other counties or cities, or wait for the pediatric surgeon from

Taipei to do operations once a month. There are also no pediatric

endocrinologists. If there are children with delayed development or

precocious puberty, they could only be cared by general

pediatricians in Taitung. They have to be transferred to other cities

for help if the conditions of the children are severe. It is not easy to

travel between Taitung-Kaohsiung or Taitung-Hualien, because it is

hard to get the tickets of trains or flight, and the costs of tickets are

expensive and the parents can’t afford them. (Note 1.1)

2. High neonatal mortality rate

In 2020, the neonatal mortality rate was 2.6 per 1,000 in

Taipei, and the neonatal mortality rate was 6.7 per 1,000 in

Taitung. The neonatal mortality rate in Taitung was 2.5

times that of Taipei. (Note.22)

1 Note 1. [Hospital Referral] Use the Puyuma train as an ambulance? Broken hospital referral lifeline

https://www.twreporter.org/a/child-health-care-no-referral-platform

There are no pediatric surgeons in Taitung. "You buy me a ticket for the Puyuma train, and I'll help

transfer it to a hospital in another city." This bold doctor is Zheng Yi, a pediatrician at Taitung

Christian Hospital, who is often regarded by children as an "uncle doctor." "The female doctor

pushed 4 bottles of oxygen in a cart, and took the train with the parents to transfer the child named

Xiaoxian to the National Taiwan University Hospital. It took a total of 4 hours by train and changed

2 oxygen cylinders.

2 Note 2. Taiwan's low birthrate problem is getting worse, impacted by the fact that Taiwan's infant

mortality rate is among the highest in the world

https://health.udn.com/health/story/5999/4904365

Judging from the average statistics from 2018 to 2019, Hualien County, Taitung County and

Pingtung County are the top three highest infant mortality rates, and the mortality rate has soared

22

 3. Disparity in the early intervention and rehabilitation for children

in Taipei and Taitung

2020 Taipei City (per Taitung County (per

10,000 people) 10,000 people)

number of speech 0.53 0.37

therapists

Number of clinical 1.02 0.37

psychologists

Number of physical 4.16 2.04

therapists

Number of 1.56 1.11

occupational

therapists

Source: Taiwan Ministry of Health and Welfare

Statistics from the Taiwan Ministry of Health Services in 2020 show

that the ratio of speech therapists is 0.53 per 10,000 people in

Taipei, and only 0.37 in Taitung. The ratio of clinical psychologists is

1.02 per 10,000 people in Taipei, and only 0.37 in Taitung, The ratio

of physical therapists is 4.16 per 10,000 people in Taipei, while it is

only 2.04 in Taitung. The ratio of occupational therapists is 1.56 per

10,000 people in Taipei, while it is only 1.11 in Taitung. Overall,

children with developmental delays in Taitung have relatively few

resources and opportunities for treatment.

4. The transportation convenience in remote rural areas is

insufficient, the public transportation network is sparse, and the

medical accessibility is poor

The remote rural areas are sparsely populated (Taitung County

to 5.9 per thousand to 7.9 per thousand people.

23

 covers an area of 3,515 square kilometers and the city in Taipei is

271.8 square kilometers). The convenience of transportation is far

worse than that of the city, and the public transportation network

is sparse. For example, buses only run once an hour. It is extremely

inconvenient for parents in Taitung to take their children for

medical treatment or rehabilitation, not to mention islands outside

Taiwan.

A pediatrician in Taitung said that she had a patient from Lanyu.

The mother took three months off work to take her child to live in

Taitung for early intervention and rehabilitation, which seriously

affected her family and work. She finally had to move her family

out of Lanyu for her child’s sake.

5. Part-time doctors from other cities lack medical experience in

rural areas, making it difficult to integrate and adapt to rural

medical care models

Because children's sub-specialists are seriously scarce, part-time

pediatricians have to be hired from other cities in order to provide

more opportunities for children in remote areas. Some

pediatricians can only come to Taitung once a month, only from

9:00 am to 2:00 pm, rushing to take the 3:00 pm flight back to Taipei.

Most of them are reluctant to stay a little longer, even if the

Ministry of Health and Welfare issued an official document stating

that patients cannot be rejected. Children can’t be evaluated due

to lack of doctors and times

(Doctors have to fly back to Taipei at 3 pm).

24

 6. Insufficient hardware and software equipment for remote

diagnosis and consultation. The network signal is weak and the

performance is poor, unable to help meet the medical needs of

remote areas.

For example: Since last year, the Genetics Department of Hualien

Tzu Chi Hospital and Taitung Christian Hospital have started

medical teleconsultation four times a year. The conditions of

software and hardware equipment used were unstable, and the

computer frequently crashes. For every medical teleconsultation,

the hospital's computer staffs must be on call to resolve

emergencies.

7. The cost of transferring to other hospitals is high, and parents in

remote areas cannot afford it, which is like leaving their

children waiting to die

The population in remote areas is relatively small, and the medical

staffs of critical care lack experience. Severely ill patients can only

be transferred to larger hospitals in other cities, but the transfer

costs are high, and some children are given up for treatment.

Example: A Taitung pediatrician sadly stated that a patient need

extra-corporeal membrane oxygenation, (ECMO). Because there

was no 24 hours medical staff in Taitung Hospital, they could only

be transferred to other hospitals. However, parents need to pay

NT$100,000 for the transfer, which is equivalent to their four-

month income. The parents were unable to afford it, and finally had

to give up the treatment of the child, and the child died.

25

 8. The government's medical care policy does not fully consider the

actual situation children

The government is now promoting “dedicated doctors” for children.

Only pediatricians or family physicians could be “dedicated

doctors”. The government's children's medical care program can

only be implemented by pediatricians and family physicians.

However, in Taitung and Lanyu, there are not enough pediatricians.

If the doctors are not pediatricians or family physicians, the

children can not have this welfare, which is very unfair.

Conclusions and Recommendations:

1. Increase the government budget for medical care in remote

area, especially in areas with high neonatal mortality.

2. Remote areas, especially in areas with inconvenient

transportation such as Hualien and Taitung, can implement

transportation subsidies for children to seek medical care, as

well as the priority to reserve seats for public transportation

when seeking medical treatment across cities.

3. Provide free referral services for severely ill children in remote

areas.

4. In specific rural areas, the salaries and subsidies of medical

staffs should be increased.

5. To engage, develop, train, and reward local residents in remote

areas to do various medical care-related jobs, and provide them

with scholarships and future job opportunities.

26

 6. Accelerate the legalization of requirements and guidelines for

tele-medical care consultations or treatment.

7. Strengthen the construction of electronic network signals in

remote areas, and optimize hardware and software equipment.

In addition to taking into account the privacy of local residents,

the policy should also consider making it more convenient for

local residents.

8. Only by setting up an exclusive plan for the care of children in

remote rural areas can they truly help children in remote areas.

City system may not fulfill the requirement of rural areas.

27

---

來源 PDF:34_20230628105813_3469693.pdf

兒童權利公約

第二次國家審查 2022 影子報告

涉及 CRC 條次

⚫ 主題一：聯合國〈兒童權利公約〉第二條第一項、第三條第一項、第七條第一項

⚫ 主題二：CRC 第二次國家報告條約專要文件第 52 點、第 53 點

⚫ 主題三：CRC 第二次國家報告條約專要文件第 54 點

⚫ 主題四：CRC 第二次國家報告條約專要文件第 184 點、第 205 點、第 213 點

⚫ 不公開

聯繫電話: 0912902090

twvipcare@gmail.com

中華民國 111 年 3 月 31 日

0

 目錄

主題一、同性收養子女有礙兒童最佳利益………………………………2

條文…………………………………………………………………………………………2

問題現況……………………………………………………………………………………2

問題分析……………………………………………………………………………………2

具體建議……………………………………………………………………………………5

主題二、現今「性別」教育及政策，傷害兒少安全、人權及健康權.……6

條文…………………………………………………………………………………………6

問題現況……………………………………………………………………………………6

具體建議……………………………………………………………………………………8

主題三、「性別(Sex)」、「社會性別(Gender)」定義不清，「多元性別」

用詞不當，不利兒童發展權益……………………………………………13

條文…………………………………………………………………………………………13

問題現況……………………………………………………………………………………13

問題分析……………………………………………………………………………………13

具體建議……………………………………………………………………………………15

主題四、偏鄉兒童健康權不被重視與落實………………………………16

條文…………………………………………………………………………………………16

問題分析……………………………………………………………………………………16

具體建議……………………………………………………………………………………19

1

 主題一:同性收養子女有礙兒童最佳利益

涉及公約條文聯合國〈兒童權利公約〉:

第二條第一項：「簽約國不得因兒童本人或其父母或法定監護人之種族、膚

色、性別、語言、宗教、政治或其他主張、國籍、出身、財

富、殘障、出生或其他地位之不同而有所歧視。應尊重並確保

其轄區內每一兒童在本公約中所揭櫫之權利」；

第三條第一項：「所有關係兒童之事務，無論是否由公私社會福利機構、法

院、行政當局或立法機關所主持，均應以兒童之最佳利益為優

先考慮」；

第七條第一項：「兒童於出生後應立即被登記，兒童出生時就應有取得姓名以

及國籍的權利。 在可能的範圍內有知其父母並受父母照顧等權

利。」

問題現況:

高雄少家法院裁定許可男同性戀者喵喵的「收養聲請」，正式成為女寶寶

肉肉在法律上的另一個爸爸 (連結：https://reurl.cc/pWEMv4)。本案台灣高

雄少年及家事法院，在未經民主程序修改法律的前提，及無法源基礎及前案例

的情況下，「指導告訴人」-類推〈司法院釋字第七四八號解釋施行法〉」後，

無視無法律基礎擅專判決女童由兩位父親共同收養，完全忽視「母性」於兒童

成長過程中「獨特」且「不能被忽視」的重大影響，並台灣行政單位明知法院

未依法判決又知道〈兒童權利公約施行法〉為我國業於 2014 年生效，台灣行政

與司法單位明確違背〈兒童權利公約〉，未有充分捍衛兒童最佳利益。

問題分析:

1.台灣高雄少年及家事法院，非但僅在提示告訴人聲請方向後才開庭，又僅 開

庭一次，更在未經民主修法辯論程序的前提下，就擅專地不依法也不依前例

擅專判決，除違背司法公正及程序正義外，尚不依法判決，法官政治改革目

2

 的行經高於對兒童最大利益之考量，違背〈兒童權利公約〉第 3 條第一項事

實明確(及〈兒童權利公約第 14 號一般性意見書第 39 點〉：

A.台灣憲法法庭之「釋字第 748 號解釋」理由書第 18 段明確指出以民法

「婚姻章規定…作成解釋，不及於其他」，而收養他人子女屬《民法》

親屬篇父母子女章明確不在釋字第 748 號解釋之範疇中。

B.台灣憲法法庭之「釋字第 748 號解釋」理由書第 16 段：「如認婚姻係以

保障繁衍後代之功能為考量，其著眼固非無據。然查婚姻章並未規定異性

二人結婚須以具有生育能力為要件；亦未規定結婚後不能生育或未生育為

婚姻無效、得撤銷或裁判離婚之事由，是繁衍後代顯非婚姻不可或缺之要

素」，台灣憲法法庭於「釋字第 748 號解釋」清楚切割憲法所保障之「二

人，為經營共同生活之目的，成立具有親密性及排他性之永久結合關係」

並不涉及「傳宗接代」之保障，故難以將本憲法解釋延伸致人民有「因傳

宗接代而收養」之基本保障。

C.我國〈司法院釋字第七四八號解釋施行法〉第二十條雖有規定：「第二條

關係雙方當事人之一方收養他方之親生子女時，準用民法關於收養之規

定」，(然此條文確與憲法法庭之「釋字第 748 號解釋」裁決基礎「性傾

向屬難以改變之個人特徵（immutable characteristics）」(理由書第

15 段)，即是若性傾向屬於不可改變的特徵又怎麼會有合意之前段婚姻兒

女呢？) 故，台灣法規面根本沒有可以兩位同性別人是共同收養的解讀空

間。

2.本案告訴人更是先「以單身名義收養」、再締結「釋字第 748 號之二人永久

同居關係」、又先開記者會再遞狀，開庭後又再次開機者會，處處都是政治

司法倡議動作，直讓人民團體感覺乃係以「社會文化革命訴求」為考量，而

非以女童最佳利益為訴求。(有違背〈兒童權利公約第 7 號一般性意見書〉及

〈兒童權利公約第 14 號一般性意見書〉之重大疑慮。)

3.台灣高雄少年及家事法院未依法進行裁判，而台灣行政單位更無視本案明確

讓女童因為其出身(父母無能養育)而被不平等的對待(成長過程中欠缺母親的

介入)，根本就是違背〈兒童權利公約〉第 2 條第一項，同時也未有以兒童最

佳利益考量，違背〈兒童權利公約〉第 3 條第一項，而行政單位的消極作為

更是完全牴觸了〈兒童權利公約〉第 7 條第一項，讓兒童由其父母照顧之權

利，分訴如下：

3

 A.幼童為人權及兒童公約權利主體於〈兒童權利公約地 7 號一般性意見

書〉第三條明確表達。 並依照〈兒童權利公約第 7 號一般性意見書〉

第五條及第六條，國家行政單位之目標乃係幫助幼童之血親父母得以落

實有充分照料幼童之幫助，包括積極經濟上的援助。 (意見書第 21 點)

B.〈兒童權利公約第 14 號一般性意見書〉明確界定了行政與司法單位對

於兒童最大利益應有的考量，就此部分，本會提醒如下：

1)我國允讓單身收養的初衷亦同，是出於單身者有機會進入男女婚姻中

（當時未通過同婚），讓孩子能夠在備類似父親與母親的環境中成

長。本案告訴人等，更似為同性性傾向群體去鑽法律漏洞，先單身

收養、再締結同性親密同居關係；此等類比透過或是先假離婚為單

身，收養成功後再次結婚的方式，已經難讓人民信服是以兒童最大

利益為考量。台灣出養人對於收養對象亦偏好雙親家庭，單身收養

媒合成功案例十分少見，以 2020 年為例，我國兒少被收養統計，總

數 262 人，其中國內收養 139 人，單身收養從數字判斷可能僅有 3

人

( https://www.sfaa.gov.tw/SFAA/Pages/ashx/File.ashx?FilePat

h=~/File/Attach/2667/File_180887.pdf)，我們建議政府有必要檢

討此項法條存在之必要性，或修法防堵漏洞，以保障兒童最佳利

益。

2)兩位同性別家庭型態是否適合撫養兒童，研究基礎必須建立在家庭的

「穩定性」上。荷蘭有一份經過 10 年追蹤同婚穩定度的報告，顯示

同性婚姻關係整體而言穩定度不佳。（ https://www.cbs.nl/en-

gb/news/2021/13/20-years-of-gay-marriage-in-the-

netherlands-20-thousand-couples）,再回頭看台灣，開放同婚合

法時間雖短，離婚率卻很高，家庭穩定性令人堪慮

(https://news.ltn.com.tw/news/life/breakingnews/3406068 )。

就此部分，台灣如何在民主程序下，宜透過透過科學事實進行一般

家庭與單身家庭及同性家庭之研究，再依照科學事實研擬相關收養

出養法規範的修正，此乃屬於台灣社會應的討論，實在不適合由司

法單位，在缺法科學佐證母性對於幼童成長的影響前，代替人民擅

專決定。

4

 C.基於我國憲法男性有服兵役之義務，並台灣與大陸並未有結束內戰。高

雄少年及家事法院之判決導致女童無「母親」可適用《關於戰時保護平

民之日內瓦公約》第 14 條之保障，未有以兒童最佳利益考量，違背

〈兒童權利公約〉第 3 條第一項事實明確。如綜合考量〈兒童權利公

約〉第 3 條第一項及〈兒童權利公約〉第 7 條第一項，並台灣政府的兒

少預算由 107 年的 1,593 億元，下跌至 110 年的 823.億元，高雄少年

及家事法院應判決立法院預算違背〈兒童權利公約〉，並應裁決凍結立

法委員薪資全面補助本案之生父母家庭才是。

具體建議:

科學研究調查報告清楚指出原生家庭的父親及母親才是最合適兒童之環

境，縱然社會人間多有不幸，但台灣社會應以追求兒童最佳生長環境，才符合

兒童的最佳利益。

在 2015 一個超過 20 萬人樣本數的大型調查中顯示,同性雙親家庭對兒童情

緒穩定性劣於有血緣異性雙親，已婚繼父母次之、再同居異性伴侶、單身家庭

（ https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2500537 ）,這

份研究結果與目前我國領養制度與實務上，遵行聯合國兒童權利公約第七條精

神相符，即有父母家庭最適兒童成長，也最符合兒童最佳利益原則。台灣人民

並沒有授予法官能夠罔顧兒童最大利益，更不能認可僅考慮同性性傾向群體的

政治理念裁判。台灣政府不應該成為阻斷兒童進入和原生父母生理上一致的較

利於其成長發展環境的機會(如果被同性家庭收養，這個機會將被阻斷)。

政府應對修法開放同性伴侶收養子女更加慎重以待，尤其絕對不可忽視母

親對於兒童成長的必要性，我國少子化問題嚴重，每一個都要更加珍惜，許孩

子一個更好的未來，請優先以兒童最佳利！

5

 主題二: 現今「性別」教育及政策，傷害兒少安全、人權及健康權

涉及 CRC 第二次國家報告條約專要文件

第 52 點：《十二年國民基本教育課程綱要》（下稱《108 課綱》）於領域課

程中實施人權及性別平等教育議題。

第 53 點：多元性別議題執行阻力之因應措施：

(a) 2018 年成立高級中等學校（下稱高中）「性別平等教育資源中

心」，培訓種子教師研習，研發及甄選多元性別議題教案。

(b) 與地方政府合作辦理友善校園工作計畫「性別平等教育工作」

研習。

(c) 向學校宣導應提供性別平等學習環境，將多元性別議題融入各

類非正式課程。學校因學生性別、特質、認同或傾向而差別待

遇，由主管機關調查並要求改善。

問題現況:

1.小學一年級生理男學生利用「性別自主認定」，主張自己是女生入女廁侵犯

生理女學生隱私。

家長於噗浪陳述：「女兒小一，已經在說有男同學自稱女生，硬要上女生廁

所。而且他根本不上，是想偷看女生尿尿 女生一起趕他也不走，他都說自己

是女生。 」(圖 1) (1)

圖 1 有關小一生理男學生入侵女廁之網路截圖

6

 2.臺灣精神科醫師及小兒內分泌醫師，2019 年於醫學會中報告(圖 2)，對未成

年 12 歲小學五年級性別不安女學生，施用極具爭議的「青春期阻斷劑」 (2)

此藥劑會致未成年者骨質疏鬆、智力下降及高血壓 (3)

圖 2 精神科醫師於 2019 年於醫學會中報告使用青春期阻斷劑

3.具有原男性生殖器官的女性免術換證成功

最高行政法院於民國 110 年判決:E 生理男未經手術摘除生殖器官（陰莖及睪

丸），申請變更戶籍身份性別為女性勝訴。台灣產生第一人「具有原男性生

殖器官的女性」。依法理原則，其應被視為女性，適用各項女性權益及義

務。(4)

問題分析:

1.課本內不適齡的性別定義（多元多樣）(5)，已經造成學生性別自主認定，並

利用來進行不當行為

7

 2.國外已有多起生理男跨性女學生入月廁性侵生理女學生事件

2021 年 5 月份，斯科特·史密斯的九年級女兒，被一名"穿裙子"男學生在美國

盧頓縣學校女廁裡性侵。 男孩最終被控一項強迫肛交罪和一項強迫口交罪

(6)。婦女和女童的安全受到「多元性別」運動嚴重威脅。

3.英國及瑞典禁止對 16 歲以下未成年性別不安者施用青春期阻斷劑

英國因出現青少年變性後悔者 Keira Bell 出面控告醫師，及 Christopher

Gillberg 教授等醫學專家的證詞「我們放棄了實證醫學，僅基於信念，就對

易受傷害的青少年和兒童開立效力強且會改變生命的藥物。」「青春期阻斷

劑對未成年者身體有各式各樣極大傷害」。性別不安兒少之健康權已遭受嚴

重戕害。該國之高等法院於 2020 年年底判決禁止對 16 歲以下未成年性別不

安者施用青春期阻斷劑 (7) 。瑞典於 2021 年 5 月禁止對未成年性別不安者

施用青春期阻斷劑 (8)

4.性別自主認定將讓更多男人進入女性的空間

在混合更衣室裡，婦女和女童更加脆弱，這些地方有可能吸引性犯罪者。

《星期日泰晤士報》根據資訊自由法例（freedom of information (FoI)

laws）向市政府取得的資料顯示，2017-18 年間，在市政府轄下公眾泳池及體

育館共收到 180 宗性侵犯、性騷擾及偷窺案件的報告，當中 134 宗在更衣室

發生，其餘 46 宗分別在泳池、球場、走廊、停車場或不肯定確切地點發生。

並非所有事件均有報警。而在那 134 宗在更衣室發生的風化案報告中，近九

成（120 宗）在不分男女的更衣室發生，只有 14 宗在男或女更衣室發生。(9)

婦女和女童的安全及人權被嚴重侵犯。

具體建議:

1.性別平等教育法法規對「多元性別差異」名詞之解釋含糊不清，與英文原文

意涵分歧，導致基層教師對性別教育執行困擾。建議修正法條第二條第一項

解釋:「多元性別差異」為「性別表現多樣化」（10）。

2.課綱編列及性平內容請納入「兒童發展」、「教育心理」、「教育課程設

計」、「兒童醫學」等專業人士，而非僅參考國外激進的性別課程內容或醫

療處置行為。

8

 3.應重新檢視課綱及課本的不適齡及不當的所謂「多元性別」內容，明確定義

「性別」，高中以下階段「不應」灌輸「性別認同自主決定」等內容。

4.建議衛福部或醫學會應參考英國及瑞典，禁止對臺灣未成年者使用極具爭議

的青春期阻斷劑，以減少對兒少的傷害。

5.政府研議性別變更要件法制化之諮詢研商小組，應邀請「婦幼及兒童權益」

相關團體參與，評估性別變更要件法制化對於婦幼及兒童權益的影響。

6.政府研議「性別變更法制化」，應以國外免術換證引發之問題為借鏡，國外

寬鬆的性別變更要件規範，已有許多兒少受到性侵及暴力攻擊，故政府應

「從嚴規範」性別變更要件。

(1)家長於噗浪討論「小一生理男性別自主認定入侵女廁」之連結

https://www.plurk.com/p/orsz5g

(2)2019 年 9 月 29 日青少年性別不安講座逐字稿

「…跟家長溝通的過程，需要花非常非常久的時間，那最近也很幸運的就是我們有遇

到一個她哦，那個小孩子很主動，她是一個小學的女生，小學五年級的一個女生，身

體上的女生，可是她從小就非常明確的知道自己其實是想要成為一個男性。好，她現

在學校裡頭參加是男子足球隊這樣子。哦，她的家長也非常非常開明，而且也願意讓

她說一個男性的性別角色在學校生活，也特別把她挑了一個學校，其實是相對比較友

善的這樣子。學校環境對於性別這樣發展友善，所以我們也跟臺大這邊的小兒就是內

分泌科這邊合作好，他家長也充分能夠理解到這件事情，所以我們開始可以使用

blocker (青春期阻斷劑)，好像這樣子的個案，讓他未來能夠爭取更多的時間，那她

有更多時間思考，以及他未來能夠真正成為自己想要的一個內外合一的人。我相信在

未來的十幾 20 年，這一定會漸漸發展下去，我們會讓我們的青少年有更多能夠理解自

己的機會，有更多的選擇權，那其中對於兒童青少年。相對是容易的，對於家長的衛

教反而是困難的，那我覺得也是這堂課能夠跟大家分享的一些經驗，這絕對不是一條

容易的路，但是如果大家在臨床過程當中有這樣的的話，我們至少可以讓我們家長能

夠有一些些開啟他們更多元想像的機會。」

(3)鄭弋 (2021)兒童及青少年性別不安-文獻回顧

https://www.tma.tw/ltk/110640504.pdf

(4)跨性別變更性別取消強制手術要件案 原告小 E 獲勝訴

https://udn.com/news/story/7321/5766469

9

 (5)性別定義（多元多樣）相關內容

案由 性別定義（多元多樣）已經造成(性別)不安(台灣實例),這樣情況

下孩子該不該接受這樣的教育呢?

課本 1

翰林五

下綜合

活動 108

年8月

版本

課本 2

南一五

下 藝術

與人文

108 年 2

月出版

10

 課本 3

泰宇高

中護理

108 年出

版

行政院

多元性

別之學

校教育

109 年 6

月擷取

https://www.ey.gov.tw/Page/9277F759E41CCD91/b39986b6-

49e6-4b13-8a1e-d325abbc89ba

11

 (6)Parents demand Virginia superintendent be fired over alleged sex assault

cover-up

https://nypost.com/2021/10/13/parents-demand-superintendent-be-fired-for-

alleged-sex-assault-cover-up/

(7)Daily mail. 'A live experiment on children': Mail on Sunday publishes the

shocking physicians' testimony that led a High Court judge to ban NHS's

Tavistock clinic from giving puberty blocking drugs to youngsters as young

as 10 who want to change sex, 2021. https://www.dailymail.co.uk/news/article-

9130157/The-physicians-testimony-led-High-Court-judge-ban-child-puberty-blocker-

drugs.html

(8)Sweden’s Karolinska Ends All Use of Puberty Blockers and Cross-Sex

Hormones for Minors Outside of Clinical Studies

https://segm.org/Sweden_ends_use_of_Dutch_protocol

(9)Unisex changing rooms put women in danger (2018)

https://www.thetimes.co.uk/article/unisex-changing-rooms-pu

t-women-in-danger-8lwbp8kgk?region=global

(10) 性別平等教育法

第2條

本法用詞定義如下:

一、性別平等教育:指以教育方式教導尊重多元性別差異，消除性別歧視，促進性別第魏

之實質平等。

12

 主題三：「性別(Sex)」、「社會性別(Gender)」定義不清，「多元性別」用詞

不當，不利兒童發展權益

涉及 CRC 第二次國家報告條約專要文件

第 54 點：將「去除性別刻板印象與偏見」列為性別平等重要議題，訂定性別

目標「促進民眾對多元性別及多元家庭（含同性婚姻、單親、非婚

同居家庭等）之認識與接受度」，2019 年 至 2022 年推動「法規

修訂及落實」、「媒體宣導及識讀」、「結合地方政府與民間資源

辦理教育宣導及活動」、「加強媒體及廣告中正面、非刻板印象之

女性描繪」及「辦理民意調查」等策略。

《經濟社會文化權利國際公約》ICESCR 第 13 條第 3 項

行使「…確保子女接受符合其本人信仰之宗教及道德教育之自由。」

問題現況：

當前性別平等教育及性別主流化相關政策於落實階段，因翻譯及偏頗的詞

彙使用，而導致公眾難以理解法律政策之本意，除直接教學資源未能平均分配

到不同民族及社會文化背景之兒童身上、違背平等對待原則，更妨礙少數族群

兒童之父母家長依聯合國《經濟社會文化權利國際公約》ICESCR 第 13 條第 3 項

行使「…確保子女接受符合其本人信仰之宗教及道德教育之自由。」

問題分析：

1.兒少代表於 110 年 2 月 23 日「兒童權利公約第 2 次國家報告民間意見徵詢會

議」發言向政府詢問：「多元性別總共有多少種？」 並獲得會議主席回覆以

下：「A. 我也不知道有多少種，B.隨著時代演進，可能性別會越來越多種」

之答覆。

13

 2.參照聯合國衛生組織(World Health Organization)及婦女權署(UN Women)之

「社會性別(Gender)」名詞解釋，乃是明確指：「建立在生理的男女(或男孩

與女孩)間之不同社會構面特性」，故雖然面相有所多元，但並未有以「種

(類)」作為分辨之依據，可見「社會性別(Gender)」一詞依台灣文化翻譯後

之「艱澀難懂」，即便政府官員亦難向公眾解釋。

3.現行台灣政府以「性別」一詞作為聯合國「社會性別(Gender)」名詞之中文

翻譯，除了有和台灣公眾所使用的「生理性別(Sex)」完全一樣外，更因著

〈性別平等教育法〉第 2 條中定義僅有「性傾向」與「性別認同」兩項人格

上的社會構面特性，以至於台灣〈性別平等教育法〉與「性別主流化」政策

之落實，完全以增加「同性-性傾向」及「跨-性別認同」群體之利益為「獨

一考量」，無視台灣不同「社會構面特性」(如：不同民族文化或宗教背

景」)在同等對待下應有的教學及學習資源，並妨礙不同文化背景兒童身心依

父母期望健康發展及成長。

14

 具體建議：

政府應檢視法規、政策用詞之原意，如性別乃意指聯合國「社會性別

(Gender)」，則應改以「社會性別(Gender)」取代，以彰顯乃指「建立在生理

的男女(或男孩與女孩)間之不同社會構面特性」，並亦應依照聯合國婦女權署

及 WHO 定義，將「社會性別」中的重要「社會文化-構面特性」，如：民族、階

級、族群、社經地位、年齡、宗教文化等全數納入〈性別平等教育法〉第 2 條

中，以實質且絕對平等的方式保障不同「社會構面特性」之群體，特別是兒

童。

15

 主題四: 偏鄉兒童健康權不被重視與落實

涉及公約條文：CRC 第二次國家報告條約專要文件

第 184 點：2020 年核定《優化兒童醫療照護計畫》強化初級照護及健康管理，

改善周產期與急重症醫療照護，降低新生兒及兒童可預防的死亡

率。

第 205 點：截至 2021 年 8 月已培育 637 名在地養成醫學系公費生，其中婦

產科專科醫師（含訓練中）計 21 位、兒科專科醫師計 25 位、助

產師（士）187 位。在地養成公費生畢業後分發返鄉服務，履約完

成後近 7 成續留原住民族及離島地區服務。2008 年至 2020 年執

業兒科專科醫師由 3,340 人增至 4,469 人，每萬兒童人口之兒科

醫師數由 6.42 增 加至 18.99，成長率 33%。2015 年至 2017 年

補助醫院團隊辦理兒科重難症醫療照護團隊獎勵方案，以提升服務

品質。

第 213 點：縮短早期療育資源城鄉差距措施： (a) 2019 年規劃《療育資源缺

乏地區布建計畫》（2019 年至 2021 年），2020 年衛生、 社福、

教育 3 類資源不足的 37 個鄉鎮區已全數完成布建；2 類資源不足

的 130 個鄉鎮區持續布建中，已完成 123 個鄉鎮區，服務覆蓋率

94.61％。 (b) 《全民健康保險早期療育門診醫療給付改善方案》

規劃「以家庭為中心之早期療 育整合照護費」加成措施，設立於山

地離島地區之參與院所得加計 20%，辦理情 形參附件 7-30；如屬

《全民健康保險山地離島地區醫療給付效益提昇計畫》，以 巡迴醫

療方式於社區服務據點提供行動早期療育服務之院所，得加計

30%。

問題分析:

1.兒童接受兒科醫師醫療照顧資源落差

2020 年 台北市 台東縣

新生兒數 18399 1350

兒科醫師數 715 17

資料來源: 衛生福利部

16

 以台東縣為例，2020 年台北市新生兒人數：18,399 人，台東縣出生人數為

1,350 人。台北市兒科醫生 715 人，台東縣兒科醫生 17 人。台北市平均一名兒

科醫生照顧了 25.73 名新生兒，台東縣平均一名兒科醫生照顧了 79.41 名新生

兒。台東兒科醫生的工作量是台北兒科醫生的三倍，說明台東兒童接受兒科醫

師治療的資源只有台北市兒童的三分之一。

台東的醫生很少，兒科次專科醫師就更少了。沒有小兒外科醫生，對於疝

氣、睾丸引流、尿道下裂等手術，病患只能去其他縣市，或者等台北馬偕醫院

的小兒外科醫生每個月來一次，給所有病人做手術。也沒有兒科內分泌專家。

如果有長不高的孩子和性早熟的孩子，如果症狀不嚴重，會由其他亞專科兒科

醫生跟進。嚴重的還要到外縣市看病。每三個月來一次台東-高雄或台東-花蓮

之間的旅行並不容易，因為火車票很難買到，而且機票又貴又班次少，父母很

難負擔。 （注 1。）

2.新生兒死亡率高

2020 年台北市新生兒死亡率千分之 2.6,台東縣新生兒死亡率千分之 6.7 ,台

東新生兒死亡率是台北的 2.5 倍。(註.2)

3.特殊兒童接受早療復健機會落差大

2020 年 台北市(萬人為單位) 台東縣(萬人為單位)

語言治療師數 0.53 0.37

臨床心理師數 1.02 0.37

物理治療師數 4.16 2.04

職能治療師數 1.56 1.11

資料來源: 衛生福利部

台灣衛服部 2020 年的統計數據顯示，在台北平均每萬人有 0.53 個語言治療

師，在台東僅有 0.37 個；在台北，平均每萬人有 1.02 個臨床心理師，台東僅

有 0.37 個；台北平均每萬人有 4.16 個物理治療師，台東僅有 2.04 個；台北平

均每萬人有 1.56 個職能治療師，台東只有有 1.11 個。 整體說來台東發展遲緩

的孩子可以得到治療的資源與機會相對少很多。

17

 4.偏遠鄉區交通便利性不足，大眾運輸交通網稀疏，醫療可近性差

偏遠鄉區人地廣人稀(台東縣全縣面積 3515 平方公里，台北市全市面積

271.8 平方公里)，交通的便利性遠遠差於都市，大眾運輸網絡又稀疏，例如公

車一小時才一班次，台東的家長要帶孩子就醫或是做復健極不方便，更不用說

台灣以外的小島了。在台東執業的兒科專醫師說，她有一位來自蘭嶼的病患，

為了做復健，這位媽媽工作請假三個月帶孩子住在台東，嚴重影響家庭與工

作。為了同時照顧好家庭和工作，最後她只好全家搬離蘭嶼而去其他縣市。

5.其他城市兼職的醫師缺乏偏鄉醫療經驗，難以融入及因應偏鄉醫療照護模式

因為兒童次專科醫師嚴重稀缺，為了能讓偏鄉兒童多一點接受醫療照顧機

會，只好從其他城市聘請兼職兒科醫師。有的兒科醫師一個月只能來台東一

次，只從早上九點看到下午兩點，趕著搭下午三點的飛機回台北。他們多數不

願意再多留一點時間，就算衛福部出公文表示，不可以拒絕病人；這也無法改

變有看診需求的兒童，就算排隊仍無法接受到治療的困境。

6.遠距診療會診軟硬體設備不足。網路訊號弱且效能差，無法協助滿足偏鄉醫

療需求

舉例而言: 從去年開始花蓮慈濟醫院遺傳科跟台東基督教醫院開辦一年四次

醫療遠距會診。使用的軟硬體設備效能不穩定，電腦頻繁當機。每次醫療遠距

會診，醫院的資訊部人員就必須待命以解決突發問題。

7. 轉至其他醫院費用高，偏遠鄉鎮家長負擔不起，形同讓孩子等著死

偏遠鄉鎮地區人口較都會少，醫護人員中的重症醫療，其人力及經驗不足。

偏遠鄉鎮地區居民人數不足而無法設置大型醫學中心。重症病患只能轉至其他

城市的較大型醫院，但轉送成本高，有的孩子因此被放棄治療了。

18

 舉例來說: 一位台東兒科醫師悲痛陳述，一位病患裝 extra-corporeal

membrane oxygenation,(ECMO)。因為當時台東醫院內沒有專屬的三班制醫護人

員輪班，只能轉去其他醫院。但這樣的轉出，家長需要自己負擔新台幣 10 萬

元，相當於當地家庭平均四個月收入總合。病患家長無力負擔，最後只能放棄

治療孩子，孩子就過世了。

8.政府醫療照護政策未充分考慮偏鄉醫療實際情況。缺乏彈性的規劃造成偏鄉

兒童被不平等對待

現在政府推動幼兒專責醫師制度。理論上，幼兒照護是基層兒科或家醫科醫

師所負責的。但是以台東地區而言，沒有足夠的兒科醫師，像是蘭嶼也只有小

型區域公共衛生所，連醫療診所都沒有。政府的兒童醫療照護計畫都只能是兒

科醫師跟家醫科醫師負責執行。如果小型區域公共衛生所的醫師是其他專業(例

如內科或是外科)，這邊的孩子完全無法享有這項政策，非常不公平。

結論與建議:

1.增加偏遠鄉鎮城市醫療的政府公費經費預算，尤其是新生兒死亡率高的地

區。

2.偏遠鄉鎮城市，尤其像花蓮、台東等交通不便地區，可以實施兒童就醫交

通費補助。以及跨城市就醫時的大眾運輸工具優先保留座位。

3.為偏遠鄉鎮重症病童提供免除自負額的轉診服務。

4.特定偏鄉地區，應提高醫護人員薪資待遇與補助。

5.開發與培訓、獎勵偏鄉當地居民從事各種醫護相關工作，並提供他們獎學

金與未來工作機會。

6.加速開放遠距數位視訊醫療照護看診或諮詢的各項要求與規範。

7.加強偏鄉電子網路訊號建設，並優化硬軟體設備。政策除顧及當地居民隱

私，也要考慮更方便當地居民。

8.設立偏鄉兒童醫療健康專責醫師照顧的專屬計畫，才能真正幫助到偏鄉兒

童，而不是硬把都會模式套用偏鄉地區。

註 1. 【醫院轉診篇】把普悠瑪列車當救護車？斷裂的醫院轉診生命線

https://www.twreporter.org/a/child-health-care-no-referral-platform

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 台東沒有小兒外科醫師。「你們幫我買一張普悠瑪號火車的車票吧，我來幫忙轉送到其他城市的

醫院。」這個大膽的醫師是台東基督教醫院小兒科醫師鄭弋，一個常被孩子看成是「叔叔醫師」

的女醫師，以推車推了 4 瓶氧氣，和家長一起搭火車把名叫小憲的孩子轉送到台大醫院。共費了

4 小時火車車程、換了 2 個氧氣瓶。

註 2.少子化問題雪上加霜 我國嬰兒死亡率在世界也名列前茅

https://health.udn.com/health/story/5999/4904365

就 2018 至 2019 兩年平均統計來看，嬰兒死亡率以花蓮縣、台東縣與屏東縣為前三高，死亡率

更飆高到千分之 5.9 至千分之 7.9 間

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