Bước đầu nghiên cứu về hành vi nạo thai ngoài hôn nhân

Nhiem vu ciia chung tf^ trong nghien cuu nay la phac thao nhung luan cu khoa hoc va tren ecr scV dc' de xuat nhirng giai phap cc the de' giam thie'u hien tucmg nao thai ngoai hem nhan..

Nguyin Quy Thanh

BU6C OAU NGHllN CUU VE

HANH VINAO THAI NGOAl H O N NHAN

Chuyen n^anh : Xa hoi hoc

Mdso : 5 01 09

LUAN AN THAC SY KHOA HOC XA HOI HOC

[ V^.Xi

Nt^i/cxi hu('fni^ dan khoa hoc:

PTS Nguy€n Quoc Trieu

Ha noi, 1995

Bao cao chlnh tri cua Ban chdp hanh Trung uong Dang cong san Viet Nam (Khoa VI), trinh bay tai Dai h6i dai bi^u toan quoc Idn thir VII vi^t :"Giam toe do tang dan so la m6t quoc sach, phai tro thanh cu6c van d6ng rong 1cm, manh me

va s^u sde trong toan dan Tang kinh phi, phuong tien, can be), dong thcM thirc hi6n dong bO cac bifen phap d^' day manh cu6c van dc)ng sinh de c6 k^'hoach"

Di CO thi thirc hien duoc chi^'n luoc nay, cac nha khoa hoc phai ti^'n hanh

hang loat nhung nghi^n ciJu nhSm thi^'t lap nhiJng luan cu khoa hoc cho nhirng muc ti6u dan so cu th^'

Da CO rat nhiCu nhu*ng nghifin cuu \i nhiJng hien tucmg va qua trinh dan so

khae nhau Nao thai ciing la mc)t hien tuofng c6 li^n quan d6:n chuong trinh dan so

va kC hoach hoa gia dinh duoc nhi^u nha dan so hoc, xa hoi hoc, y hoc quan tam nghi^n cihi Boi vi hien tuong nao thai c6 tac dong manh dCn mUc sinh ciia mOt quoc gia Nhung mat khac no cung c6 nhung anh huong to Ion d6n sue khoe ciia nhiJng phu nu nao thai noi riCng va boat dong cua toan xa hoi noi chung Do

do nhi^u nha nghi^n cuu da k^u goi tim mot giai phap wi mat khoa hoc va thuc

tifin cho nghich ly nay Tire la giam duoc so ca nao hut, nhung lai khong phuong hai dCn cac muc tifiu v^ dan so

Cac nha khoa hoc Viet Nam da thuc hien kha nhi^u nghiCn cuu xa hoi hoc, nhiCu each ti6p can khac nhau d^'n hien tucmg nay, nham tim toi mot giai phap toi uu

Y tucVng nghiCn cuu ciia chung toi \i hien tucmg nao thai ngoai hem nhan

xua't hien tir nam 1993 Khi tiCn hanh nghiCn cuu vc^ sinh vifin, chung tc')i tha'y a4

xu hircmg tir do tinh due trcmg tinh yCu da bat dfiu xua't hien Mat khac hien tucj

V;ln kiCn Dai hAi dai bic'u loan quoc Lin Ihu VI NXH SinhAt Wa Noi \W\, uJU

LOI NOI D A U

CHLfQNG Q : Nhiinsi ket qua va phdn tick ban ddu

2 Nhung nguyen nhin cua viec mang thai ngoai hOn rih:ln-_

n Ve viec nao thai n^oai hOn nhiln 2.1 Nhung yeu to xa hpi tdc dpng den quye'i Jinh nao thai cua nguai phu nu khOng chOng

Trans

CHL/QNG I NhUng ca sa ly ludn ciia viec nghien cuu

ve nao thai ngoai hon nhan 4

1 Tinh cap bach ciia van de nghien cuu 4

2 Y nghia ly luan va thuc tien ciia luOn an 7

3 Doi tuong, muc dich va ^la thiet nghien cuu S

4 Phuong phap luOn va phuong phap he nghien cuu

ve hanh vi nao thai ngoai hOn nhan !()

5 Tc^ng quan nhung nghien cuu hanh vi nao thai Hizoai hOn nhan i "^

[ Ve hien tircTng mang thai ngoai hOn nhin "^2

I Tinh hinh chung 32

2.2 Mot sO dac diem ciia nhom phu nu co hanh vi nao thai

ngoai hOn nhan 62

K£TLUAN ^3

DANH MUG TAI LEU THAM KHAO SO

PHU LUC <^

Bao cao chlnh tri cua Ban cha'p hanh Trung uofng Dang cc)ng san Viet Nam (Khoa VI), trinh bay tai Dai h6i dai bi^u toan quoc Idn thu VII viet :"Giam tcSc do tang dan so la m6t quoc sach, phai tro thanh cucic van dc)ng rong 1cm, manh me

va sau sdc trong toan dan Tang kinh phi, phuong tien, can be), dc^^ng thcM thuc hien dong be) cac bien phap d^' day manh cuc)c van dc)ng sinh de ccS ke hoach"

Di CO th^' thuc hien ducyc chie'n luc^c nay, cac nha khoa hoc phai tien hanh

hang loat nhirng nghien curu nham thiet lap nhirng luan cu khoa hoc cho nhiJng muc tiCu dan sc) cu the'

Da cc) rat nhieu nhiJng nghien ctJu ve nhiJng hien tucmg va qua trinh dan s6

khac nhau Nao thai cung la mc)t hien tucmg cc) lien quan den chucmg trinh dan sc)

va ke hoach hoa gia dinh duoc nhieu nha dan so hoc, xa hoi hoc, y hoc quan tam nghien ciJu, Bai vi hien tucmg nao thai cc") tac dc)ng manh den muc sinh ciia

mc)t qucK^ gia Nhung mat khac no cilng cc^ nhung anh hucmg to Ic'm den sue khoe ciia nhung phu nu nao thai noi rieng va boat dc)ng ciia toan xa hoi nc)i chung Do dc) nhieu nha nghien cuu da keu goi tim mot giai phap ve mat khoa hoc va thuc lien cho nghich ly nay Tuc la giam ducyc sci ca nao hut, nhung lai khC^ng phucmg hai den cac muc tieu ve dan sei

Cac nha khoa hoc Viet Nam da thuc hien kha nhieu nghien cuu xa hoi hoc, nhieu each tiep can khac nhau den hien tucmg nay, nham tim tcM mc)t giai phap

iCn uu

Y tucmg nghien cuu cua chung toi ve hien tucmg nao thai ngoai hc'^n nhan xuat hien tir nam 1993 Khi tien hanh nghien cuu ve sinh vien, chung tc)i thay c6

xu hirc'mg tir do tinh due trong tinh yeu da bat dfiu xuat hien Mat khac hien lucmg

VAn kiOn Dai hCti dai biCu loan quoc lAn thir VI NXH SuthAt I la Noi 1*;91 uJO

hien tuong nO sinh vien do yeu qua he\ minh phai mang thai va nao thai cang trcV nen phcS bie'n Nhirng dieu nay da cuon hut chung tcM thu tim mot each thuc de'ngan chan

Chung t6i thay rang giua mang thai va nao thai c6 mcSi quan he

nhan-qua, rat phu hctp vofi mc^^ hinh ly thuyet cua trucVng phai hanh vi luan (Behaviorizm) Cho nen chung tcM da thiet lap mc)t nghien cuu - phan tich ve nao thai ngoai hc^n nhan dira tren ly thuyet nay

Nhiem vu ciia chung tf^ trong nghien cuu nay la phac thao nhung luan

cu khoa hoc va tren ecr scV dc') de xuat nhirng giai phap cc) the de' giam thie'u hien tucmg nao thai ngoai hem nhan

Viec xac dinh chinh thuc day la de tai ciia luan an Thac sT khoa hoc xa

hAi hoc duetc tie'n hanh vao thang 5 nam 1995 Do dc) chung tc)i ccm ml it thoi

gian de' thuc hien cac y tucmg nghien cuu ciia minh Do vay cac van de ducrc xem xet hfiu nhu cung chi dung lai cV mirc do ban ddu

Tuy vay chung te^^i cung hy ve^ng nghien cuu ciia minh se dong gop mot phrin nhc) be vao viec nghien cuu cac hien tucmg - qua trinh dan sd, nhfim thuc hien tcM chii tructng, dueVng leSi ciia Dang ta

Nghien cuu cua chung tr)i khe^^ng the thanh ccmg ducrc ne'u nhu thieu nhung ge)p y quy bau ciia giao vien huong ddn, ciia GS Le Thi Nham Tuyet Giam deSc Trung tam nghien cuu Gioi - Gia dinh - Me'^)i trucmg trcmg phat trie'n (CGFED), Trung tam nghien cuu Phu niJ va Gia dinh (CFWS) sir he') tret ve mat

ui chuc ciia Ban chii nhiem khoa Xa he)i hoc, Tam ly hex- thuc)c trucmg Dai hoc Khoa hoc Xa hc)i va Nhan van, Dai hoc Quoc gia Ha Noi, sir ho tro trong vice thu thap cac tai lieu nghien cuu ciia TrucVng khoa, Phc') khoa San Trung lam y

te Tir Liem va Nhan dip nay chung tc')i xin gui loi cam (m chan thanh va sau siic nhat tc'ti ho

nao thai ngoai h6n nhan" ngoai Ldi noi ddu ccNn bao gcSm :

Chuong 1 : NhGng ce^ sa ly luan cua vice nghien cuu ve hanh vi

nao thai ngoai hon nhan

Chuemg 2 : Nhung ket qua va phan tich ban ddu

Ket luan

Va cac phu luc va danh muc cac tai lieu tham khao

Day la me)t nghien cjjfu nhe^ va cc) tham vcmg nhc> Do vay chdc khc) tranh het duofc nhirng thie'u sot Kinh mcmg sir dc'mg ge)p chan tinh ciia cac nha khoa hoc

NHUNG CO S 6 LY LUAN CUA VIEC NGHIEN ClTU

VE H A N H VI NAO THAI NGOAl HON NHAN

1 Tinh cap bach cua van de nghien cuti

Kie'm soat sir phat trie'n ciia dan scS la mc)t trong nhirng muc tieu hang

ddu ciia nude ta nham dam bao sir phat trie'n on dinh ciia xa he)i Viec tu do hoa nao thai la mot trong cac bien phap nhdm tac de)ng de'n muc sinh a nude

ta Tuy nhien sir gia tang manh me s6 luemg cac ca nao thai hang nam da lam cho nhieu nha khoa hoc quan tam den hien tucmg nay phai len tieng bao dong

Theo cac chuyen gia y te, dii vcn ky thuat tcM nhat, vice mao thai vdn c6 the' de' lai nhiJng hau qua xau cho sire khoe ciia mot ty le nhat dinh phu nu Mat khac do me)t se^ luemg kha 1cm phu niJ hang nam phai nghi de' nao thai, nen

xa he)i mat hang chuc trieu ngay ceing lao dong, gay teSn that ve kinh le cho xa he)i va chinh nhe^m phu nu nao thai Mac ddu vay so luemg Idn phu nir nao thai hang nam vdn tang len Cuc)c dieu tra nhan khau hoc giua ky nam 1994 cua TeSng cu theSng ke da cho ta con se1 la 12,8% tcSng sc1 phu nu trcmg do tucSi sinh

de da tung nao pha thai

Cc) me)t nghich ly de quan sat thay la, cang tuyen truyen nhieu ve chucmg trinh dan sf) ke'hoach hoa gia dinh, cang ca'p phat nhieu cac bien phap ngua thai, thi ty le nao - pha thai khcmg nhung khcmg giam ma lai tang len

Vi du theo s6 lieu dieu tra ciia Bo Y te thi nam 1993 ty le ngucVi chap

nhan su dung cac bien phap tranh thai la 49,3^/r nam 1994 la 49,1%, trong khi dc) scS ngucVi nao hut ciia 26 tinh thanh duoc dieu tra nam 1993 hi 611.173,

thai*

Viec cho phep tir do nao - pha thai da lam giam dang ké muc sinh a Viet

Nam (theo u6c tinh thi giam gdn 1/2 muc sinh) Nhung nhirng hau qua tam ly,

sinh ly, xa hc)i sau nao thai voi ngucVi phu n\i khien chung ta phai quan tam

den viec tim nhung each thirc, nhdm lam giam sf) ca nao thai hang nam nhung lai kheing anh hucVng dén cac muc tieu ciia chuctng trinh dan sé> KHHGD

Trcmg so nhiJng phu niJ nao thai hang nam c6 mc)t ty le dang ke la nhiJng phu nir khc^ng chr^ng nao thaị Theo so lieu dieu tra ciia Uy ban dan so

Ha Noi 1993 thi eo 11%; se1 phu nir trcmg mSu dieu tra la chua ccS gia dinh Scl lieu cua Temg cue Thếng ke nam 1994, cung cho thay phu nir cV dc) tucSi 15-19

nao thai la 6,1%; va d đ lucii 20-24 la 16,3%^ tcSng sc) phu nir trcmg dc) tuoi sinh

dẹ Se) phu nir chua sinh ccm nao thai la 14,2%

Nhiíng phu nir khêmg chc)ng nao thai chiu nhirng anh hucVng nghiem trcmg hem nhieu ve cac mat sue khoe, tinh thdn, sinh ly, xa hoị so vcVi nhom phu nir cc) chemg BeVi vi ho la nhirng ngucVi thucmg la chua cc) ccm Va ho se phai sinh ccm trong mot tucmg lai gdn Khcmg ai dam chdc rang vice ngueVi phu nir nao thai sc'tm,nhieu, khCmg cc) anh huémg gi den the he tucmg lai ciia họ

Tai sao sc^^ luemg phu nir khcmg chemg nao thai ngay cang tang len ? Hien tucmg nay chiu sir tac dc)ng ciia cac yeu tc) nao ? Lieu day ccS phai la khiem khuyet ciia chucmg trinh truyen throng ve dan sc) hay khc')ng 7 Do la

nhirng cau hen cdn cd sir tra IcVị

Nhin chung nao thai la mot sir lira chcm bat đc dT cua ngucVi phu nir

Vay nhirng yéu id nao giiip cho ngucri phu nir c6 duetc me)t quyet dinh toi uụ

NcM each khac nhirng ngucti phu nir, dac biet la phu nir khong chong chiu su

IVio cao ciia IV> Y tólai hCn lh;io vO sire khoe sinh s;in Il.i Noị H-\')')^

NguyOn CJuoc TriCu va cac lac gi;i kkhac ITiirc (rang nao ph.'i ih.ii a fla Noi v;i c(^ng ịic dan sn ko họtch hoa gia dinh I!a N(»ị \W^

nhat trong tinh huong eu th^

Chiing t6i cho rang ne'u phan tich duc^c qua trinh lira che^n va thuc hien

hanh vi nao thai cua ngueVi phu nu khong che)ng, chung ta se tim ra ductc nhirng giai phap nham nang cao tinh thdn trach nhiem cua ngueVi phu nu khe'mg chc)ng trong viec lira che^n hanh vi nao thai Va dieu nay chdc chdn se ddn den viec ge)p phdn giam (it hay nhieu) ty le nao pha thai ngcxii hr^n nhan noi rieng

va ty le nao thai noi chung, ma vdn khcing anh hueVng de'n cac muc tieu dan sc) ke'hoach hoa gia dinh

Viec nghien ciru ve hanh vi nao thai ngoai hr^n nhan la rat cap bach va cdn thiet trcmg giai doan hien nay BeVi vi, thir nhat hien tucmg mang thai - nao thai ngoai he'^n nhan dang IrcV thanh mot van de xa hoi nc'mg bc'mg (dac biet la mang thai - nao thai vi thanh nien) Thir hai, vice deii men nen kinh te ciia dat

nuc'yc ciing ven qua trinh da phucmg hoa quan he cc) lam bien dCn nhirng dinh

kien, quan die'm ciia ngueVi dan ve viec mang thai, nao thai ngoai hem nhan hay khc')ng la cau hen dang cdn IcVi giai dap TTiir ba phai chang chucmg trinh dan so

ke hoach he^a gia dinh chua coi nhom phu nir khc^^ng cheSng la dc)i tucmg cua minh, nen men c6 me)t tinh trang nao - pha thiii nhu vay Thir tu nhieu phu nir trt^ da tc) ra thieu nhii'ng kien thure set dang ciia giao due tinh due, lieu dieu nay

CO lam anh hueVng de'n sir lira chon hanh vi nao thai dung ddn ciia ngucVi phu nir hay khcmg ? Mat khac ne'u nhin tir gcK do xa hoi hoc, qua nhirng tai lieu hien cc') chiing ta thay rang mang nghien ciru ve nao thai ngoai hCm nhan chua ductc chu y me)t each thich dang Dac biet la cc>n thie'u nhirng cc) gdng nham phan tich hien tucmg nay theo nhirng ly thuyet Ic'm ciia xa hc)i hcK\

Vice thu nghiem, tim tc^i mot each tiep can moi trong nghien ciru cac hien tucmg xa hoi, trcmg dc) cc') hien tucmg nao thai ngoai hon nhan rat cdn thiet NeS se geSp phdn nhc^ be vao vice giai quyet mot van de ly luan ciia xa hoi

thuyet hanh vi

Noi torn lai viec nghien ciru ve hanh vi nao thai ngoai hr^n nhan (hanh vi nao thai eua nhiing phu nir khong c6 cheing) dap iJng ca nhirng nhu cdu ve khoa hcic va xa h6i

Do chinh la ly do cua sir lira chon va'n de nghien ciru : 'Nao thai ngoai

hon nhdn\

2 V nghla ly luan va thuc ti^n cua luan an

Trcmg luan an nay, chung tc')i cd gdng dua ra me)t thu nghiem nhdm

nghien ciru ve hien tucmg nao thai ngoai hfm nhan tren ect so ciia ly thuyet hanh vi Noi each khac chiing toi cc) gdng dua ra mot mc> hinh ciia hanh vi nao thai ngoai hc'in nhan va tren ect seV dc') tie'n hanh phan tich cac ye'u to va thanh phdn cua no

Chung ten hy vcmg rdng luan an nay s.e la mc)t dc')ng gcSp nhc) vao vice irng dung cac ly thuyet cua xa hc)i hoc, cu the' la thuyet hanh vi vao vice giai quyet cac va'n de thuc tien Nguctc lai nhirng ket qua ciia luan an nay cung la

su demg geSp khiem idn lam phemg phii them ve ly thuyet hanh vi

Tren ca set nhiing phan tich ket qua nghien ciru, chiing tc')i hy vong luan

an nay se giup chiing ta hie'u rd hem ve hien tucmg nao thai ngoai hc)n nhan ncM

chung va hanh vi nao thai ngoai hem nhan noi rieng Chung te)i cung hy vong rfing se dua ra ductc mc)t vai ket luan va giai phap de giai quyet hien tuemg nao thai ngoai hc^^n nhan, nhung khc^)ng anh huc'mg den cac muc tieu dan so, gop phdn hoan thien hem cc)ng tac dan so ke hoach hoa gia dinh

Chiing tc')i cung hy vong rang ket qua ciia luan an nay duoc diing de giang day cho cac sinh vien xa hoi hoc va dan so hoc

3 Ddi tucmg, muc dich va gia thiet nghien cuti

3.1 Doi tucmg nghien ciru

Hien tucmg nao thai ductc nhieu nganh khe^a he;)c quan tam nghien ciru nham tim ra cac ky thuat an toan nhat, gay it tai bie'n nhat, it anh hucVng den

sire khoe ngudi phu niJ nao thai nhat v.v Dan sd hoc quan tam xem tdn xuat

nao thai trcmg xa hoi the'nao va vai trc) tac dong ciia neS den mirc sinh, chucmg trinh ke'hoach hoa gia dinh ra sao thi xa hc)i hoc chii trong nhieu den cac yeu

id xa hc)i tac dc)ng de'n hanh vi nao thai, nao thai trong cac nheSm xa hoi, cac

tc'^)n giao v.v

Trong luan an nay chiing tc'^)i khcmg hy vong cc) the' lam ro tat ca cac van

de, tra leVi tat ca cac cau hen ve hien tucmg nao thai nhin tir gc')c do xa hoi hoc Trong qua trinh quan sat va phan tich hien tucmg, chiing tc)i thay rang hanh vi nao thai ngoai he')n nhan la mot van de dang quan tam nghien ciru boi tinh thoi

sir ciia no Chinh vi vay chiing tr)i da xac dinh ddi tucmg nghien ciru ciia minh

la hanh vi nao thai ngoai hon nhan Hanh vi nay la mot hanh vi xa hoi bcVi 10 nc') chiu sir tac de)ng ciia vd van cac ye'u tc") xa hoi va ben nc') c6 y nghla voi ngucVi phu nQ thuc hien hanh vi nay Nd\ tcSm lai trong luan an nay chiing toi

muc)n xem xet hanh vi nao thai ngoai hem nhan va mot vai ye'u te) quan trong anh hucVng de'n neV

3.2 Muc dich

Luan an nay dat cho minh me)t sd muc dich khiem tc'^n nhu sau :

- Lam re') mot sd khai niem tre)ng deS quan tre)ng nhat la khai nicm hanh

vi nao thai

dinh m6t so dae di^m ca ban cua nh6m phu nir co hanh vi nao thai ngoai hc>n

nhan

- Dijng cac so lieu d^ phan tich ve cac thanh phdn ciia mei hinh nao thai ngoai hOn nhan

- Dua ra mc)t so ket luan va kie'n nghi tren ca sd cac phan tich nham gop

phdn han che' hien tucmg nao thai nge^ai hcin nhan noi rieng va nao thai noi chung nhung khcing anh huctng de'n cac muc tieu dan sc'^' va nang cao trach

nhiem ciia ngueVi phu nQ khong c6 chong tre^ng qua trinh ra quyet dinh nao

thai

3.3 Gia thuyet nghien ciru

Khrmg phai moi hanh vi mang thai ngoai he)n nhan deu ddn den hanh vi nao thai ngoai hc^^n nhan Nhung moi hanh vi nao thai ngoai hr)n nhan deu ce') ngueSn gcK' tir cac hanh vi mang thai ngoai hc)n nhan

Co nhieu nguyen nhan ddn de'n hanh vi mang thai ngoai hem nhan nhung ect mot nguyen nhan cer ban hem ca la su kem hie'u biet ve giao due tinh

due Cang it hie'u biet ve giao due tinh due cang de c6 nguy ca mang thai

ngoai hem nhan va cang nhieu kha nang nao thai ngoai hr^n nhan

NgucVi phu nir ciing se dua ra quyet dinh nao thai hem khi ho hie'u biet met he), hoac khcmg hie'u biet ve hau qua den veti sire khoe^ ciia vice nao thai ciia he) Nguetc lai khi ho hie'u re') cac hau qua thi vice dua ra cac quyet dinh cung khc) khan hctn Tuy nhien dii phai suy nghT nhieu hem khi dua ra quyet dinh nao thai rat nhieu phu nir van chap nhan nao thai Vi nhirng phu nir nay tim cho minh cac ly do tu an lii ban than nhu vice nae) thai kheVng nguy hie'm nhu ngucti ta vdn nc)i v.v

Kh6ng phai ta't ea men phu nH chua c6 gia dinh deu tu nguyen thuc hien

hanh vi nao thai eua minh, co mOt so dang ke^ bi ep bue)c thuc hien hanh vi nao thai Sir ep bu6c nay xua't phat tir ban tinh, gia dinh, xa he)i Ngay ca trcmg nhiing trucmg hop ngucti phu nir tu nhan la hc^ tu nguyen nao thai, ho vdn chiu sir chi phcn cua cac ye'u to cac sir kiem che' thuc te NgucVi phu nir chua co gia dinh chiu sire ep ciia nhiJng ngucVi than xung quanh minh manh hem sire ep ciia

xa he)i neVi chung Khi sire ep ciia xa he)i de'n nhung ngueVi nay phii herp veVi y kie'n ciia nhiing ngUeVi than thi ho de dang hem trong vice tuan thii theo sir khuyen bao tir ben ngoai Trong cac trueVng hctp do ngueVi phu nir chua co gia dinh de di de'n quyet dinh nao thai hctn

4 PhU(mg phap luan va phucmg phap he nghien curu ve hanh vi

nao thai ngoai hon nhan

4.1 Khai niem hanh vi (Behavior) hanh vi nao thai, va hanh vi nao thai

ngoai hem nhan

Me)t trong nhiing khai niem ca ban ductc dung xuyen sue)t trong luan an

nay do la khai niem hanh vi nao thai ngcxii hcVn nhan NeVi each khac detn vi phan tich trcmg nghien ciru cua chung toi la hanh vi nao thai ngoai heVn nhan Vice phan tich hanh vi nao thai ngc^ai hein nhan dac biet ceV hieu qua neu chiing

ta tiep can tir goc de) ly thuyet hanh vi

Ly thuyet hanh vi ceV ngucin gc^c sau xa tir nhung thi nghiem ve phan irng ccV dieu kien ciia nha sinh ly hoc vT dai ngueVi Nga PaplcSp Nhirng y tucmg ciia PapleSp trong cac thi nghiem nay da duetc mot nha khoa he)c ngUcVi My la Skinner diing trong nhung nghien ciru tam ly hoc Net can ban cua ly thuyet hanh vi thiia ban ddu la neV chi thira nhan vice nghien ciru tam ly ce)n ngUeVi thcmg qua nhii'ng bie'u hien hanh vi ben nge)ai (nhirng cai ceV the quan sal ductc) MeV hinh ly thuyet chu ye'u ciia ly thuyet hanh vi da duetc J.B Watson,

nha ly luan so m6t cua trueVng phai nay, the^ hien qua men quan he het sire dem

gian : S ^ R Trong do S la tac nhan, la kich thich (Stimul) ceVn R la phan irng,

la sir tra loi (reactions, respones) Tre^ng meV hinh nay Watsem da bc^ qua, khe'^ng de'm xia deh vai tro ciia y thirc trc:)ng hanh vi ciia ca nhan

Nhu vay luc nay khai niem hanh vi duetc hie'u bao gc)m toan bo nhirng bie'u hien cc) the' quan sat ductc ct ben ngc^ai men ca nhan

Ly thuyet hanh vi co anh huetng cue ky to letn de'n sir phat trie'n ciia tam

ly hoc noi rieng va nen khoa hc^c ve con ngUeVi tai My noi chung Y tucmg nghien ciru ve nhiing khia canh chii quan trong hanh vi con ngucti chi ccV the' nghien ciru thc')ng qua nhirng hanh vi c6 the' quan sat ductc da tao thanh mot trong nhirng nguyen t^c ciia chii nghTa thuc chirng meti rat phc) bien trong xa hoi hoc

Tir nhu'ng y tuetng kinh die'n ciia ly thuyet hanh vi, da ceV rat nhieu huetng phat trie'n ciia ly thuyet nay Mc)t trong nhirng huetng phat trien la ciia E Tolman (1886-1959) Tolman da dua vao me) hinh cua Watson khai niem cac bien trung gian (intervening variables) Khai niem nay nham chi me)t tap hctp

cac yeu id nhan thirc va kich dc)ng, va meV hinh meti ciia Tolman duetc the hien

: he theV'ng nhu cdu, he thcV'ng gia tri, tinh hue)ng thuc hien hanh vi

I'ir diOn \a h6i hoc NXH C'hinh tri.Mockv.i 198*^, Tir "Chu nghIa ihirc chirng v;i ihuc chirng mtti' (liong Nga)

N6n theo eae tac gia kinh die^m cua ly thuyet hanh vi thi me)t hanh vi duoc ung h6, lien tucmg thi ductc cung co va nguetc lai Mc)i quan he nay la tuye'n tinh, co hc)e Nhung theo nhung tac gia ciia ly thuyet hanh vi meti nhu Tolman thi sir thuc khcmg detn gian nhu vay Con ngucti ciing phai suy nghT, doi ehie'u, can nhdc tru6c cac tac nhan moi khi dua ra me)t phan irng, mc)t quyet dinh

Nhu vay de'n Tolman khai niem hanh vi da phong phii va phirc tap hctn,

no kh6ng chi c6 cac tac nhan (ben ngoai) va cac phan irng (ben ngoai) ma ngucti ta da neVi de'n nhiing nhan to ben trong ceV anh huetng den qiia trinh phan irng

Ly thuyet hanh vi, dac biet la ly thuyet hanh vi meti (Nee^behaviori/m ) ductc su dung kha re)ng rai trong xa hc)i hoc Me)t trong nhiing irng dung ly thuyet hanh vi meti vao xa hc)i hcK thanh ceding nhat la ciia nha xa hoi he)c, tam

ly hoc xa he)i nen tie'ng ngucti My la G.Mead.Ong da cc) gdng xem xet, phan tich sir da dang ciia nhirng cai qui dinh hanh vi con ngucti Mead ciing ceV quan die'm gdn quan die'm ciia ly thuyet hanh vi ct che\ c)ng cho rdng cai tam ly cdn ductc giai thich thueVng qua hanh vi quan sat ductc Tuy nhien nguetc lai veti chii nghTa ca nhan ciia ly thuyet hanh vi chinh thong, c>ng dua ra luan die'm ve ban chat xa he)i ciia hanh vi ce^n ngucVi Ong vie't : "Chiing ta thu giai thich hanh vi

ca nhan theVng qua hanh vi c6 to chirc ciia nhcVm xa hoi, hanh vi xa hc)i kheVng the' giai thich duetc ne'u xay dung no tir tac nhan va phan irng NeV cdn duetc phan tich nhu la me)t chinh the' linh hc^at, khong mc)t phdn nao ciia chinh the nay ceV the' duetc phan tich thuc hien ductc mot each de)c lap "G Mead, Sell and Sociaty Chicago 1939 Mead G) De'n day chiing la thay rang kheVng the hieu hanh vi detn gian nhu la mot sir phan irng deVi veti me)t tac nhan ma phai hie'u deV la Me)t chinh the linh boat bao ge)m cac ye'u te) ben trong va cac bie'u hien ben ngoai ceV quan he hun ect veti nhau NeVi each khac deV chinh la su

tuong tae eua eae ea nhan hoac nh6m veti moi trueVng (nghTa rong) xung quanh, va duoc thue hien nho vao tinh tich cue ben ngoai (mat van dc^ng) va tinh tich cue bfen trong (mat tam ly) ciia ca nhan hoac nhom

Tir dinh nghTa chung ve khai niem hanh vi neu tren, chung ta c6 the' riit

ra dinh nghla v^ hanh vi nao thai nhu sau : Do Id mot chinh the linh hoqt cua

viec ngu&i phu nu mang thai va tham gia vao qua trinh nao thai (voi hdc si) cung v&i nhiing yeu toxd hoi duffc hoi tu hen trong y thAc cua ngu&i phu nH

CO anh huong den viec ra quyet dinh nao thai cua ho NhUng yeu to xa hoi

do CO the Id tdc dong cua gia dinh, han he, ngu&i yeu, ngu&i tinh du luan xa

hoiy cdc kiem sodt xa hoi vd thuc te v.v

CeVn hanh vi nao thai ngoai hcVn nhan do la hdnh vi nao thai cua ngu&i

phu nit khong co chong

4.2 Me') hinh phan tich hanh vi nao thai ngoai he)n nhan

Tren ect set phan tich ve mot mo hinh hanh vi noi chung a tren, chung ta

cd gdng xay dung mot mo hinh dac trung ciia hanh vi nao thai ngoai hem nhan

Nhu tren, chiing ta thay rang trong men mc)t hanh vi bao gieV ciing ceV 3 thanh phdn ndm trong sir thong nhat Do la cac tac nhan, cac ye'u to trung gian va nhiing phan irng quan sat ductc Trong hanh vi nao thai ngetai hc^n nhan re') rang tac nhan tiep deV la viec mang thai ngoai heVn nhan Tat nhien viec mang thai ngoai he)n nhan cung co nhieu nguyen nhan khac nhau Nhung cai thai ngoai heVn nhan nay cc) the' la nhung cai thai ductc mong deti nhung phdn nhieu la nhung cai thai ngoai y mue)n Gia dinh, ban be, ngUeVi yeu, cac dinh kien teVn

giao v.v la nhiing ye'u id xa hoi tac dong de'n y thirc ciia ngUeVi mang thai

ngoai heVn nhan, anh huetng den vice ra quyet dinh nae) thai cua he) Nhirng you

tcV nay ket tu trcmg y thirc meVi ngucti nay va tae) ra cac nhan id trung gian Cac

nhan t6 trung gian nay se suy xet : nen hay khong nen nao thai ? Ban be neVi gi

Gia dinh suy nghT gi ? NgucVi yeu co y kie'n gi ? Nao thi co Icti gi 7 v.v Tom h

no dua ra rat nhi^u nhan xet, phan quyet nhung cuen ciing phai ra duetc mc)t quy^ dinh nao hay kh6ng nao

Khi da ra ductc me)t quyet dinh nao (hoac bi ep bue)c ra quyet dinh) tl phan ijrng quan sat ductc ciia ngucVi nao thai ngoai he^n nhan la viec ho di nao iha]

Nhu vay mci hinh hanh vi nao thai ngoai hc^n nhan duetc the' hien nhu sau :

Nhu'ng khiing hoang

cua ca nhan

Muc)n ccV con

Do tac dOng ciia tu

tucmg tu do heVa tinh due

Hieu qua

tranh thai kem

Thieu kie'n thirc

giao due tinh due

Ye'u id khac

NGUOIPHUNUrVA VI|C MANG THAI NGOAI HON NHAN

Sinh con ngoai heVn nhan

I — •

NgucVi phu nir

va vice nao thai ngoai heVn nhan

Cac yeu le) trung gian lac dc)ng den qua trinh

ra quyet dinh nao thai :

Xa he)i, cac tie'u mOi trucmg xa hc)i va cac kie'm soat thuc te

Thuc te trong ly thuyet hanh vi mcM tac nhan S] deu ceV the la mot phan irn ciia me)t tac nhan S^> khac NeVi each khac mot tac nhan S hay mr)t phan irng R vii dc)ng theVi da timg la me)t phan irng hay me)t tac nhan thee) set de) sau :

Si -> R] = S2 ^ R2 = S^ -> R;

Qua so do nay, doi ehie'u v6i mo hinh hanh vi nao thai ke' tren, chiing ta tha'y rang viee mang thai ngoai hon nhan virala nguyen nhan (S) ciia viec nao thai ngoai h6n nhan, lai vira la hau qua (R) cua cac nguyen nhan gia dinh do v5, mudn co con, do tac d6ng cua loi song tu do tinh due, kem hie'u biet ve giao due tinh due, v.v

Tat nhien viec mang thai ngoai hon nhan co the' ddn de'n mc)t hien tucmg

khac do la sinh con ngoai gia thii, rat phd bie'n cV cac nuctc phuetng Tay Tuy

nhien trcmg luan van nay do nhieu ly do chung te^)i chi gicti han eV viec phan tich hanh vi nao thai ngoai he)n nhan

Theo G Mead thi men hanh vi ciia con ngUeVi vdn la mc)t hanh vi xa he)i,

do do hanh vi nao thai ncVi chung va hanh vi nao thai ngoai heVn nhan ncVi rieng ciing la hanh vi xa h6i Va de' nghien ciru co hieu qua ve hanh vi nay thi phai nghien ciru no trong mat chinh the' thc)ng nhat Tire la hien tucmg nae) thai kheVng the' nghien ciru tach reVi khc')i hien tuemg mang thai ngoai heVn nhan, he)ac khcM cac suy tinh, ddn do, deV'i chieu, so sanh ciia meVi phu nir khi dua ra quyet dinh nao thai NeVi each khac cac hien tucmg phai duetc nghien ciru tre)ng me)i quan he qua lai veti nhau Tir mf) hinh hanh vi nao thai ngoai hcVn nhan chiing ta co the' riit ra 4 cum van de quan trong cdn xem xet trong me)i quan he khi nghien ciru ve hanh vi nao thai ngoai hem nhan

1 Cac nguyen nhan ciia hien tucmg mang thai ngoai he'^n nhan

2 Ve thuc trang mang thai ngoai hc"m nhan

3 Cac ye'u tcV' xa hc)i anh huetng de'n quyet dinh nao thai ciia ngueVi phu nir khcmg ccV chc)ng

4 QTc khia canh ciia thuc trang nao thai nge)ai heVn nhan

Vice lam re') cac cum van de quan trong giiip chiing ta xac dinh duetc he phuetng phap cu the phii hctp cho de tai

3 Xae dinh he phucmg phap cu the' trcmg nghien ciru ve hanh vi nao thai ngoai h5n nhan

D6'i veti nhiJng nguoi phu n\i Viet Nam khong che)ng di nao thai thi day

khdng phai la de tai co the' trao den de dang va thoai mai ductc Do do trong

trueVng hctp nay viec dung quan die'm nghien ciru ngucti tir ben trong (insider concept) la quan die'm phii hctp hctn ca Quan die'm nghien ciru nay da duetc

"Care international" diing thanh ccmg trong nghien ciru ve nguy cet HIV/AIDS

va tinh due ct Viet Nam nam 1993 No bao ge)m cac quan sat, treV truyen tir ben trong

Trong nghien ciru ciia chiing teVi nhu'ng ngueVi tham gia thu thap theVng tin theo quan die'm noi tren la cac nhan vien y te' da duetc tap hua'n ve cac the^ng tin cdn thu thap Ho lam vice tai cac cet seV y te'duetc phep tien hanh nae) thai, chii ye'u tai khoa San benh vien Tir Liem va Tram y te thi Iran NghTa Tan Tir Liem

NheVm thir hai thu thap thcVng tin tir ban be than thiet da tirng nae) thai hoac ceV ban gai da tirng nao thai TcSng se) da phemg van, treV chuyen 129 phu nir da nao thai, trcmg deV ceV 33 phu nir kheVng ceV che)ng

Mot hue'mg thu thap theVng tin khac nira deV la phan tich cac tai lieu theVng

ke va cac seV' lieu ve nao thai da ceV Do la cac se) lieu ve nao thai et Ha Ne)i, eV

Thai Binh, Quang Ninh, thanh phd Hd Chi Minh va tinh hinh nao thai mot se)

nuetc tren the gicti Ngoai ra ceVn ceV cac tai lieu, sach bao ve hien tucmg mang thai ngoai heVn nhan

Chiing teVi ciing tie'n hanh phe>ng va'n cac y, bac sT san khoa duetc phep lam nghiep vu nao thai

DeV'i veVi mot sd khia canh ciia cum van de thir 3, nhu DLXH veti hanh vi

nao thai, chiing ta da sir dung phuetng phap trung cdu y kie'n 200 nguoi hang bang lirghi hoac bdng phemg van nhanh

Cac th6ng tin thu ductc m6t phdn ductc xu ly dinh lucmg bdng may tinh

va thu cAng, nhu eae phong va'n tir ben trong co chuong trinh, cac trung cdu y

kie'n bdng bang tu ghi, phe^ng va'n nhanh, xu ly lai cac se) lieu da co v.v Cac cu()c trcV truyen, tam tinh quan sat, me)t set tai lieu duetc xu ly chii ye'u thee) phuetng phap dinh tinh, nhdm ndm duetc xu huetng, quan he va ban chat cac se) lieu

Qua trinh thu thap thcmg tin phuc vu cho de tai chinh thirc bdt ddu tir thang 5/1995 ke't thiic thang 8/1995 Qua trinh xu ly va phan tich seV' lieu ductc tie'n hanh gen ddu Hai qua trinh nay ket thuc 15/9/1995

5 l o n g quan nhiimg nghien ciiru hanh vi nao thai ngoai hon nhan

VeVi nhiJng tai lieu ccV trong tay, chiing teVi thay rang cho den nay chua ceV me)t nghien ciru ccV he the)ng, ddy dii ve hanh vi nae) thai ngoai heVn nhan Chinh

vi ly do deV vice idng thuat nhirng nghien ciru ve hanh vi nae) thai nge)ai heVn

nhan rat kho khan Mac dii vay qua nhirng nghien ciru ve vice mang thai va nao thai ngoai hc^in nhan neVi chung tre)ng va nge)ai nuetc chiing ta ceV the chdt loc cac y tuetng khoa hoc phuc vu cho nghien ciru ve van de nay eV Viet Nam

1 Tinh hinh nghien ciru ve hanh vi nae) thai nge)ai heVn nhan tren the gicti

1.1 Ve hanh vi mang thai ngoai heVn nhan

Vice mang thai ngoai he)n nhan la hien tuemg rat pheS bie'n a cac nuetc

phuetng Tay nhu My, Dire, Phap v.v TheVng thuctng ceV hai khuynh huetng trong nhiing ngueVi mang thai ngoai hcVn nhan - Thir nhat dcV la sinh ce)n ngoai

gia thii TTieo teV TheVi bao Los Angeles thi ceV teVi mc)t phdn tu se) tre sinh ra d

My, rneVt phdn ba ct Phap va me)t nira ct TTiuy Dien va Dan Mach la con sinh ra nge)ai heVn nhan TTiir hai deV la nheVm tiep nhan hanh vi nae) thai ma chung ta nghien ciru trong luan an nay

ITico ban dich ciia tol.os Angeles Time (i;lng trOn NIK'N .So r ng;tv |()'0'1')*;S n IS

v^u/Ul

Nhu vay hie^u tron ven ve hanh vi nao thai ngoai hc)n nhan chiing ta khftng the^ kh6ng xem xet v^ hanh vi mang thai ngoai hon nhan (xin xem them phdn ) Trong nhung phu nii' mang thai ngoai hctn nhan thi set ngucti

tre iu6i va thanh thie'u nien chie'm da sd Do vay chiing ta se tap trung phan

tich ve hanh vi mang thai ngoai hon nhan ciia thie'u nir

Sir tructng thanh setm ve mat sinh ly, deti semg kha hctn nhiing quan die'm giai phcVng trcmg vdn de tinh due da khie'n cho cac thie'u nir My boat dOng tinh due setm hctn David Bender va Bruno Lecme trong Icti gicti thieu cue)n "Tinh due thanh thie'u nien" (Teenage sexuality xuat ban nam 1994

taiMy) da dua ra cac sd lieu cho tha'y ty le thie'u nir tham gia boat de)ng tinh

due trueVc he'^n nhan tai My nam 1970 la 29%/de'n nam 1988 con sc) nay len de'n 52%K Va nam 1993 cuc)c dieu tra ciia tap chi Time chi ra rdng 19%^ se) thieu nien My tir 13-15 tucSi da tirng co quan he tinh due, se) veti 55% cua liratue^i 16,17"

Hoat de)ng tinh due setm ddn den hang loat cac hau qua ve tam ly, xa

hoi ddi veti nhom thie'u nir nay nhu va'n de lay nhiem HlV/AlDS , cac re)i

loan tam ly, mang thai ngoai hr^n nhan

Ciing D Bender va B Leone da tom tdt 3 dac trung ciia tucSi tre ma theo do ho de mang thai, mac dii hien nay da ddy day cac phuetng tien tranh thai Dac trung thir nhat do la nhiing thie'u nir hoc kem cV trucmg de tret thanh ngucti mang thai ngoai heVn nhan hctn Dac die'm thir hai deV la hdu nhu tat ca thanh thieu nien (My) deu chia se cam giac ddy tu tin vao sire manh ciia ban than DeVi veti ho vice ceV thai la mc)t cai gi deV xa veti chir kheVng phai la mc)t ket qua leVgic ciia boat deVng tinh due Chinh vi vay thee) nha ccVng tac xa hc)i bang Virginia Cartoof "Ho kheVng cdn biet den cac giai de)an

sau ciia cudc seV'ng Ho se)ng vi theVi die'm hien tai" NeVi each khac he) seVng

David IHender and Hruno Leone Teenage se\u;ility e'opyrighl 1*'*M hv ( neenh.tven Press, inc I SA Sdd irang 13

gap va mu6'n hudng thu ngay Dae die^m khac nira la sir xem thuctng cac ki^'n thiire v^ tinh due Tie'n sy Doris Tirado binh luan rdng :"Ra't nhieu trong sd ho tin tuong rdng ho khong the^ co thai trong Idn giao hctp ddu tien"

Da'y la ba dac die'm ciia thanh thie'u nien khie'n cho cac thie'u niJ My

de dang mang thai ngoai hon nhan Tuy nhien day ciing chua phai la tat ca

Ciing trong tae pham "Tinh due thanh thieu nien", Suzanne Fields da neu ra m6t nguyen cet quan trc)ng ciia viec co thai ngoai hon nhan Theo tac gia sir tan vet ciia cac gia dinh la nguyen nhan thuc ddy viec cac thie'u nir

mang thai ngoai he^n nhan Su tan vd ciia cac gia dinh hat nhan tao ra me)t

the'he thanh thie'u nien phi luan ly va thie'u sir chi ddn cua cha me Nhiing

thieu nQ dang nay de mang hoang thai va ceV the' lai sinh ra nhiing dira tre*

ma sau nay IcVn len lai lap lai cac veVng deti ma me neV da di qua

Khac veti Suzanne Fields, Mike Malemc)t tac gia khac trong cueVn sach neu tren ket te)i nhiing ngucti dan cVng (tren 18), phai chiu trach nhiem

ve viec cac thieu nir mang thai ngoai hon nhan Tac gia dua ra mot se) lieu the)ng ke cho tha'y rdng 70%^ sc) tre em My do cac thieu nir sinh ra ceV cac

"cVng be)" et do tudi tren 20, co mcVt phdn sau cac ong bd nay tren 25 tudi Dieu nay rat phii hctp veVi mc)t qui luat la dueVng nhu cac phu nir tre^ lueVn tim ban tinh la nhiing ngucti letn tudi hctn minh

Tiep can tir mot hucmg khac, Claire Brindis tret ly giao su khoa Su pham, demg Giam deVe Trung tam nghien ciru chinh sach sire khoc^ sinh san DHTH California, cho rang cac phu nir tre^ it'treVng cheV vao vice hoc hanh cua ho ducmg nhu de ceV thai hctn nhirng ngueVi phu nir tin rang vice he) ket thiic Trung hoc va Dai hoc si^ ceV Icti che) ho Tire la neu ngUeVi phu ntf tre

Sdd, I rang 53

" Sdd (rang 58

Sdd, Irang 63

cam tha'y chan nan xung quanh viec hetc hanh ciia minh va nhin tha'y it ceV trie'n vong v^ viec lam thi ho ecV it ly do de' nghT de'n viec tranh thai hctn Va

do do ciing de mang thai hctn khi boat dc)ng tinh due Theo Claire Brindis trucVc day co nhieu y kie'n cho rdng cac cc) gai bc) hoc la vi hc) ccV thai, nhiing nghien ciru gdn day da cho tha'y ket qua nguetc lai : Ho bd hoc truetc khi ceV thai Nhung se) lieu thu thap ductc cho tha'y rang trong se) tat ca nhirng thieu nu' be') hoc va sinh con da nghien cuu ceV 28%^ reVi nha tructng truetc khi mang thai Mc)t nghien ciru khac ve cac phu niJ 20 tudi chua ceV che)ng, ceV thai va bc) hoc cho tha'y rang 61%^ cac thai nghen xay ra sau khi ho be') hoc

Cac tac gia ke' tren thucmg chi neu ra cac nguyen nhan detn le ciia vice mang thai ngoai heVn nhan Khac veti ho 2 tac gia Lawanda Rave)ira va Andrew L Cherry khang dinh rang hang loat cac yeu te) dong theVi tac de)ng den vice mang thai ciia cac thie'u nir chua chong Nhirng yCu te) nay gdm :

1 Nhirng va'n de cV tructng hoc

2 Vi the kinh te va chiing toe

3 Tudi bdt dau sinh boat tinh due

4 Ap luc ciia be ban

5 Anh huetng ciia cha me va cac quan he gia dinh

Theo hai tac gia nay khong the' giai thich hien tuemg mang thai ciia cac thieu nir chua che)ng bdng mc)t yeu td detn le nao deV, ma phai xem xet

no bdng mot loat yeu tc) lien quan Me)i quan he giua boat de)ng tinh due setm veti vice mang thai ngoai hcVn nhan ciia cac thieu nur, va vice he)c hanh kem la mdi quan he hay duetc de cap hctn ca Tuetng tu nhu quan diem ciia Claire Bendis, K.Pittman cho rdng vice he)c hanh kem ce')i lam giam me)ng mucVn phcVng thai cua cac ceV gai

rrang (>5

Sdd.Irang 77

Khi so sanh eae dae trung van hoa - xa hc)i ciia nhcVm thanh nir mang

thai ngoai h6n nhan veti nhom thanh n\i kheVng mang thai trong ciing mot

viing tai Santiago, Chi Le cac nha nghien ciru M Alvarez, R Burrows,

A Vaighat, va S Muzzo da tha'y rdng cac thanh nir mang thai ngoai heVn nhan CO ket qua hcte tap tai trueVng va he se) IQ thap hctn so veti nheVm kheVng mang thai

Viec phan tich me)t each teSng hctp hien tuemg mang thai nge)ai heVn

nhan ciia cac thie'u nQ la mdt hueVng di diing ddn Beti vi mdi hien tuemg

trong xa he)i khe^ng tc)n tai mc)t each de)c lap veti nhau Cach tiep can nay giiip chung ta hie'u reV hctn ve hanh vi mang thai ngoai hcVn nhan va tir do ddn den vice phan tich hanh vi nao thai ciia mc)t se) letn tre)ng se) he)

1.2 Ve hien tuemg nao thai va hanh vi nao thai ngoai heVn nhan

Stanley K Henshaw, pheV giam deVc Vien nghien ciru The Alan Guttmacher Newyork, nam 1990 da viet mot bai tcSng thuat ve tinh hinh nae) pha thai tren the'gicti thuc trang va quan die'm

Bdt ddu tir IcVi de ddn cho ta biet 87% cac ca nao thai tai My duetc thuc hien ngoai cac benh vien Mot phdn letn cac ca nao et Ha Lan, Na Uy, BaLiin, Tay Dire, cung duetc thuc hien ngoai cac benh vien

S Henshaw cho rang xu hueVng tu do hoa nao thai bang luat phap dang tie'p tuc tren the gicti Tir 1986 de'n 1990 da co them cac nueVc Canada, Czechoslovakia, Hi Liip, Hungary, Rumani, Lien XcV (cu), Viet Nam da cho phep nao thai chinh thirc, theo cac mirc de) tu de) khac nhau De'n nam 1990

ce') 4(y/(> dan scV the'gieVi scVng trong cac queV'c gia cho phep nao thai theo yeu

S<ld irang 77

' Slanlev^ Henshaw Induced Abortron; A world Review, 1*^*){)

cdu ciia phu nO", va 25% song trong cac qude gia chi cho phep nao thai ne'u eue)e song eua nguoi phu niJ bi de doa ne'u de' mang thai, sinh con

S Henshaw tie'p tuc cho biet rdng nam 1987 ueVc tinh ceV khoang 26 de'n 31 trieu ea nao chinh thiJe va 10 de'n 22 trieu ca bi mat tren toan the gicti Ty le nao thai chinh thirc cao nhat la 112%e) c't Lien XcV cu va tha'p nhat

la 5%u) or Ha Lan so veti teSng sd phu niJ trong dc) tueSi sinh de

Trong dai da sc^ cac nuetc Tay Au va cac nuetc noi tie'ng Anh, khoang me)t nua cac ca nao thai la ciia cac phu niJ tre, chua co che)ng trong khi tai cac nucVc Dc)ng Au cii va tai cac nueVc dang phat trien nhiing phu nir ceV hanh vi nao thai chii ye'u la nhiJng ngucti co gia dinh va ceV tir hai con hoac

la hctn

Luat phap ciia cac nucVc tren khap the gicti dieu chinh hanh vi nae)

thai ciia ngucti phu nU noi chung trai dai tren mot true veti 1 cue la ca'm gdn

nhu hoan toan vice nao thai va cue kia coi nao thai nhu la quyen ciia ngueVi

phu nQ mang thai DeV'i veti cac queVe gia va Ifinh thd ceV tren 1 trieu dan va

CO luat phap cho phep nao thai theo tirng mirc dc) khac nhau, thee) S Henshaw co the' chia vao 4 nhom letn

Nhom 1 : 53 qude gia veti 25%> dan sc) the'gicti reti vao nhom gieVi ban nhieu nhat Hanh vi nao thai chi ductc cho phep neu no nham muc dich ciru seVng ngucti phu nir mang thai

NheVm 2 : ge)m 42 quc)c gia, veVi 12%^ dan sc) the gieVi, cho phep nae) thai vi nhiJng ly do y te rc)ng rai nhu : de tranh anh huetng den sire khe)e ngucti phu nir neVi chung (kheVng nhat thiet chi gieVi ban beti me)i de de)a den tinh mang), trong trucmg hctp ngucti phu nir bi hiep dam, hoac thai nghen la ket qua ciia hanh vi loan luan

NhcVm 3 : gdm 14 queV'c gia veVi 23^/'r dan sd the gieVi, che) phep nao thai theo cac chi dinh xa hoi hoac y-xa hoi Tire la ngUeVi phu nir co the nao

thai ne'u ho eo ly do cho tha'y rdng viec mang thai se c6 nhirng dieu kien bat Icti cho ho v^ mat xa h6i hctae ve mat sire khoe

• • •

Nhom 4 : Com 23 quoc gia veti 4()%> cho phep nao thai theo nguyen vong ciia ngucti phu niJ, Viet Nam ndm trong nhom cac nuetc thir 4 (xin xem them phu luc)

Mdt sd nu6c doi hoi ngUcVi phu nQ co chdng phai ductc sir ddng y che)

phep ciia chdng thi meti ductc nao thai (nhu Dai Loan, Thd NhT Ky )

Trong tructng hctp ngUeVi nao thai chua che)ng, lai it ludi thi cdn phai ceV y

kie'n ciia cha me

Trong mc)t quc)c gia mc)t dao luat ve hanh vi nao thai ciing co the ductc giai thich khac nhau tai cac viing khac nhau Hoac trong mot lien bang thi cung co the' bang nay cho phep nao thai nhung bang khac lai cam

Vi du tai MehieeV nam 1990, Nghi vien bang Chiapas da phe chudn dae) luat coi vice nao thai den 90 ngay tudi kheVng ccV le)i, neu vice do vi ly de) ke hoach hoa gia dinh, vi chua ceV cheVng, v.v Nhung dao luat nay da bi cac lire luemg bao thii cheV'ng pha quyet liet, cuc)i ciing Nghi vien lai phai bac be') dao luat da ra

CeVn ct Hoa Ky thi co nhiing bang nhu Missourri, Pennsylvania, Kentucky va North Dakota tie'p tuc ca'm nao thai tai cac benh vien ciia nha nuetc, trong khi 14 bang khac cho phep nao thai nhung veti nhu'ng phu nir dueVi 18 tueSi chua chc)ng thi cha me phai duetc theVng bao hoac deVng y Nhu'ng bang ceVn lai ce'ti met hctn trong van de nae) thai

Ngoai vice phan tich ve luat phap va chinh sach ddi veti nao thai tai cac nUcVc S Henshaw ceVn xem xet nhieu khia canh khac cua nae) thai nhu seV luemg nao thai tai cac nuetc, tudi thai khi nae), cac van de sire khoc' sau khi nao thai, theVi gian ndm vien khi nao thai v.v (xem them phu luc)

Kproduclive heallh mailer Number 1 May 1W3 pp 5'* - f)(i

' A -" ' ' •

S Henshaw khi xem xet ve van de tueVi thai khi nao da dua ra mcVt nhan xet rat dang ehii y Do la nhiJng phu nir tre hctn 20 tudi thucmg di nao thai mudn hon so v6i nhirng phu nir cao tudi hctn Va sd phu nir hctn 40 tudi nao thai mucVn d6ng hctn phu nir do tudi 35-39 mot chiit Them vao deV trinh

do hoc va'n tha'p ma nguoi phu niJ co ductc ciing gdn veVi viec cham nao thai Tat nhien viec nao thai mue)n cung co the' do vice nghi ngcV hoac xac dinh ductc thai hi khuyet tat

Tudi ciia nhcVm phu nQ cd hanh vi nao thai theo Henshaw dan trai tir

dueVi 14 cho de'n tren 40 tudi, tuy nhien de) tudi dueVi 19 tudi va 20-24 chie'm

ty le de'^ng hctn ca et My, Scotland, NaUy, Newzealand, Anh queV'c, Canada, trong khi eV cac nucVc Bungari, Tiep Khdc (cu), Tay Dire, a'n Do, Nhat, Singapore v.v thi nhdm phu nii' nao thai chii ye'u reti vao do tudi 20-29

Veti cac sc) lieu da cd ve tinh trang gia dinh ciia nheVm phu nir ceV hanh

vi nao thai tai mdt seV' queV'c gia, Henshaw da chi ra me)t khuynh huetng la tai Hoa Ky va mc)t seV nuetc phat trie'n noi tieng Anh (tai Ha Lan va cac nuetc Scandinavia) ty le phu nir chua che)ng nao thai kha cao tren 60% se) ngueti nao Tai Dire, Phap con se) nay thap hctn chiit it CeVn tai cac nuetc khac (ma

da CC) SC) lieu) hctn 2/3 sc) phu nir ceV hanh vi nao thai da cd cheVng Bang se) lieu dueti day se giiip chiing ta nhin reV hctn khuynh hue'mg do (xem bang 1)

Theo Henshaw nhcVm phu nir chua ceV cheVng nao thai vi chua mong mueV'n ceV con ddu IcVng Trong khi nheVm phu nir cd chdng nao thai vi kheVng mueV'n sinh con mau qua hoac khcVng mucVn dt^niJa

O cac nucVc phat trie'n noi tie'ng Anh thi hanh vi nao thai chii ye'u cd d

phu nir tre: CeVn tai cac nuetc Trung Au va DeVng Au cac phu nir tre chua cheVng ciing thucmg cd thai nge)ai heVn nhan nhung he) thueVng cueti chdng va

de sinh con (J Nhat Ban va Tunisia vice mang thai truetc heVn nhan it cho nen vice nao thai ngoai beVn nhan cung it Nhirng phu nir da cd cheVng (V

Nhat Ban it sur dung thuoc tranh thai va cac phuang phap dinh san do do

day la nhom thudng hay nao thai nhat a Nhat Tai Bungari, Tiep Khdc (cu)

va Hungari tinh trang cung tuong tu nhu vay

Bang 1 Ty le phan bo ciia phu niJ nao thai theo tinh trang hon

78.3 24.5 77.6 33.6 24.8 32.5

42 2 48.4 68.1 92.8 67,6 34.4 27.7 39.1 23.0 68.7 35.8 16.7

Da tung CO chong

21.7 8.2 7.9 7.4 9.8 9.3 9.2 6.0 10.7 1.3 3.5 9.3 13.2 6.6 11.6

" 2.5 10.5 83.3

Chua tirng ket hon

67.3 14.4 59.0 65.4 58.1 48.6 45.7

1 1 T

5.9 28.9 56.2 59.1 54.3 65.4 28.8 53.7

TOng

KK) 1(K)

Ngudn : S Henshaw Induced Abortron : A world review; 1990 Table 7

Trong veVng nam nam tir 1986-1990 da cd nhirng thay ddi nhat dinh trong cet ca'u ludi ciia nhdm cac phu nir cd hanh vi nao thai Thi du tai New

Zealand trong khi ty le thie'u nien nao thai eSn dinh thi ty Ic nao thai d mot seV nhdm khac lai tang manh Ty le nae) thai d cac thanh thie'u nir cung giam

so veti phu nir cV cac nhcVm tudi cao hctn tai Canada, Dan Mach, Phan Lan va

Hungari

Tuy nhifen ty le phu nil' chua chemg cd hanh vi nao thai da tang nen eV nhi^u nuctc xu huomg nay co the' do cac phu nir do chua mue)n xay dung gia dinh va sinh con hctac co the' do gia dinh ho tan vet Mac dii vay et Canada,

Phdn Lan, New Zealand ty le phu nQ khong chetng nao thai kha cSn dinh

Phu nQ a'n Dd va Singapore cd hanh vi nao thai chii yeu la phu nir cd

chc)ng va hc) nao thai la vi muc)n gian khoang each giua cac con hoac theVi khe^ng sinh con

Ngoai nhtitig phan tich ke' tren Henshaw cdn dua ra cac se) lieu ve sir phan bc) cac phu nU ceV hanh vi nao thai theo se) con va se) Idn nao thai

Tom lai xu hucmg tu do hoa nao thai la mot xu huetng tat ye'u, mac dii nhu'ng nam gdn day tc)c dA tu do boa ceV cham lai Nhung hang loat cac yeu teV tac dOng de'n viec lir do hoa nao thai nhu nhirng ngueti phu nir hoac cac cap vet chemg quan tam hctn den vice kie'm soat sir sinh con ciia he), hay nhu vai treV va quyen ciia ngueti phu nir ngay cang duetc tang cueVng, va yeu le) quan trong khac niJa la ap lire cua dan sc), se thiic day cac queVc gia sua ddi me)l phdn hoac bai be) cac dieu luat ngan ca'm nao thai

2 Tinh hinh nghien ciru ve nao thai ct Viet Nam

O Viet Nam hanh vi nao thai duetc hctp phap boa tir nam 1986 Viet Nam ciing nhu nhieu nuetc khac ciing phai deVi ddu veti tinh trang gia tang cac ca nao thai Theo Bo Y te mdi nam nuetc ta cd xa'p xi 1,3 trieu ca nao ihai so veti xap xi 2 trieu ca sinh Cd mc)t dieu nghich ly la cang nhirng nam gdn day ty le seV' ngucti chap nhan cac bien phap tranh thai ciing tang thi ty

le nao ihai ciing tang

Vice tuyen truyen cac chuetng trinh Dan se) ke he)ach he)a gia dinh cang rdm ro, cac phuetng tien va dich vu tranh thai cang phd bien va de tiep can thi con seV' cac ca nao pha thai van tang len Theo nghien ciru ciia Trung

tam Gi6i - Gia dinh - Moi trudng trong phat trie'n, n^'u tinh so ca nao pha

thai trfen 1000 ca sinh thi a Thai Binh nam 1980 co 1()6/1()()()

nam 1990 c6 850/1000

nam 1991 co 1190/1000

9 thang nam 1992 co 1720/1000 Sc) cac ca nao thai et Tien Giang nam 1990 so veVi 1980 tang 10,3 Idn :

nam 1980 3483, nam 1990 36149

Ha Bdc 1980 - 6186 , 1990 - 35007 tang 8,3 Idn

Thanh phc) He) Chi Minh ceV ty le nao thai so veti sc) sinh thue)c loai eae) nhat nueVc 1692/1000

Hien trang la nhu vay ! Cac nha khoa hoc Viet Nam va nghien ciru

ve Viet Nam cd quan tam den va'n de nay chua ?

VeVi nhirng tai lieu cd trong tay chiing'tcVi tha'y rang hien tuemg nae) thai noi chung da ductc cac nha khoa hoc Viet Nam va nghien ciru ve Viet Nam chu y de'n (xem D Goodkind : Abortion in Vietnam : Measurements Puzzles and Concerns Tap chi Studies in Family Planning USA) Da cd nhu'ng du an kha qui mcV nham nghien ciru ve hien trang va cac bien phap can thiep nhdm lam giam nao thai nhung vdn dam bao cac muc tieu dan se) The nhung phan tich cac nghien ciru nay chiing ta tha'y rdng mdi me)t nghien ciru deu thuc hien rat teVt muc dich cu the' dat ra trong timg du an C^'ic muc tieu nay theVng thucmg chi de cap de'n mc)t thanh phdn de quan sat nhat ciia hanh vi nao thai Do la vice phan tich cac ca nao thai, he)ac nhung phan tich theo cac dac diem nhan khau xa hoi, phan tich ve mot se) ly do ciia hanh vi nao thai

Tuy vay cung chua tha'y cd nghien ciru nao di sau vae) hanh vi nao thai ngoai heVn nhan Song cung da cd nhirng thu nghiem ban dau Irong vice

dat hanh vi nao thai ngoai hon nhan trctng mcV'i quan he veti hanh vi mang thai ngoai h6n nhan va cac nguyen nhan ciia no (xem Le Thi Nham Tuyet -Viec mang thai, nao thai d tudi vi thanh nien, tim giai phap cho mot thuc trang CGFED, 1994) TiJc la mc)t cd gdng xem xet hanh vi nao thai nhu mc)t chinh the' tron ven gdm cac bO phan cdu thanh Trong bao cao khoa hoc neu tren, tac gia L6 Thi Nham Tuyet da di tir mOt trong nhu'ng die'm gdc ciia hien tucmg mang thai vi thanh nien do la thie'u hie'u biet ve gicti tinh, ve tinh due Va hien tuetng mang thai vi thanh nien la nguyen nhan true tiep ciia hanh vi nao thai vi thanh nien dudi ap lire ciia gia dinh, xa hc)i

Trong nghien ciru ve thuc trang nao pha thai et Ha Noi cac tac gia cung danh mc)t phdn de' phan tich ve van de cd thai ngoai heVn nhan

Ngoai nhirng ccV gdng tim hie'u va'n de mc)t each tron ve;n trong bao cao tren, hdu nhu cac nghien ciru khac chi tap trung lam reV me)t thanh phdn nao dd ciia hanh vi nao thai Cu the' la chii ye'u chi tap trung vao phan tich true tiep cac ca nao thai va mcVt phdn cac yeu te) tac dc)ng Cdn hanh vi mang thai va cac ly do ciia nd hdu nhu chua cd nghien ciru nao de cap mot each ddy dii Do dd qua cac sd lieu da cd, chiing ta cd mot birc tranh kha chi tie't ve chan dung ciia nhdm phu nif cd hanh vi nao thai Mot sd phan tich ve cac ye'u tet tac dong den hanh vi nao thai (xem Thuc trang nao pha thai va ceVng tac dan sc) KHH-GD et Ha Noi, PTS Nguyen Qude Trieu va cac tac gia khac, Ha Noi 1993) Tuy vay meVt cau hoi letn ductc dat ra : theo cac

sd lieu da cd vice tang cucmg cac bien phap tranh thai khcVng dam bae) duetc vice giam ty le pha thai, nhu vay mudn giam ty le pha thai ceVn ce)n dueVng

khac nQ'd la giam ty le mang thai ngoai y muc)n Vay lam the' nao de giam duac vice cd thai ngoai y mueV'n ? Dac biet la giam hoac ngan ngira viec

mang thai ngoai heVn nhan ? Beti vi dieu nay kheVng chi cd y nghTa ve mat dan scV ma ceVn cd y nghTa ve xa hoi

Nghien ciru ve dan sd va sire khoe Viet Nam ductc UBDSQG ciing Tdng cue thdng ke thuc hien nam 1988 (DHS) tuy khong phai la me)t nghien c ^ rieng ve nao thai nhung no ciing da cho tha'y mot xu hueVng tang

sd lucmg cac ca nao hut hang nam nhu la mc)t die'm ye'u ciia chuetng trinh ke hoach hoa gia dinh

Nam 1990 trong cucVc nghien ciru FFS ciia Vien xa hoi hoc tai xa Van Nhan da tim hie'u ve cac bien phap tranh thai ma phu nir da nghe ndi, biet

va dang sijr dung Ngoai ra, nghien ciru ceVn xac dinh duetc 3,1%^ sc) phu nir duetc hoi da tirng nao hut

Nam 1992-1993 trong mc)t chuetng trinh hctp tac giua td chirc SIDA Thuy Die'n va Trung tam nghien ciru Gicti - Gia dinh - MeVi trucmg trong phat trie'n da thuc hien mc)t nghien ciru qui mcV ve he thcV'ng sire khoc^ et Thai Binh Trong dd ceV mOt mang quan trong ve hien trang nao thai Mang nghien ciru ve nao thai ciing da xem xet de'n ca va'n de hieu qua ciia cac bien phap tranh thai dang duetc su dung - mot van de lien quan chat che veti vice CC) thai ngoai y muc)n Ngoai ra nghien ciru ceVn de cap den ca nhirng nguyen nhan khac ciia nhu'ng cai thai ngoai y mue)n

Cac nha nghien cuu ciia Thuy Die'm va Viet Nam ceVn phat trien mot van de khac ciia hien tuetng nao thai Dd la nao thai muon Trong dd cac tac gia (Le Thi Nham Tuyet, Nguyen The' Lap, Annika Johanson, Nguyen Thi TTiu Huyen, cung da ceV nhirng phan tich so sanh hanh vi nao thai ciia cac phu nir cd chc^)ng va chua chc)ng trong nhieu khia canh, dac biet la cac khia canh lien quan de'n sire khoe: sinh san

Cuc)c dieu tra dan seV' giua ky nam 1994 cua Tdng cue theV'ng ke da danh mOt seV' cau hoi ve hanh vi nao thai Ke't qua cho tha'y la 12,8 phu nir Viet Nam da timg nao pha thai (J Viet Nam phu nir trCn 25 tudi nae) hiit

Tap chi Khoa hoc xa h(}\ 1-IW4 Tran^ 12 (tiOng Anh)

rmmg lai Mot s6 vAn i\6 dAn so' tu hucVng \a hOi hoc NXH Kht)a hoc \;1 hoi I ia Noi I '>*^2 Ir f>X

thuctng xuyen hem phu ni? tre Di^u nay gie)ng veti d mc)t sd nuctc chau A khac (xem them phdn 1 va phu luc) Me)t ke't qua khac cho tha'y ne'u tinh tir

1991 tret lai day ty le nao hiit thai ciia phu nii' viing niii, trung du Bdc Bd ga'p

10 Idn so veti ty le nao hut ciia phu nQ duyen hai mien trung

Sd lieu thu ductc cung cho tha'y mc)t xu huetng nghich ly : hoc van

cang cao nao thai cang nhieu Nguetc lai hoan toan veti phan tich ciia S Henshaw v^ tinh hinh nao thai tren the' gicti Bang sd lieu dueti day minh hoa them ve cac nhan xet tren

Bang 2 Trinh dc) hoc va'n ciia cac phu nir nao thai

% da timg

naothai

4.2S 4.14 8.33 10.38

S(') Idn nao thai

1.57

] TO

1.20 1.20 1.18

SC) Idn

mang thai trung hinh

6.26 5.08 5.25 5.10 4.34

.S<") phdn tram su dung biCn phap tranh thai

24.04 42.38 61.21 59.16 66.39

Nguc)n : Bao cao ve nao thai va hiit dieu hoa kinh nguyet Bo Y te Dieu

tra nhan khdu hoc giira ky 1994 Bie'u 4.12

Thuc trang nay cd the' cd ly do la nhu'ng phu nir cd hoc thuctng kheVng mueV'n cd con setm hoac ho chap nhan qui mcV gia dinh nhd, do dd khi leV ke hoach, ho thucmg chon nao thai de tranh sinh, ceVn nhirng phu nir he)c van thap chua chap nhan qui meV gia dinh nhc) he)ac khe)ang each ceVn thua, che) nen ho thuctng de' de khi bi leV

Nghien ciru ciia td chirc Care queV'c te tai Vict Nam nam 1993 "Nguy cet SIDA ct Vict Nam" tuy khcVng true tie'p lien quan de'n van de nae) thai, nhung nhiing phan tich ve hanh vi tinh due ciia gai mai dam, khach ch(ri

moi thanh phdn cung giup chiing ta cd the' hie'u them ve nguy cet mang thai

ngoai hc'^n nhan Dac biet la khi cac nha nghien ciru de cap de'n thai de) va vice sU dung bao cao su

Thii dc) Ha Nc)i cung la me)t die'm cd ty le nao thai cao Nam 1993 cir

1000 ca sinh thi cd 1579 ca nao thai, trong dd cd 11% la phu nir chua cd chc)ng Nam 1993 nhcVm cac nha nghien ciru gcVm PTS Nguyen QueV'c Trieu

phdi hctp veVi me)t sd cet quan da tien hanh phan tich 627 ca nao thai de tim

hie'u ve hien tuemg nao thai et Ha N^i Cac nha nghien ciru da xac lap chan dung xa hc)i ciia nhcVm phu nir cd hanh vi nao thai theo cac dac diem nhan

khau - xa he)i : nhu tudi, tinh trang heVn nhan, nghe nghiep, sc) con, cheV a

hien nay v.v va xem xet mc)t se) quan he nhu ly do khcVng tranh thai theo tueii, tucii cd thai Idn ddu veti hoc va'n, se) Idn sinh he)c van v.v Dang chii

y la nghien ciru nay da de cap den va'n de mang thai - nae) thai nge)ai heVn nhan nhu mc)t va'n de quan trong cdn chii y nghien ciru Tuy nhien de) nhieu

ly do vice phan tich meti chi dirng a mot mirc do gieVi han chua khai thac het

cac khia canh cua van de

Chirang II

NHUNG KET QUA VA PHAN TICH BASf DAU

I Ve hien tirang mang thai ngoai hon nhan

1 Tinh hinh chung

Chiing ta nhan tha'y rdng ne'u toan be) cac vu cd thai ngoai heVn nhan deu CC) ke't cue la cac ca nao thai, thi viec xac dinh sd luemg cac thai nghen

ngoai hf)n nhan dd phitc tap hctn Tuy nhien tren thuc te' sd lucmg Idn phu

nir mang thai = se) luemg Idn phu nir nao thai ngoai heVn nhan + sc) lucmg tre

em sinh ra ngoai gia thii

Viec xac dinh chinh xac se) lucmg Idn phu nir chua cheVng cd hanh vi nao thai la vice lam kha khd khan Beti vi mac dii eV nuctc ta hien nay cac dich vu nao thai kha thuan Icti nhung vdn ccVn mot ty le phu nir chua cd chemg nao thai chui Mat khac ngay tai cac cet set y te Nha nuetc nhieu phu nir vdn khcVng dam khai that ve tinh trang hcVn nhan cua ho (cho dii cac nhan vien y te nhieu khi xac dinh ductc ho ndi that hay kheVng) Nhung bang cac suy luan logic chiing ta ceV the' dua ra duetc cac uctc doan tuetng de)i chinh xac

Tlicc) ket qua nghien ciru ve thuc trang nao thai ct Ha Ne)i nam 1993 thi cd 11% seV ngucti nao thai ductc hoi chua cd chcVng Ket qua phan tich tai lieu ciia 1190 ca nao thai cV ngoai thanh Ha Ne)i va mot se) huyen ciia tinh

Ha Tay cung cho tha'y se) luemg tuetng tu la 10,4% Theo cac bac sy san khoa thi seV luemg cac phu nir chua cheVng nae) thai xap xi 15% Mat khac sd lieu dieu tra dan seV giua ky nam 1994 che) thay cd 14,2^>f se) phu nir da nao thai chua ceV dira con nao Mac dii seV luemg phu nir chua cd con cd hanh vi

IVio cao k^'l qua diCu tra nhAn khAu hoc giua ky i W4 IV> Y 10 HiOu 4.1 2

nao thai kh6ng bdng sd phu nir chua chdng nao thai Nhung chiing ta thay rdng tren thuc te' cd it cap vet chdng ddng y nao thai khi chua cd dira con nao Hon nii'a chiing ta luon cd sir khai bao chua chinh xac va sir nao thai

chui cua cac phu nQ chua chdng Sd lucmg nay cd the' duetc thay the beti sd

cap vet chdng chua cc^n nhung cha'p nhan nao thai trong tcSng sd 14,2% ke' tren Va nhu vay khoang ty le 14%-15% la tuetng deV'i phii hctp veti sd luemg nao thai ngoai hon nhan

Ne'u cc)ng them ty le sinh con ngoai gia thii la khoang 1%^ thi con sd Uctc tinh ciia set' thai nghen ngoai heVn nhan la 15-16%^ se) phu nir cd hanh vi nao thai hang nam Tire la mdi nam nuetc ta cd khoang 300 nghin luett phu nir mang thai ngoai he)n nhan

Day la me)t sc) luemg kheVng nhd va la nguyen nhan true tiep tao ra sir biing nd ciia hien tuemg nao thai ngoai heVn nhan ndi rieng va nae) thai ndi chung trong mc)t vai nam gdn day Dueti day chiing ta se xem xet me)t vai nguyen nhan tao ra sc)' lucmg thai nghen ngoai heVn nhan ke' tren

2 Nhirng nguyen nhan ciia viec mang thai ngoai heVn nhan

2.1 Gia dinh tan vet (ly hcVn)

Sir tan vet ciia cac gia dinh la mot hien' tucmg de quan sat tha'y trong nhiJng nam gdn day Trong mcVt nghien ciru ciia chiing teVi tai ngoai thanh

Ha Ndi 3/1995 cho tha'y ty le ly heVn tcVi 30%^ Mac dii con sd nay cd the len cao, tuy nhien xu hue'mg tang nhanh ty le ly hcVn, dac biet la et cac thanh phd le'm ductc nhieu nha khoa hoc thira nhan Nhirng ngueti chiu thiet thoi nhieu hctn ca trong cac cuOc chia tay nay la cac em be gai Khi nghien ciru ve

"cac tre: em gai thiet thoi" nam 1994 ciing veti CGFED tai Ha NeVi va Yon Bai chiing teVi da thdy rdng cd 11,5% sd cac em phai hie) deVng vat va, it

duoc hoc hanh, hoac lang thang a ducmg pho, hoac xa vao cac tc nan xa hoi

h6 me da ly h6n, 7,7% bd me ly than, 23,1% da ch^'t mot, va 3,8% mo coi

ca bd me

Nhu vay gia dinh tan vd cac em gai de bi khiing hoang tam ly va sa

da vao cac te nan xa hOi hoac se)ng bat can,.bucVng thd Chinh nhiJng dieu nay khie'n cho cac em thie'u suy nghT chin chdn khi cha'p nhan quan he tinh due, hoac ban than bi ep bue)c lam nhu vay Them vao do sir thieu hieu biet

ve kie'n thirc ncVi chung va ve tinh due neVi rieng khien cho cac em de mang thai ngoai heVn nhan

Tat nhien kheVng chi cd cac em gai chiu tac de)ng manh ciia cac cuoc

chia tay ciia bc) me chiing ma ban than cac ba me chiing khi a vao cac cetn

khiing hoang nay cung de reti vao tinh trang mang thai ngoai hcVn nhan Theo ke't qua tcSng dieu tra dan sd nam 1989 cd 0,3%^ tdng sd dan eVng Vict

Nam va 0,9%^ phu nir tir 18 tudi tro len dang a trong tinh trang ly heVn (chua

ke't heVn lai vao theVi die'm dieu tra)

Ciing theo seV' lieu ciia dieu tra nay vao theVi die'm dd ceVn 69.356 nam gicti va 200.651 phu nir dang cho ly hcVn hoac ly hcVn thuc te (te)a chua ceVng

n h a n ) ' * Dd la sd ngucti ly than Ho chinh la mot ngudn quan trong bd

sung vao sd luemg cac vu ly heVn cac nam sau dd

Theo cac sd lieu neu tren, chiing ta thay rdng xac sua't nhirng ngueti

phu nii' va gia dinh ho hay cha me ho tan vd khie'n ho phai reti vae) cac cetn

khiing hoang tam ly va de cd cac kha nang mang thai ngoai heVn nhan van

Km Va hucVng de' giai quyet va'n de nay la giai quyet tc)t cac cetn khung hoang tam ly do cac cuoc chia tay gay ra

" NguyCn e^uy 'ITianh IVio cao dir an Ire cm gai thiOl thoi I4-1S ('(ill-.l) v.i I N K "I.IV

" PhAn lich qua diCu Ira mAu Fe T K lia N<>i lr.^7-7S

" • Sdd 77-78

2.2 Mudn cd con

Di^u nay cd ve nhu nghich ly tuy nhien viec mong mueV'n cd con de khang dinh quan he vdi ngucVi minh yeu la me)t ly do kheVng phai la it Trong nghien cihi ve nao thai muAn ciia CGFED nam 1993 cho thay cd 2,5%^ sd de'n nao thai, chua chdng phai pha bd cai thai ma ho da timg mue)n

cd Ne'u tinh tren tdng the^ cac ca nao thai ngoai hcVn nhan thi con se) ndi tren

cd the' cao hctn Trong mftt phe)ng vdn sau ciia chiing tcVi chi H 24 tudi sinh

vien tam sir "Em c\s nghT rdng em ceV thai thi anh a'y se cueVi em, se cd trach

nhiem veVi em hctn " va "Nhieu dira ban em cung nghT nhu em ".Se) phu nir mueV'n ceV con veVi hy vong rdng ban tinh, ngucti yeu ho se cueti he) chii yeu la ct nhcVm chua tirng ceV cheVng va mong mucVn hiy che)ng Chi L 30 tudi, ccVng nhan ndi "Em vcVi anh a'y yeu nhau cd de'n hctn 2 nam, cir mdi Idn

em giuc cueti la anh a'y lai bao tir tir, chua dii tien Em cung set anh ay theVi nen em lieu ceV con Liic deV em nghT la em ma cd mang anh ay phai ban lam

le cueti ngay " "Cha ai xui em lam the, tu em theVi ,"

Khcmg phai moi phu nu chua cheVng mudn cd con deu la vi mueVn

ductc ban tinh cueti Ciing cd mot seV dac biet la cV nhdm tre tudi, mucin ceV con chang qua chi de' khang dinh minh Cung chi H ndi tren khi duetc he')i khi biet la cd thai mimg hay lo ? Chi ndi "liic ddu thi mimg, sau lai le)" Tai sae) ? "Thinh thoang tha'y sach bao viet the nay the kia ve vcV sinh, em cir ban khoan khcVng biet minh the nao ", "the la cm cd the cd con "

MAt seV khac nira mueV'n cd con ngoai gia thii bat cha'p ngUeVi quan he

dd cd la'y ho hay khcVng Ho chi cdn 1 dira ce)n de seV'ng ciing he) Dieu nay dac biet hay xay ra tai cac neVng tructng, hTm trueVng cd tuyet dai da sd la phu nii' Mot sd phu nir ct day da "xin" con, hay ndi each khac "kheVng cheVng

ma chua", hc) sinh con va semg ciing veti con cai ho me)t cue)c seVng vat vuetng

Tuy nhien nhdm phu nir muetn cd con (ngoai gia thu) nay thucmg khcVng di nao thai khi ho cd mang, khac veti nhirng ngueti phu nif mueVn c(') thai de' ep ngueVi yeu, ngueti tinh cueti hay detn gian chi de' "xem cd the minh the'nao" Sau khi khc')ng dat duetc y mucV'n cueti cheVng hoac da "thoa man" chi teV meV la luc ho lo set phai tim each giai quyet hau qua Do dd vice giai

quyet tan gdc nguyen nhan mang thai ngoai hcVn nhan nay bang bien phap

giup cho ho ceV nhirng kien thirc diing ddn, diing liic ve gicti tinh va giiip he) than trong hctn trong quyet dinh cd mang ciia minh

2.3 Anh hucmg ciia quan niem tu de) he')a tinh due

Cach day mdt vai nam tren bao Tien phe)ng da cd me)t dien dan tranh luan xung quanh chii de "Yeu hien dai, scV'ng hien dai" ngu y yeu va seVng

het minh, kheVng cdn giQ gin Cd nhieu bai ddng tinh veti quan niem nay

nhung sc) bai phan deVi nhieu hctn Va trong xa hoi ciing chia ra lam 2 lueVng quan die'm IcVn dcVng tinh va phan deV'i Sc) ngueti ling ho quan niem "Yeu hien dai, seVng hien dai" liic dd chua nhieu, nhung chiing da phai thira nhan meVt sir thuc la da hinh thanh mot nhdm (dang deVng ddn) cd quan niem nhu tren Dieu dang ndi la thanh phdn chii ye'u ciia nhirng ngucti cd quan niem nay la gicti tre) ma dac biet la sinh vien (xin luu y them ngucti ddu tien dua

ra quan niem yeu hien dai, seVng hien dai de tranh luan tren bae) Ti6n phe)ng

la 1 nif sinh vien ciia trueVng DHSP Ha Noi I liic dd) Trong nghien ciru gdn day ve sinh vien nam 1994 lai meVt sd trueVng dai he)c (V Ha NeVi, chiing toi cung nhan thay rdng sd luemg sinh vien tan thanh quan nicm san sang cho

' NguyOn Ilianh TAm Tap chi NghiOn ciru khoa hoc vO phu nu St) I - 1'>*U

ta't ca, s6ng hfe't minh, chap nhan quan he sinh ly truoc hon nhan khong it

Bang sd Ii6u du6i day se minh hoa th^m cho nhan xet nay

Bang 3 - Y ki^n ciia ban v^ quan niem "y^u la phai het minh, phai

cho va nhan tat ca"

Sinh vi^n khoa hoc xa h()i

Sinh viCn khoa hoc tir nhi^n

Chung

Dong y 49,3 34,0 40,0

Phan ddi i(),7 60,0 60,0

Qiung

39,4 60,6 100,0

Nhu vay ty le sinh vien sdn sang cd quan he tinh due truetc heVn nhan

la 40%^ Trong sc) nay cd 50%^ deVng y quan he sinh ly truetc heVn nhan veti ban deti tuetng , 48,2%^ veti ngueti minh yeu, 5,4%^ veti ngueti quen, 10,3% sdn sang veti bat ke' ai Trong quan niem ve mot ngucti ban deti ly tuetng, tu tueVng " chif trinh dang gia ngan vang" khcVng cdn la tieu chuan sd me)t khi mdt nam sinh vien chon vet CueVc nghien ciru tren ciia chiing teVi da che) thay danh sach tieu chuan theo thir tu uu tien khi chon ban deti cua nam ntf sinh vien nhu sau :

Nam sinh vien

1 Khoe* manh

2 Dep(hinh thirc)

3 TheVng minh

4 Hien, diu dang

5 Chua yeu ai (trinh trdng)

6 Trung thuc

7 Chung thuy

Niif sinh vien

TTieVng minh Lanh hien Khe')e manh Dcp trai Trung thuc - chung thuy Chua vou ai