The status, the factors that influence gender imbalance at birth in bac giang province and some effective interventions

Stemming from the above reasons, we performed the theme: "The status, thefactors that influence gender imbalance at birth in Bac Giang province and someeffective interventions" 2012 - 20

Gender imbalance at birth (GIB) have appeared since the beginning of the80s of XX century, severely affecting the economic situation, security, politics,society of many countries in Asia

In Vietnam, GIB occured later, from the early years of the twenty-firstcentury, which took place at a faster speed, increasingly widespreaded and hasreached a critical level Bac Giang is one of 10 provinces having the sex ratio atbirth (SRB) high If this situation lasts for, there is no strong interference will causeconsequences in many aspects of economic and social development of Bac Giangprovince in particular and the country in general

Stemming from the above reasons, we performed the theme: "The status, thefactors that influence gender imbalance at birth in Bac Giang province and someeffective interventions" (2012 - 2013) with the following objectives:

1 Describe the status and a number of factors influence gender imbalance at birth

in Bac Giang province (2007-2012);

2 Evaluate initially the effectiveness of some interventions to reduce the increase ofgender imbalance at birth in Bac Giang province (2012 -2013)

New contributions on practical science of the theme:

Described by the status and identified a number of factors affecting GIB:Age, level of education, practice residency and inheritance; knowledge, attitude andpractice of fetal sex selection (FSS); the situation of service providers

After 19 months, implemented a number of interventions in the province and

in 6 villages studied of 3 districts: Issued directive PPC, Planning andimplementing the Directive, the media and interventions applying for serviceproviders As a result, SRB is 117.4 in the province, down 2.3 percentage points;SRB of 3 studied districts are lower than before the intervention; knowledge,attitude and practice of the FSS subjects obvious changes

The layout of the thesis consists of 145 pages: Introduction: 2 pages;Chapter 1 Overview: 35 pages; Chapter 2 Objects and research methods: 22pages; Chapter 3 Results: 40 pages; Chapter 4 Discussion: 43 pages;Conclusion: 2 pages; Petition 1 page; 31 tables; 28 charts; 2 pictures; 7Appendix; 123 references (108 Vietnamese and 15 English documents).

Chapter 1 OVERVIEW 1.1 The ststus of gender imbalance at birth

1.1.1 Some related concepts

1.1.1.1 Sex ratio at birth: A statistical index, determined by the number of

boys being born in a year on 100 girls being born

1.1.1.2 GIB: SRB as a rule 104-106 / 100; biological standard 105/100 GIB

when SRB exceeds 108/100

1.1.2 Situations of gender imbalance at birth

1.1.2.1 GIB in some countries in the world

1.1.2.2 GIB in Vietnam

1.1.2.3 GIB in Bac Giang

1.2 Factors affecting GIB

1.2.1 Factors affecting GIB in the world

1.2.2 Factors affecting GIB in Vietnam

1.2.2.1 Generic researches in Vietnam

1.2.2.2 Researches in a number of provinces

1.3 Implications and control solutions GIB

1.3.1 Implications of GIB

1.3.1.1 Social influence

1.3.1.2 Affecting economic growth

1.3.1.3 Affect the security and politic

1.3.2 The solutions control GIB

1.3.2.1 The intervention of some countries in the world

1.3.2.2 The interventions in Vietnam.

Chapter 2 SUBJECTS AND METHODS 2.1 Object, time, location study

2.1.1 Research subjects: Couples who have children from 1/2007 - 12/2011;

elderly, leadership committees, governments, village and district populationofficer, health officier, statistics, justice, women, youth, the Fatherland Front,culture, information, married women perform abortions from 08 weeks of age

or older; all facilities providing reproductive health services;

2.1.2 Research time: Study the status of 5 months (from 01/2012 to 5/2012

end); 19 month intervention study (from 6/2012 until 12/2013)

2.1.3 Research location: In 03 districts: Luc Nam, Lang Giang, Viet Yen;

each district, town and village with high SRB to investigate and intervene

2.2 Research Methods

2.2.1 Study design: Descriptive cross-sectional study combine quantitative

and qualitative research, retrospective statistics and community interventionstudies (with before – after comparison), there is no control group

2.2.2 Descriptive study

2.2.2.1 SRB status of Bac Giang province: SRB (1999-2011), by birth order;

characteristics of the study subjects by retrospective statistics methods

2.2.2.2 A number of factors affect GIB: knowledge, attitudes, practice of

SSB; status of SSB service providers and abortion situation

- Study design: Descriptive cross-sectional study combine quantitative

and qualitative research

- Research subjects, sample sizes and sampling

+ Sampling object: couples have children from 1/2007- 12/2011, followsthe formula, calculate the number of samples in each village and town to

investigate is 194 x 6 = 1.164 (couple), reality has collected 1.164 satisfactoryquestionaires (Luc Nam 387; Lang Giang 387; Viet Yen 390).

+ Select the entire sample of 319 married women performing abortion from 8weeks of age or older, the actual interview was 300 (per district 100); 108 ownersprovide reproductive health services, interviewed 100 (Luc Nam 33, Lang Giang34; Viet Yen 33); each village have 10 in-depth interviews = 60; 3 seminars in three

districts, 6 in 6 social seminars

2.2.3 Intervention studies

2.2.3.1 The content and the interventions

- Intervention on the scale of the province: perform the state managementmeasures (issues a directive of the PPC; plans, seminars); media; interventions forservice providers (interdisciplinary inspection, testing and disseminating regulationsand organizations signed not SSB)

- Intervention in the research area: Seminar, group communication, directcommunication consulting at home, praising represented women, building team;training; common provisions; flyers, pictures, posters ; Posting propaganda; provideinformation; signed commitments, extracurricular activities, reported newspapers

2.2.3.2 Evaluated the effectiveness of interventions

- Study design: community intervention studies.

- Sample sizes and sampling

+ Subject: couples have children after the intervention period, calculated according

to the formula to assess the effectiveness of intervention, be n = 244 However, by the time

of the investigation, there are over 413 subject in areas with a baby should fullyinvestigate, real interviewed 400 subjects (Luc Nam 133, Lang Giang 134; Viet Yen 133)

+ Select the entire sample of 104 married women performing abortion from

08 week or older at the time of the survey after the intervention, the actualinterview is 99 (per district 33); 107 owners provide reproductive health services,actual collect 101 questionaires (Luc Nam 34; Lang Giang 33; Viet Yen 34)

2.2.3.3 The index evaluated the effectiveness of interventions

The effectiveness for the SRB of studied province and 3 district; effectivenesschange knowledge, attitudes, practices of SSB; the provision of services; choiceservice providers; change the SRB at areas; reduce the pressure to have an abortion to

a son, reduce the rate of known fetal sex before abortion and abortion to FSS

2.2.4 Methods and tools for data collection

2.2.4.1 Methods of data collection: Quantitative methods, Qualitative methods 2.2.4.2.Tools for data collection

Includes 6 form, investigating the couple, owners of ultrasound, owners

of abortion service provider, married women perform abortions from 08weeks of age or older, in-depth questionnaires, group discussion guide

2.3 Organizing research

2.3.1 Survey, investigate to collect data

2.3.2 Implement interventions

2.4 Measures to control errors: Design toolkit, select investigators,

supervisors have experience, pre-testing, clean check

2.5 Data processing: Data processing by software EpiInfo 6.04 and SPSS

16.0; use some biomedical statistical algorithms; general qualitative results

2.6 Ethics in research: Compliance of medical ethics in research, ensure

privacy; objectively interview; truthful information; data security

2.7 Limitations of the study: Research area is narrow, small sample size, the

representation is not high; intervention studies comparing before - after nocontrol group, did not perform on the same subject; short intervention period(19 months)

Chapter 3 RESEARCH RESULTS 3.1 Status, the factors affecting GIB in Bac Giang

3.1.1 SRB of Bac Giang province, period: 2007 - 2011

- From the year 1999-2002, the SRB has not increased (from 101.0 to106.0); By 2004, SRB began to increase (108.4), especially since 2006 (115.8).

- SRB, during 2009-2011: increased since first birth: 112.0; second:113.4 and spike at third: 217.3; fourth and above: 293.7

3.1.2 Several factors affecting GIB

3.1.2.1 Some characteristics of the study subjects

- Birth mother's age

Table 3.3 SRB under the birth mother's age (n = 1,164)

SRB under the birth mother's age <35 was 113.5; groups of 35 or more is 132.7

Table 3.4 SRB under the mother's education level (n = 1,164)

- Ethnicity: Most studied couples are Kinh (98.6% wife, 99.8% husband);

- Children’s name: 100% of the study subjects take father’s name;

- Economic conditions: 67.9% of couples rated themselves average

economic; 27.0% of couples are prosperous; 4.5% of couples are poor

- Life situation: 50.4% of studied subjects whose husband was the eldest son.

- The number of son, daughter and sex birth order.

Table 3.5.The number of son, daughter under sex birth order (n=1,164)

3.1.2.2 Knowledge, attitudes and practices of FSS

- Knowledge of the subject of FSS

36,7

12,3

28,035,1

Graph 3.6 Percentage the object known measures of FSS is used in

the community (n = 1,164)

28.0% objects know FSS measures is used in the community

Table 3.6 Measures of FSS that subjects know

(n = 1,164)

Measures Luc Namn % Lang Giangn % Viet Yenn % nTotal%

Table 3.7 Understanding the affect of FSS and the prohibited behaviors (n = 1,164)

Affect /Behavior Luc Nam Lang Giang Viet Yen Total

+ Opinions of objects on reasons of FSS.

Table 3.9 Reasons for choosing FSS (n = 1,164)

Reasons Luc Namn % Lang Giangn % Viet Yenn % nTotal%

Pressure to be born son

There was pressure 205 53,0 50 12,9 106 27,2 361 31,0

The reason for the behavior of fetal sex selection has been made

Nobody reminder 99 25,6 92 23,8 60 15,4 251 21,6Many support

There are 31.0% answered there was pressure to be born son; there aremany reasons for the behaviors of FSS still performed

+ Opinions of objects on restrictive measures of FSS status:

Table 3.12 Opinions on the type of effective media (n = 1,164)

Type of media Luc Namn % Lang Giang Viet Yenn % n % nTotal%

- The attitude of the object of fetal sex selection

Table 3.13 Intend to have more children and the desired sex of the

child in the next birth (n = 1,164)

Intended/ desired Luc Namn % Lang Giangn % Viet Yenn % n Total%There are intended 218 56,3 130 33,6 168 43,1 516 44,3

No answer; 9,5%

No; 72,5%

Yes; 18,0%

Graph 3:8 Rate object has FSS in last birth (n = 1,164)

18.0% has FSS in last birth;

+ The reason for performing the abortion of the objects

Fenale fetus, 8,7% Male fetus, 0,5%

Healthy, 14,8%

Spike, 73,2% Others, 2,7%

Graph 3.10 Reason for abortion of the subjects (n = 183)

Of the 183 subjects abortions, there are 8.7% the fetus is a girl

3.1.3.3 The situation of FSS service provision

- Condition know fetal sex before birth:

No answer; 0,6% Not know; 24,7%

Know; 74,7%

Chart 3:12 Rate know fetal sex before birth (n = 1,164)

There are 74.7% of subjects know fetal sex before birth

- Status diagnostic fetal sex by ultrasound:

Biết con trai

Biết con gái

Không trả lời

Graph 3:15 Rate of subjects known fetal sex by ultrasound (n = 1,155)

There are 70.3% of subjects known fetal sex by ultrasound

3.1.3.4 Status of abortion in Bac Giang province through the survey of married women have an abortion from 8 weeks of age and older, in three districts studied, 2012

- The ultrasound before abortion and abortion reason of object

Table 3:20: Rate of subjects knows fetal sex before abortion and how to know fetal sex

(n = 300)Sex/ Reconigned

Graph 3:16 The reason of subjects perform abortions (n = 300)

10.7% of subjects performing abortions fetus is a girl

- Pressure to be born son

Table 3:21 The pressure have an abortion to be born son (n = 300)

3.2 Effectivens Evaluation of Some Intervention

3.2.1 Effective interventions on the scale of the province

Table 3.24 Births, SRB of province and 3 studied districts, 2013

Graph 3:17 SRB before and after intervention

Post-intervention SRB of province and the studied districts were reduced

3.2.2 Efficiency at studied areas through surveys among women giving birth

- Make changes FSS in knowledge, attitude and practice (Unit: Percentage %)

122.4 116.7

Scale of province Luc Nam Lang Giang Viet Yen

Before intervention (2011) After intervention (2013)

Table 3:25 Change knowledge about the influence of FSS

Content (n=1.164)Before (n=400)After Compare (increase,decrease) EI

The number said FSS does not effect on society is reduced,EI 34.1%

Table 3:26 Effective changes the intention to have more children

Intention (n=1.164)Before (n=400)After (increase, decrease)Compare EI

- Have 1 children alive 83,5 88,7

The number of subjects with 2-3 children alive intend more children decreased

Table 3:27 Effective changes the desired sex of the child in the next birth

Desired sex

Before(n=1.164)

After(n=400)

Compare(increase,decrease) EI

8,8

0 5 10

15

20

Before (n=1.164) After (n=400)

Graph 3:18 The rate of FSS in last birth

The rate of FSS in last birth reduces, EI=51.1%

- Effective for service delivery situation after the intervention

63,9%

70,3%

TCT (n=1.155) SCT (n=379)

Biết GTTN qua siêu âm

Graph 3:19 Rate knows fetal sex by ultrasound

Rate of the subjects knows fetal sex after intervention by ultrasound63.9%, is down by 6.4% compared to pre-intervention, EI = 9.1%

64,8%

74,7%

Biết GTTN trước sinh

Graph 3:20 Rate of the subjects knows fetal sex before birth

Rate of the subjects knows fetal sex before birth after intervention is64.8%, down 9.2% compared to pre-intervention, EI=12.4%

- Efficiency for SRB in the areas of research:

Table 3:29 SRB by birth order before and after ntervention

3.2.3 Efficiency at research areas across objects having abortion

- Efficiency for service providers:

5,0%

11,7%

Con trai Con gái

Graph 3:21 Effective for know fetal sex before abortions

Rate of objects know before abortions after the intervention (13.1%),lower than before the intervention (27.4%); EI=52.2%

- Efficiency reduces the pressure of family and community on abortion

41,4%

61,7%

TCT (n=300) SCT (n=99)

Có bị áp lực

Graph 3:23 Efficiency reduces the pressure to have an abortion to a son

Rate of subjects have pressure to have an abortion to a son afterintervention was 41.4%, down by 20.3% compared to the pre-intervention,EI=32.9%

- Efficiency for the performance of abortions to FSS: