p W O E C O ^
NGHIEN CUU KHOA HOC
NGHIEN CUU TINH HINH NAO PHA THAI TAI TRUNG TAM CHAM SOC SUC KHOE SINH
SAN THANH PHO DA N A N G NAM 2013
V 6 V a n T h a n g \ Phqm Thj Kidn^
TOM TAT:
Gidi thieu: Sd lieu hien nay chua thdng ke day du ve tinh hinh nao phd thai. Tuy nhien, dnh hinh nao pha thai trong nhiing nam gdn day ed nhieu chieu hudng thay ddi, tang cao d liia tudi vi thanh nien - thanh men vd ngdnh nghe la nhiing nu cdng nhan... Sir dung cae bien phap trdnh thai hien dai va hieu biet ve each sir dung dung nhdt la each Idra gidm c6 thai ngodi y mudn.
Muc tieu: Nghien ciiu md ta dac diem cdc ddi tugng den nao pha thai va md ta cac bien phap tranh thai dugc ddi tugng sir dung bi that bai.
Phuong phdp nghien cihi: Mo td cat ngang, chon mdu ngau nhien cua 450 ddi tupng den nao pha thai va tai khdm sau nao pha thai ve dae diem va cdc bien phdp tranh thai su dung nhung bi that bai.
Ket qua: Tudi vi thdnh nien-thanh nien chiim ty le khd cao vdi 21,8%, dp tudi sinh de ludn chiem uu thg vai 45,5%. Nghe nghiep la cdng nhdn cd ty le cao nhdt vdi 27,6%, ke den la ndng dan vdi 25,5%, hpc smh- sinh vien cung chiem ty le dang quan tam vdi 10,2%, trinh dp hpc vdn gap cao nhat la PTCS va PTTH vdi 53,5%, trung cap cao dang la 26,2%i, dai hoc vd sau dai hgc chiem ty le khdng nhd vdi 15,8%i. Ddi tupng chua ket hdn cd dSn 94 trudng hgp (20,9%), ddi tugng chua ket hdn cd kinh t^
phu thudc la phdn Idn chiem 59,6%, nguoc lai ddi tugng da ket hdn chii yeu la kinh te ddc lap chiem 82,6%, ddi tugng cd kinh te ngheo hoac can ngheo chiem ty le khd
cao trong mau nghien ciru vdi 34,7% Bien phap tranh thai doi tugng sii dung bj that bai nhieu nhdt la tinh vdng kinh vdi 34,5%, thude tranh thai khdn cap Id 22% vd xudt tinh ngodi am dao la 19,2%), thudc tranh thai hang ngdy Id 14,6% vd bao bao su chiem ty le 8,4%.
Ket luan: Nghien eiiu nay mot ldn nira cdnh bao hdi chudng bao ddng ve tinh hinh nao pha thai tai Viet Nam ndi chung va thdnh phd Da Nang ndi rieng, ddc biet la tinh hinh nao pha thai d tudi tre nhu cdc em hgc sinh- sinh vien hay nii cdng nhan Chpn lua vd sir dung diing bien phdp trdnh thai se (dm giam tdi thieu viec cd thai ngoai y mudn dan den nao phd thai.
Tw khoa: Bien phap tranh thai ABSTRACT
Background: The recent data about the situation of abortion is limited. However, the abortion rate in Viet- nam has been likely to change for recent years, rising highly in aldoleseent - young age, female workers..
Using the modern contraceptive methods and having knowledge to use correctly is the way to decrease having the unwanted prenancy.
Objective: To describe the characteristics of the abor- tion objects and describe the contraceptives was used failure.
Method. This cross- sectional study was conducted in 450 objects being abortion and re-examine after abortion
1. Trinmg Dai hgc Y Dircrc Hue
2. Trung tam Cham soc sire khoe sinh san TP. Da Ndng
» Ngay nhan bai: 17/02/2015 I >i Ngay phan bien' 21/02/2015 | » Ngay duyet dang: 25/02/2015
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about the charactenstics of the abortion's objects and us- ing contraceptives failure.
Results Adolescents - youth was high rate of 21,8%, reproductive age are dominant with 45,5%. Workers have the highest rates (27,6%.), farmers (25,5%), students and pupils with interest rates (10,2%i), secondary and high school education reported with 53,5%, intermediate col- lege was 26,2%, undergraduate and postgraduate they are not small rates with 15,8%. Unmarried with 94 cases (20,9%i), unmarried subjects with dependent economy was largely (59,6%), married subjects with independent economic was 82,6%. Subjects with poor or near-poor economic was a high rate (34,7%). The contraceptive be- ing used failure include: the counting menstrual cycles was common (34,5%), emergency contraceptive pills was 22% and coitus interruptus was 19,2%), the pills ev- eryday was 14, 6% and using condom was 8,4%.
Conclusion: This study was warning alarm about the situation of abortion in Vietnam in general and in partic- ular the city of Da Nang again, especially the situation of abortion in adolescents-youth such as pupils- students or female workers. Selection and proper use of contra- ceptives will minimize unwanted pregnancies lead to abortion.
Key: Contraceptives LDATVANDE
Mgt van de gay nguy co cho siic khde phu nii Viet Nam hien nay la ty le nao hiit thai cao, vdi sd tai bien do ntio pha thai cung khdng nhd. Theo thdng ke cua Hdi Ke hoach hda gia dinh hdng nam cd khodng 1,2 den 1,6 trieu trudng hgp nao hut thai vd la nguyen nhan ciia 5%
tli vong d sdn phv [5]. Tren toan cdu cd khodng 47.000 ca tli vong mdi nam chiem 13%o tir vong me tren toan the gidi Id do pha thai khdng an todn [9]. Bao cao cua Dao Xuan Diing nam 2010, Viet Nam la mgt trong ba nudc cd ty le nao pha thai cao nhdt the gidi, trong dd 20% Id d Ilia tuoi vi thdnh nien, tren cd nude cd 5%» cdc em gai sinh con trudc tudi 18, 15% sinh con truac tuoi 20 [2].
Theo so lieu ciia td chute Quy Dan sd Lien hiep qudc nam 2009, tai Hoa Ky va Dong Au hang nam c6 khoang tir 1/2 din 3/5 phu nu cd thai ngoai y mudn va dugc can thiep bdng nao pha thai [8], Su phd biin eua nao pha thai cdn lien quan din quyen sinh sdn, quyen tinh due va sire khoe phu nir. Nhi6u trudng hgp nao pha thai vi ly do lua chon giai tinh thai nhi, mOt dieu trdi vdi luat phdp Viet Nam va CO nguy ca ddn d6n mdt cdn bang gidi tinh. Nao phd thai
nhiiu hay it cdn la thudc do ve khd nang dap ling nhu cdu sir dung cac bien phap tranh thai, chat lugng dich vy ki koach hod gia dinh. Theo nghien cim ciia Nguyen Thi Thiiy Linh, Le Hdng Cdm nam 2008 vdi nhdm phy nir chua cd con thi ty le sir dung bien phap tranh thai thdt bai Id 53,45% [6]. Vd ty le nay la 55% d nhdm phu nu da cd chdng trong nghien ciiu eua Nguyen Dire Vy vd Vuong Tiin Hoa 2007 [2].
Nhin chung, viec nghien ciiu ve ITnh vuc ndy da dugc thuc hien d nhiiu dia phucmg khde nhau trong ca nudc ciing nhu tren the gidi. Tuy nhien, nao pha thai cd xu hudng tang lai trong nhiing nam gan day dac biet Id d tudi tre vd viec su dung cac bien phdp tranh thai cdn chua dugc ehu tdm d nhieu phu nii nhat la nhiing phu nii cd van de ve siie khde.
De tai: Nghien emi tinh hinh nao phd thai tai Trung tdm Chdm soc sue khde sinh sdn thdnh pho Dd Ndng nham md ta dac diem ciia ddi tugng den nao pha thai vd md ta bien phap tranh thai ddi tugng sii dung nhung bl that bai giup phat hien eac van d6 edn ton tai trong cdng tdc truyen thdng, gido due d van de nay, tir dd cd nhiing de xudt vd gidi phdp cu the cho tiing trudng hgp nham ngan ngua viec cd thai ngoai y mudn dan den nao pha thai.
n . PHl/ONG PHAP NGHlfeN CtTU
De tai dugc thuc hien tren 450 ddi tugng den nao phd thai vd tai khdm sau nao pha thai tai Trung tdm Cham sdc SKSS thdnh phd Dd Ndng trong thdi gian tii 01/7/2013 din 31/12/2013.
Phucmg phdp dieu tra theo mdu ngdu nhien trong nghien ciiu md td cat ngang ed phdn tieh. Md ta dac diem doi tugng nghien ciiu va md td bien phap tranh thai ddi tugng sir dung bi thdt bai theo mdu cdu hdi dinh san [4].
Bd edu hdi bao gdm nhiing ddc diem ve ddi tugng nghien cim nhu: tudi, nghe nghiep, trinh dp hpc vdn, tinh trang hdn nhdn, tinh trang kinh te, tinh hinh nao pha thai nhu tien sir nao pha thai, hieu biet ve tdc hai ciia nao pha thai, tien sir benh tat. Ddi tugng nghien ciiu cdn tra Idi cdc cau hdi vl tinh hinh sir dung cdc bien phdp tranh thai nhu: ddi tugng dang sir dung bien phap tranh thai nao, ly do ddi tugng chgn lira va ly do ddi tugng nghi bi thdt bai, bien phap tranh thai ddi tugng du dinh sir dung sau lan nao pha thai ndy la gi?.
So lieu dugc thu thdp va xir ly theo phuang phap thdng ke y hgc vd dugc xu ly bdng chuang trinh phdn mem SPSS 18.5 [7].
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( . NGHIEN cuu KHOA HOC
i n . KET QUA VA BAN LU^N 1. Dac diem cua d6i tiri^ng nghiSn ciiu
Nh6m tu6i
< 19 tu6i 20 - 24 tuoi
> 25- 35 tuoi
> 35 tuoi Tong cong
So lirong 10 88 205 147 450
Tylf(%) 2,2 19,6 45,5 32,7 100,0
Nhdm tudi trong do tudi sinh de 25 den 35 tudi, ehiem cao nhdt vdi 45,5%i. Day cung la dac diem chung ve tinh hinh NPT tai Viet Nam. Theo bao cdo Qudc gia ve tinh hinh NPT d 65 tinh thdnh tai Vi^t Nam nam 2001 chung tdi nhan thdy dieu ndy rdt triing hgp [10].
Ly gidi ve su tap trung cao d lira tudi tren day ed the do nhdm tudi nay dd cd du con mong mudn hoae do hoan canh kinh te cdn nhilu khd khan hay phdi tuan thii theo chinh sdch mdi gia dinh nen cd 1 hoae 2 con hoac do dp lye xir phat hdnh chinh ddi vdi can bd cdng nhan vien chiic [1]. Ngoai ra nhdm VTN-TN (< 24 tudi) chiem ty 2. Nghe nghiep doi tuong nghiSn ciiu
le 21,8%) la mpt con sd dang bao dgng cho toan xa hdi hien nay ve Idi sdng vd su h^n che tiep can dich vu siic khde sinh san d dp tuoi nay. Tuy nhien de so sanh vdi cdc nudc tren the gidi thi cd sy khae biet rdt rd ve ty If NPT d tuoi VTN nhu rdt cao d Cu Ba (91%), My (30%
- 44%) hoac rdt thap nhu d Diic vd Ha Lan (dudi 10%o).
Cd mpt thdng ke cho rang trong sd 500 trieu thanh thieu nien tudi tii 15 - 19 tren the gidi cd quan hS dnh due ed khodng 1,1 trieu c6 thai ngodi y mudn, hdu qua cd 38%) nao phd thai, 13% say thai va khodng 554.800 be gai sinh con [3].
30 1 20
10 -
Nr / •
Cin b^, cong nhan
fl H
Cong nhln
m
H^smta ,smh25,5%
•
^ H 5,3%
Nong dio Dich vv ( dau bep,
m m
Uipvti,lSt3n Uiach sjn, lam
tfc)
I I K I i
Biiu dol: Phdn bd theo nghi nghi$p Nao phd thai c6 thl gap d nhiing nghdnh nghe khac
nhau, tuy nhien trong nghien ciru cua ehung tdi eong nhan chiim ty Ie cao nhdt vdi 27,6%. Q nganh nghe ndy miic thu nhap thdp la Iy do cho nhiing cap vg chong da c6 1 hoac hai eon thudng di din quyet dinh NPT, hay d nhiing cdng nhan tre tudi viec sdng xa gia dinh thilu thon tinh cdm ben c^nh do ede em thudng sdng trong nhiing khu tap thl nen yeu duang sam vd
cd quan he trude hdn nhan, trong khi su hieu biet ve siic khde sinh san, tinh due cdn ban ehl nen khi cd thai ngoai y mudn thi thudng ddn din NPT. Ci nhdm ndng dan Cling chiim mpt ty le kha cao vdi 25,5%. 0 nhdm nghe ndy khi phan tich ket hgp vdi miic thu nhap va sd con hien cd cho thay yeu td dii con, ddng con, kinh t l khd khan Id Iy do gidi thich cho vi?c NPT d nhdm ddi tugng nay.
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3. Trinh do hoc van cua d6l tucrng nghien cihi
isfsns-i-l-JTI-
Mii chii Biet doc, Tieu hpc Trung Trung hpc Trung Bai hgc biet viet hgc co pho cap, cao vd sau sd thong ding dai hpc
Bieu do 2: Phdn bo theo trinh dp hpc vdn Qua ket qua d bieu do 2 cho thdy: Ddi tupng den NPT
khdng cd suphdn bietve trinh do hge van va nhan thay khdng cd gj la dac biet khi ty le ddi tugng mu chii trong nghien ciiu eua chung tdi la rat thap (1,3%) phii hgp vdi cdng tac xda mu ehii d dia ban thdnh phd Dd Nang ndi rieng vd tren toan qudc ndi chung. Nhu vay NPT khdng chi bat gap trong nhdm ddi tugng cd trinh do hgc van thap ma cdn cd ca d nhdm
ed trinh do nhan thiie cao trong xa hpi (dai hpc vd sau dai hpc 15,8%). Chiing td nhan thiic cua ngudi dan tren dia ban thdnh phd Dd Nang ve siic khde smh sdn Id rat tdt nen khi cd thai ngoai y mudn hp biet tim den ca sd y te Nhd nudc ed uy tin de tien hanh pha thai nham giam nguy ca cua qua trinh nay. Tuy nhien viec nhdn thiie vd ky nang ve sir dung cdc bien phdp trdnh thai cdn han che.
4. Tinh trang kinh te va hdn nhan cua doi tirong nghien cihi
Bang 2: Phdn bd Anh trgng hdn nhdn cua ddi tuffng NPT theo kinh te
Tmh tr^ng kinh te Doc lap Phu thuoc T6ng
Doc than n 38 56 94
%
40,4 59,6 100,0
Da ket hon n 294
62 356
%
82,6 17,4 100,0
T6ng n 332 118 450
%
73,8 26,2 100,0
Tinh trang kinh te la mdt yeu td rat Idn dan den quyet dinh NPT eua ddi tugng, nhom ddi tugng chua ket hdn (94 trudng hgp), cd den 59,6% ddi tugng sdng phu thupc kinh te vao ngudi khac. Cl ddi tugng nay khi tudi ddi cdn rat tre, cdng viec lam chua cd, kinh te cdn phu thugc vao ngudi khde nen khi co thai ngodi y mudn thi thudng di din NPT, hay 40,4% ddi tucmg du khdng phu thupc kinh te vao ngudi khac thi cac em mdi chi di Idm, cdng viee cdn rat mdi me ddi hdi eac em phai cd thoi gian hpc hdi va dau tu..., rdi nhung quy dinh, chinh sach ciia ca quan chii quan... hay sg du luan xa hdi... viec cd thai ciia cac em khi chua ket hon se la nhiing rao cdn nen nhiing ddi tugng ndy
thudng di den quyet dinh NPT khi cd thai. Ci ddi tugng da ket hdn cd den 82,6% phu nii trong mdu nghien ciiu c6 kinh te ddc lap Dieu nay cho thay phu nii ddng vai trd rdt ldn trong xa hdi vd dae biet la trong gia dinh, ngodi viee cham sde nudi day con cai, thi hp cdn phdi dam bao cdng viec ngodi xa hdi vd cd viee kiem tien lo cho ddi sdng trong gia dinh, chinh vi vay viec cd thai ngoai y mudn d nhung phu nii nay hg thudng cd quylt dinh din NPT.
Qua nhiing ly do tren chiing ta can ddy manh ban nua viee cham sdc sue khde sinh sdn cho phu nii dac biet la ngan ngira cd thai ngodi y mudn cho nhirng phu nii trong do tudi sinh de.
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5. Mo ta bi^n phap tranh thai su dung that bai ot doi tugng nghien cihi
40 • 20
f 22%
0,7%
l l ^ 1
Vong tranh Thuoc tranh Thuoc tranh thai thai khan thai hang
c^p ngay Tinh vong
kinh
iq,?%
8,4% ^m
Bao cao su XuSttinh ngoai am
d^o 0,6%
^ /
Khac
Biiu do 3: Phdn bd ty le cdc biinjthdp tranh thai su dung nhung bi thdt bgi Nhung BPTT truyen thdng nhu tinh vdng kitUi, xuat
tinh ngodi am dao vdn dugc ngudi dan chii trpng ap dung, cd the day la bien phap tu nhien khdng bien chiing va khdng 1dm cho ngudi six dung mat thai gian hay tdn kem ve kinh te... mac du tinh hieu qua cua chung rdt de riii ro do ddi tugng khdng biet chinh xdc ngdy tuyet ddi an todn, ngdy tuong ddi an todn hay ngdy nguy hiem theo bien phap tinh theo vdng kinh, hay hiSu biet ve xudt tinh ngodi am dao rat don gian, nen ngudi ap dyng vdn cd the cd thai ngoai y mudn. Thudc trdnh thai khan cdp chiem 22%. Cd the do ddi tugng tre tudi tham gia vao nghien cihi eua ehung tdi cao, ben canh dd ddi tugng ldn tudi hg eiing chgn lira BPTT nay, do tinh tien nghi ciia bien phap
cdng them su it gan gui ben ban tinh, tuy nhien viec dp dung khdng nghiem tiic dung thdi gian udng thuoc theo quy dinh nen viec cd thai ngoai y mudn Id khd trdnh khdi.
Vien thudc trdnh thai hang ngdy thudng khd sir dung, viee udng thude hang ngdy diing gid rat de lam cho ddi tugng quen udng thudc, dac biet Id vdi nhiing ngudi ban rdn nen ty 1# cd thai ngodi y mudn trong nghien cuu cua chiing tdi Id 14,6%. Bao cao su vdi ty le thdt bai Id 8,4%
hay dyng cy tir cung la 0,7%, dieu ndy chiing td cdc bien phdp trdnh thai hien dai mang lai hieu qud cao trong viec tranh thai vi vay cdn tuyen truyen khuyen khich ngudi dan nen dp dung BPTT hien dai nham han che cd thai ngodi y mudn ddn den NPT
IV. KET LUAN
• Tudi sinh de 25 - 35 tudi chiem ty le cao nhdt voi 45,5%, hpcsinh-sinh vien Id 21,2%, tudi trung binh cua mdu nghien cihi la 31 tudi.
• Nghe nghiep Id cdng nhdn chiem ty le cao nhdt vdi 27,6%), kl den la ndng ddn vdi 25,5%i, hpc sinh-sinh vien chiim ty le ddng quan tam vdi 10,2%.
• Ddi tugng co trinh dp hgc vdn la Trung hge eo sd va Pbd thdng trung hpc chiem eao nhat vdi 53,5%).
• Ddi tugng chua ket hdn cd 94 trudng hap chiem 20,9%, ddi tugng da ket hdn chiem da sd vdi 79,1%).
• Nhdm ddc thdn hdu het kinh te la phy thudc chiem ty le 59,6% va nhdm da ket hdn thi ngugc lai kinh te ddc lap chiem 82,6%o.
Bien phap tranh thai sii dung thdt b^i: Bien phap tmh vdng kinh chiim ty le 34,5%i, thudc khan cap chiem ty le
22,0%, xuat tinh ngodi dm dao chiim 19,2%i, thudc tranh thai hang ngay chiem 14,6%), bao cao su vdi ty le la 8,4%..
V. KIEN NGHI
1. Vdi nhung ddi tugng lam tai cdc eo quan thanh lap to chuyen trach ve siic khde sinh sdn cho phu nir ngay tai y te ca sd nham giao due ve SKSS/KHHGD, tu van, gido due trdnh thai ngodi y mudn cho cac ddi tugng trong dp tudi sinh boat tinh due (chii y den ddi tugng la nii cdng nhdn).
2. Cdn dua chuong trinh giao due SKSS vao chuang trinh hgc chinh khda va td chiic cac cdu lac bd ve SKSS cho ddi tugng nam nir tuoi VTN-TN. Chu y phan tich ve tac dung vd hudng ddn cdch sir dung cdc bien phdp trdnh thai, dae biet la bao cao su va vien thudc tranh thai khan cap.
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TAI LIEU THAM KHAO
1. Bd Tai chinh (2013), Quy che xii ly ky luat eong, vien chiic vi pham chinh sach Ddn sd - Ke hoach hda gia dinh. Ha Npi.
2. Dao Xudn Diing (2010), Day thi-siic khde sinh san - siic khde tinh due d thanh thilu nien Viet Nam, tr.37-40, Bao cao chuyen de vi thanh men - thanh nien Viet Nam, Ha Ngi.
3. Pham Thanh Hai, Huynh Thi Utu Thuy (2010), "Pha thai d nir vj thdnh nien". Tap chi Y hgc, 14(2), tr. 8-14.
4. Luu Ngpc Ho^t, Vd Van Thang (2011), "Cde loai thilt kl nghien cim, nghien ciiu edt ngang", Phuong phap nghien ciiu khoa hge cgng ddng, tr. 21-38, NXB Dai hpc Hul.
5. Luu Thi Hdng (2012), "Nhan xet mgt sd yiu td lien quan din viee di pha thai d phu nii chua ket hdn tai Benh vien Phy sdn Trung uang", Tap chi Sdn phu khoa, 10(2), tr. 208-212.
6. Nguyin Thi Thuy Linh, Le Hdng Cam (2009), "Cac yiu td nguy ea phd thai d phu nir chua cd con tai Benh vien Da khoa Long An", Tap chi Phy sdn, 13(1), tr. 1-5.
7. Vd Van Thang, Hoang Dinh Hul (2011), Sii dung phdn mlm thdng ke SPSS Gido trinh ddo t^o Dai hge va Sau dai hgc nganh Y,tr. 11-78, NXB Dai hgc Hul.
8. Nguyen Tuan (2011), "Mdt sd nguyen nhan nao pha thai". Tap chi Tdng eye Dan sd Viet, 124(7), tr. 45-58.
9. BanerjeeK.S.,AndersenK.L., WarvadekarJ. and PearsonE. (2013), "Effectiveness of a Behavior change communication intervention to improve knowledge and perceptions about abortion in bihar and Jharkhand, India", Intemational perspectives on Sexual and reproductive Health, 39(3), pp. 142- 151.
10. Dang Thi Nghia, Nguyen Duy Khe (2001), Vietnam Abortion Situations, Country Report, pp. 8-15, National committee for popidation and family planning. Ha Noi.
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