Sử dụng biện pháp tránh thai trong quan hệ tình dục trước hôn nhân của thanh niên hà nội thực trạng và các yếu tố tác động

Nghien ciiu Gia dinh va Gioi So - 2009 Suf dung bien phap tranh thai quan he tinh due trirac hon nhan cua nien Ha Noi: Thufc trang va cac yeu to tac dgng Iran Thj Hong Vien Gia dinh va Gidi Tom tat: Tai Viet Nam hien nay, ty le nao hut thai vi nien, nien va nguy cd lay nhiem HIV cung cac benh lay truyen qua dUdng tinh due gidi tre c6 xu hudng cang gia tang Nguyen nhan nao dan de'n tinh trang tren? Diia tren so' lieu dieu tra site khoe nien va vi nien Ha Noi 2006, vdi nhiJng phan tich tUdng quan hai bien va phan tich da bie'n hoi qui logistic, bai viet cho biet chi khoang 1/3 nien quan he tinh due trUdc hon nhan sit dung bien phap tranh thai tat ca cac Ian quan he tinh due Thie'u hieu biet ve cac bien phap phdng tranh thai la mot nhiing nguyen nhan d i n de'n tinh trang khong sit dung bien phap tranh thai Ngoai ra, quan he tinh due sdm (15-20 tudi), quan he vdi ngUdi yeu cung la ye'u to' lam han che viec sii dung bien phap tranh thai nien TU khoa: Bien phap tranh thai; Quan he tinh due trUdc hdn nhan; Thanh nien; Nii nien Ngay ngudi ta cd the quan sat tha'y nhung quan niem va hanh vi edi md han quan he nam nu d nien ndi chung va nhdm nien d cac phd Idn ndi ridng, Hanh vi tinh dtic trudc hdn nhan la T r a n Thi Hong 31 mot nhung bieu hien cua xu the' Viec quan he tinh due dieu kien thie'u hie'u biet va kinh nghiem phdng tranh thai cd the dan den nhung hau qua khong mong mudn Dae biet ddi vdi nien, dd la nhirng van de nhu nao thai trudc hon nhan va cac benh lien quan de'n dudng sinh san Vay van de an toan tinh due quan he trudc hon nhan d nien hien sao? Nhimg yeu td nao tac dgng den hien tugng nay? Tren eo sd phan tich sd lieu dieu tra sire khde nien va vi nien Ha Noi 2006, bai viet de cap den hanh vi sir dung bien phap phdng tranh thai quan he tinh due trudc hon nhan ciia nien Ha Noi va cac yeu td anh hudng den hanh vi Dieu tra sire khde nien va vi nien Ha Noi Vien Gia dinh va Gidi tien hanh nam 2006 vdi sd mSu 6363 vi nien va nien tudi 15-24 tai 11 phudng, xa, ky tuc xa trudng dai hgc tai Ha Noi Ddi tugng tham gia tra Idi phdng van gdm vi nien, nien sinh sdng hoac trg tai phudng va sdng tai ky tuc xa Bai viet chi lira chgn ddi tugng nien (do tudi 18-20) de phan tich Sd lugng nien tuoi la 4685 ngudi Trong sd nien nay, cd 6,5% (304 ngudi) cd quan he tinh due trudc hdn nhan tinh den thdi diem dieu tra nam 2006 Day la mSu nghien ciru ciia bai vie't Thirc trang siir dung bien pliap tranh thai Trong sd nhirng nien cd quan he tinh due trudc hdn nhan, chi cd tren mot nira nien sir dung bien phap tranh thai Ian quan he tinh diic Ian dau tien (54,8%) Nam gidi cd ty le sir dung bien phap tranh thai cao hen nir gidi (58,4% so vdi 37,7%) Phai chang vi nam gidi cd su chu dgng, tu nguyen quan he tinh due trudc hon nhan cao hon so vdi nir gidi nen hg cung chii dgng hon sir dung bien phap tranh thai Cd quan he tinh due vdi la mot nhirng yeu td quye't dinh viec sir diing bien phap tranh thai Ddi vdi nam gidi, nhung ngudi cd quan he tinh due vdi ngudi ydu, ngudi da dinh hon cd ty le sir dung bien phap tranh thai tha'p hon nhdm cd quan he tinh due vdi ban be/ ngudi quen biet/ ngudi lam nghe mai dam (55,6% so vdi 81,5%) Sir khac biet d nir gidi la khong dang ke vi ty le nii gidi quan he tinh due trudc hdn nhan Ian dau vdi ngudi hg khong cd tinh cam it Theo ly giai tir khia canh van hda ciia tac gia Tine Gammeltoft (1998), quan he tinh due xuat phat tir tinh yeu thudng 32 Nghien ciiru Gia dinh va Gidi Quyen 19, so 6, tr 30-42 khdng su dung bien phap tranh thai bdi lo ngai tinh ydu thuc su trd tinh yeu vu Igi, tinh toan Ngoai trir nhirng ngudi sir diang bien phap tranh thai Ian quan he tinh diac dau tien, cd 18,2% ngudi sir dung sau thang cd quan he tinh due, 10,9% sir dung vao thdi diem tir de'n thang sau dd, 3,3% sir dung sau nam thang trd len Rat cd the sau thdi gian bdt phat tinh cam quan he tinh due, nien chii y hon tdi boat dgng quan he tinh due an toan Tuy nhien, dang lun y cd 13% khdng sir dung bat ky bien phap tranh thai nao qua trinh quan he tinh due trudc hdn nhan Tim hieu ve mire sir dung bien phap tranh thai cac Ian quan he tinh due trudc hdn nhan, chi cd 35% nien sii' dung bien phap tranh thai tat ca cac Ian quan he tinh due trudc hdn nhan Cd 26,4% sir dung hau het cac Ian quan he tinh due 20,1% chi sir dung bien phap tranh thai mot so Ian quan he Nhirng sd lieu phan nao ly giai cho tinh trang mang thai trudc hdn nhan va mang thai ngoai y mudn cua khong it nien hien Tim hieu ly vi nien khdng sii' dung bien phap tranh thai tat ca cac Ian quan he tinh due trudc hdn nhan, cd 11 ly dugc dua cho nien lira chbn Hai ly dugc phan Idn nien lira chgn la (1) khong dinh quan he tinh due dd (45,7%) va (2) khdng mudn diing, dd ban than ngudi tra Idi khong mudn diing la 48,2%, ban tinh ciia ngudi tra Idi khong mudn diing la 16,8% Ngoai ra, cd 12,2% ngudi khong sii' dung bien phap tranh thai khong tin ban than/ ban tinh ciia minh cd the cd thai vao thdi didm quan he dd Cd 8,1% cho rang viec sir dung bien phap tranh thai se lam giam cam giac thich thii Cd 8,1% mong mudn cd thai Cd 8,1% cam tha'y xa'u hd phai di mua bien phap tranh thai Chi cd mot ty le nhd (2,5%) cho bie't khdng sir dung bien phap tranh thai khdng biet each sii dung hoac khdng bie't phai mua diing cu/ phuong tien tranh thai d dau Phan tich ly khdng sir dung bien phap tranh thai theo gidi tinh ngudi tra Idi, ke't qua cho tha'y ve ly "khong dinh quan he tinh due dd", nam gidi lira chgn nhieu hon nir gidi (49,4% so vdi 31,7%) Ly "khdng mudn sir diing bien phap tranh thai quan he tinh due", cung gan vdi nam gidi nhieu hon Cd 51,9% nam gidi cho bie't hg khdng diing bien phap Tran Thi Hong 33 Bieu Ly khong su dung bien phap tranh thai theo gidi tinh ngudi tra loi (%) 60 49,4 51.9 50 40 29 30 DNam 20 10 • Kliong dinh QHTD Khong muon sir dung Ban tinh khong muon sii dung tranh thai ban than khong mudn sir dung (ty le nir gidi la 34,1%) Cd 29,3% nir gidi cho bie't hg khdng dung bien phap tranh thai ban tinh CLia hg (nam gidi) khdng mudn sir dung chi cd 13,5% nam gidi cho bie't hg khong sir dung bien phap tranh thai vi ban tinh cua hg (nii gidi) khdng mudn (Bieu dd 1) Ket qua phan anh rd su phu thudc ciia nir gidi viec sir dtang bien phap tranh thai quan he tinh due Ke't qua nghien ciiu tren tuong ddng vdi ket qua eiia nghien cun ve tinh trang nao pha thai nien cua Tine Gammel Toft (1998) Phan nhieu nien cho rang quan he tinh due de'n vdi hg ngSu nhien, khdng cd chii di'ch tir ban dau ma dd la ket qua nhirng giay phiit thang hoa ciia tinh yeu Va vi tinh cha't ngSu nhien dd ndn nien khdng chuan bi ca vd tinh than cung nhu phuong tien tranh thai phii hgp Cac chuong trinh tinh due an toan cho nien can chu y den diem de xay dimg chuong trinh dat hieu qua Trong nhieu nam qua, cac chuong trinh ke hoach hda gia dinh (cung ca'p thdng tin ve cac bien phap phdng tranh thai) thudng loai nhimg nien chua ket hdn khdi nhdm ddi tugng phd bien kien thirc Vi the, sir diing bien phap tranh thai quan he tinh due chua trd mot thdi quen can thiet ddi sdng tinh diic ciia nien Dang luu y ve mot ty le khdng nhd nien, dd nam gidi chiem ty le cao ban (51,9%), khong sir dung bien phap tranh thai quan he 34 Nghien ciifu Gia dinh va Gi6i Quyen 19, so 6, tr 30-42 Bieu Bien phap tranh thai nien sii dung Ian quan he tinh due dau tien (%) 90 80.1 80 70 60 50 40 30 20 3.9 • 10 • Rao cao s u 1 7.2 1 \ ' ic n Ira n h X II a I l i n h T h u d c t n h I h ;i i k h ii n c i\ p ngiiai ih d'l Bien phap t n i y n ih d n j; Ti'nh n y a y an loan tinh due la khdng mudn sir dung Vi nien khdng mudn sir dung bien phap tranh thai? Cudc didu tra chua cung ca'p dugc nhirng thdng tin can thie't de ly giai cho dieu Va'n de dat la nien khdng mudn sir diing bien phap tranh thai lieu hg cd y thiie het dugc hau qua xa hoi ciia viec khong sir diing bien phap tranh thai Va lieu hg da cd dii nhirng ky nang can thiet de ting phd vdi viec mang thai ngoai y mudn neu nd xay hay khong Cd su khac biet ve ly khdng sir dung phuong tien tranh thai giira cac tuoi cd quan he tinh due Ian dau Nhdm nien quan he tinh due trudc hon nhan d tudi 15-20 cd ty le khdng sir dung bien phap tranh thai vi tin rang khdng the mang thai cao hon nhdm nien quan he tinh due d tudi 21-24 (15% so vdi 6,5%) Trong dd, nhdm tudi 21-24 cd ty le khdng sir dung bien phap tranh thai vi khdng cd y dinh quan he tinh due dd cao hon nhdm tudi 15-20 (54,8% so vdi 40,9%) Ke't qua cho tha'y, stJ khac biet ve hieu bie't phdng tranh thai d cac tudi 15-20 va tudi Idn hon Trong sd nhiing ngudi cd sir dung bien phap tranh thai, phan Idn hg sit diing bao cao su, cac bien phap: xuat tinh ngoai, tinh an toan, bien phap truyen thdng it dugc nien sir dung (bie'u dd 2) Ke't qua cho thay, nhiing nien cd y thirc sir diing bien phap tranh thai cung la ngudi y thiic dugc hieu qua phdng tranh thai ciia Tran Thi Hong 35 mdi bien phap Nghien ciru ve tinh trang nao pha thai ciia vi nien va nien cua Tine Gammel Toft (1998) cho thay, phan Idn nhimg trudng hgp mang thai ngoai y mudn la nien khdng sir dung bien phap tranh thai quan he hoac ne'u cd, thudng sir dung nhiing bien phap: tinh an toan, xua't tinh ngoai Hien nay, nhd sir phat trien manh me cua cac phuong tien truyen thong dai chiing cung nhu cac chuong trinh truyen thdng cho nidn, thdng tin ve cac bien phap tranh thai dac biet la bao cao su cang trd nen phd bie'n va gan gui vdi nien Cd le hieu qua va tinh tien Igi cua bien phap tranh thai la mot nhirng ly khie'n nien lua chgn nd de phdng tranh thai cung nhu cac benh lay truyen qua dudng tinh due Cac yeu to tac dong den viec sur dung bien phap tranh thai Cac nghien cun ve tinh hinh nao hiit thai cua nien da chi nhirng hau qua xa hoi ciia viec khdng sii dung bien phap tranh thai quan he tinh due trudc hdn nhan, nhu viec cd thai ngoai y mudn, van de siic khde va siic khde sinh san Tuy nhidn, thitc trang khdng sir dung bien phap tranh thai van didn ddi sdng tinh due cua nien Van de dat la yeu to nao tac ddng de'n viec nien khong sir dung bien phap tranh thai quan he tinh due? Bai viet se phan tich mo hinh da bien bang phuong trinh hdi qui phi tuyd'n tinh logistic ve cac yeu td tac ddng den viec sir dung bien phap tranh thai quan he tinh due trudc hon nhan ciia nien de lam rd dieu Phan tich cho phep xac dinh nhimg ye'u td thirc su cd anh hudng de'n viec sir dung bien phap tranh thai ciia nien Tuy nhien, trudc he't phan tich tuong quan hai bie'n, ba bie'n dugc tien hanh de xac dinh nhiing ye'u td cd kha nang anh hudng den bie'n sd phu thugc Cac bie'n ddc lap dugc xem xet phan tich ye'u td tac dgng tdi viec sir dung bien phap tranh thai gdm cd: gidi tinh cua nien, trinh hgc va'n, tudi quan he tinh due Ian dau, hieu bie't ve cac bien phap tranh thai, quan niem ve bao cao su, ddi tugng nien cd quan he tinh due, mire tham gia cac boat ddng lien quan de'n hdi nhap Bien phu thudc la: cd sir diing bien phap tranh thai tat ca cac Ian quan he tinh due cua nien vdi ban tinh dau tidn (ma 0=kh6ng va l=cd) Phan tich tuong quan hai bie'n budc dau cho tha'y gidi tinh, tuoi cd 36 Nghien ciru Gia dinh va Gidi Quyen 19, so 6, tr 30-42 Bieu Ty le sii dung bien phap tranh thai tat ca cac Ian quan he tinh due theo gidi tinh nien va nhom tudi (%) 4.') 50 T 40 36.4 34 30 D 15-20 13.3 20 E21-24 10 • Nam NO quan he tinh due Ian dau, trinh hgc van ciia nien cd lien quan tdi viec nien sir dung bien phap tranh thai quan he tinh due trudc hdn nhan Cu the, nam nien cd ty le sir diing bien phap tranh thai thudng xuyen ta't ca cac Ian quan he tinh due vdi ngudi dau tidn cao han nii nien (37,6% so vdi 22,6%) Thanh nien cd quan he tinh dtic Ian dau 21-24 tudi sir dung bien phap tranh thai thudng xuyen cao hon nhdm nien quan he tinh due 15-20 tudi (43,6% so vdi 30,6%) Do tudi quan he tinh diic Ian dau cd tac ddng tdi ty le sir dung bien phap tranh thai ciia ca nam nien va nir nien Bie'u dd cho thay d ca hai nhdm nam va nir, nien quan he tinh due Ian dau d tudi 21-24 cd ty le sir dung bien phap tranh thai ta't ca cac Ian quan he cao ban nhdm cd hanh vi d tudi 15-20 Phai chang d tudi 21 trd len, ca nam va nir nien deu y thiic hon ve hieu qua cung nhu Igi ich ciia viec sir diing bien phap tranh thai quan he tinh due Ddng thdi, d tudi Idn hon, hg cung cd nhieu kie'n thirc hon viec sir dung bien phap tranh thai so vdi tudi dudi 20 Nhdm nidn cd trinh hgc van trung cap - dai hgc va trung hgc phd thdng cd ty le sir dung bien phap tranh thai nhieu han ro ret nhdm nien cd trinh hgc van trung hgc co sd trd xudng Ty le sir dung bien phap tranh thai tat ca cac Ian quan he vdi ban tinh dau tien ciia nien theo nhdm trinh hgc van tir cao den thap la: 38%; 38,4%; 17% Tuy nhien, phan tich bie'n cho tha'y trinh hgc van chi tac ddng tdi viec sir diing bien phap tranh thai cua nir gidi Ty le sir dung bien phap Tran Thi Hong 37 tranh thai theo trinh hgc van tii thap den cao cua nii nien la: 0%; 26,1%; 35,3% Tim hieu mdi quan he giiia miic tham gia cac boat ddng mang tinh hdi nhap va miic sir dung bien phap tranh thai ta't ca cac Ian quan he tinh due cho tha'y, nhdm nien tham gia d mire yeu (khong tham gia hoac chi tham gia mot boat dgng) cd ty le sir dung bien phap tranh thai tha'p hon nhdm nien tham gia d miic trung binh (tham gia 2-3 boat ddng) va manh (tham gia ca boat ddng) Bdn boat ddng dd la: 1) Tham gia lien hoan hay tang/ nhan qua thiep nhan Li tinh yeu vira qua; 2) Tang/ nhan qua hay di lien hoan vao dip Giang sinh vira qua; 3) To chirc sinh nhat; 4) Sir dung internet Ty le tuong iing la: 20,5%; 38,9%; 35,8% Tuy nhien, ke't qua kiem dinh thdng ke p>0,05 khdng cho phep khang dinh mdi quan he giira hai bie'n sd Viec quan he tinh due vdi cd anh hudng Idn tdi viec cd sir dung bien phap tranh thai hay khong Nhung nien cd ban tinh dau tien la ngudi yeu/ ngudi da dinh hdn cd ty le sir dung bien phap tranh thai ta't ca cac Ian quan he tinh due vdi ngudi tha'p hon nhdm nien cd ban tinh dau tien la ban be/ ngudi mdi quen/ ngudi lam nghe mai dam (32,8% so vdi 55,2%) Ty le sir diing bien phap tranh thai quan he tinh due vdi ngudi ydu, va/ chdng sap cudi thap thudng la nien khdng cd y dinh quan he tinh diic vao thdi diem dd Hanh dgng dd xay la sir bgt phat va khong kiem che dugc tinh cam ciia hai ngudi yeu (Tine Gammel Toft, 1998, tr.67) Mat khac, cd the nidn thudng cam tha'y an tam hon quan he tinh dtic vdi ngudi yeu nen hg it nghi de'n cac bien phap bao ve Ngugc lai, nien cd the chii ddng hon viec quan he tinh diic vdi ngudi la nen hg chu ddng hon viec chuan bi bien phap tranh thai va sSn sang sir dung de dam bao an toan quan he tinh due Nhdm nidn bie't tir bien phap tranh thai trd len so 10 bien phap dua (gdm: xuat tinh ngoai, tinh vdng kinh, thudc udng tranh thai, bao cao su, dat vdng, thudc tiem, cay dudi da/ dat thudc dudi da, cac loai kem/thudc dat am dao, thudc tranh thai khan ca'p, triet san) cd ty le sir dung bien phap tranh thai tat ca cac Ian quan he tinh due vdi ban tinh dau tien cao ban nhdm nien bie't tir bien phap trd xud'ng (37,9% so vdi 25%) Mdi lien he giira hai bie'n sd ggi rang phai chang viec thie'u hieu bie't ve cac bien phap phdng tranh thai khie'n nien bi ban 38 Nghien curu Gia dinh va Gidi Quyen 19, so 6, tr 30-42 Bieu Ty le sir dung bien phap tranh thai thudng xuyen theo gidi tinh va so lugng cac bien phap tranh thai nien bie't (%) 50 41 40 27.4 25.5 30 nO-5 bien phap 06-10 bien phap 20 10 Nam NO che' viec sir dung cac bien phap quan he tinh diic Bie't nhidu bien phap tranh thai lam tang kha nang sir dung bien phap tranh thai quan he tinh due trudc hon nhan ciia ca nam gidi va nir gidi (bieu dd 4) Nhdm nidn sir dung mang internet cd ty le diing bien phap tranh thai tat ca cac Ian quan he tinh due vdi ban tinh dau tien cao ban nhdm nidn khdng sir dung internet (37,2% so vdi 17,6%) Cd the viec sir dung internet giiip nien cd co hdi tiep can dugc vdi thdng tin ve each sir dung bien phap tranh thai, thdng tin ve hau qua xa hdi ciia viec khdng sir dung bien phap phdng tranh thai quan he tinh due Va viec tiep can nhung thdng tin giiip nien cd y thiic hon sir dung bao cao su quan he tinh due Phan tich tac dgng cua viec sir dung mang internet tdi ty le su diing bien phap tranh thai theo gidi tinh nien cho tha'y, ca nam nien va nir nien sir dijng mang internet ddu cd ty le sir dung bien phap tranh thai cao han nhdm khdng sir dung Ty le ciia nam nidn la 38,8% va 26,1% Ty le cua nii nien la 28,6% va 0% Tuy nhien, ket qua kiem dinh thd'ng ke chi khang dinh mdi quan he giiia viec sir dung internet va miic su dung bien phap tranh thai cua nii nien Phan dudi day tim hieu mdi quan he giira quan niem ciia nien ve bao cao su vdi viec sir dung bien phap tranh thai quan he tinh due trudc hdn nhan Ci Viet Nam nhiJng van de lien quan den tinh due thudng duoc coi la dieu tham kin, it dugc ndi ra, dac biet ddi vdi nhdm ngudi chua Tran Thi Hong 39 lap gia dinh Mae dii cac bien phap phdng tranh thai ndi chung va bao cao su ndi rieng da dugc tuyen truyen rdng rai tren cac phuong tien thdng tin dai chiing song viec ndi ve bao cao su mot each cdng khai cung nhu viec nhin nhan nd don thuan la mot bien phap tranh thai vSn chua trd mot net van hda Quan niem ciia nien ve bao cao su dugc danh gia thong qua su ddng y hay khong ddng y ciia nien ve nhan dinh lien quan de'n bao cao su Cac nhan dinh dd la: 1) Bie't nhidu ve bao cao su la bieu hien cua viec quan tam den chinh minh 2) Ngudi phu nir cd the' lam ban trai khdng hai Idng neu cuong quyet bat dung bao cao su quan he tinh due 3) Hdi ve bao cao su la khd khan vi nd khie'n ngudi khac nghi la ban sap sua cd quan he tinh due 4) Sir dimg bao cao su chiing td ban khong tin tudng ban tinh 5) Bao cao su chi thich hgp vdi tinh due ngSu nhien (khong gan vdi quan he lau dai) hoac vdi gai mai dam 6) Bao cao su lam giam pha'n tinh due 7) Mang bao cao su theo ngudi la bieu hien ciia hanh vi thieu dao dtic Trong nhan dinh tren, chi cd nhan dinh thir iing hd cho viec sir dung bao cao su, nhan dinh cdn lai cd xu hudng ngugc lai Quan niem ciia nien ve bao cao su dugc xac djnh thdng qua each tinh diem: thang diem 10 cho mdi nhan dinh iing hd sir dung bao cao su (ddng y vdi nhan dinh thii nha't hoac khong ddng y vdi nhan dinh cdn lai), thang diem cho mdi nhan dinh khdng iing hd viec sir dung bao cao su (khdng ddng y vdi nhan dinh thir nhat/ ddng y vdi nhiing nhan dinh cdn lai) Tdng hgp sd diem ciia nhan dinh se cd sd diem tdng nhan dinh ve bao cao su Diem so cang gan vdi 70 nghia la cang gan vdi xu hudng iing hg viec sir dung bao cao su Diem sd cang gan vdi thi cang theo xu hudng ngugc lai Phan tich thuc trang sir dung bien phap tranh thai ciia nien quan he tinh due trudc hon nhan cho tha'y da sd nien sir dimg bao cao su quan he tinh due Vi the', gia dinh dat la nhdm nien cd xu hudng ung hg viec sir dung bao cao su cd ty le sir dung bien phap tranh thai quan he tinh diic cao hon nhdm cd xu hudng ngugc lai Tuy nhien, ke't qua cho tha'y, nhdm nien cd sd diem tir 36 trd len (cd quan niem thien ve viec iing hd sir dung bao cao su) cd ty le sir dung bien phap tranh thai cao hon khong dang ke so vdi nhdm cd sd diem tir 35 trd xudng (cd quan niem thien ve viec khong iing hg sir diing bao cao su) (36,8% so vdi 30,8%) 40 Nghien ciiru Gia dinh va Gidi Quyen 19, so 6, tr 30-42 Bieu Yeu td tac dong den miic sit dung bien phap tranh thai tat ca cac Ian quan he tinh due vdi ban tinh dau tien ciia men Mifc y nghia thong ke: *p