Thực trạng và hiệu quả sử dụng dụng cụ tử cung trong kế hoạch hoá gia đình (nghiên cứu tại các quận, huyện phía tây hà nội

Nghien ctiu Gia d i n h va G i o i So - 1 Thirc trang va hieu qua suf dung dung cu tuf cung l(e hoach hoa gia dinh (Nghien cufu tai cac quan, huyen phia Tay Ha Noi) Ooan Kim Thang Vien Xa hoi Inoc T o m t a t : Bai viet dUdi day la ket qua ciia khao sat danh gia thUc trang va hieu qua sil dung dung cu til cung (DCTC) cila 1.400 phu nuf tuoi sinh de co chong tai 14 xa/thi tran thugc cac quan/huyen ph;a Tay Ha Ngi, hai nam 2007 - 2008 nham giiip cho cac nha quan ly dan so'- ke hoach hoa gia dinh co nhiing dinh hudng phii hdp de phat huy hieu qua cua bien phap doi vdi ngUdi phu nd noi rieng va cac cap vd chong tuoi sinh de noi chung DCTC dUdc da sd'phu nd sil dung danh gia la mgt bien phap lau dai, tien ldi, it tac dung phu va de sil dung vdi g i n 90% Sd' phu nO dUdc hoi cho biet se van tie'p tuc sil dung DCTC thdi gian tdi Cac thcng tin ve sil dung DCTC khao sat eung cap cd sd dU lieu chd cac can be dan so ciing nhU y te viec nang cao chat lUdng dich vu va cham sec cac khiich hang cila minh Tii k h d a : Dung cu til cung; Ke hoach hca gia dinh; Phu nd Trong sd cac bien phap tranh thai cd tdi 3/4 dinh cho phu nCr Dung cu tir cung (DCTC)'" la bien phap dugc han 50% sd phu nu cd chdng d nudc ta sir dung Dung cu til cung la mgt bien phap tranh thai tam thdi, nhung 32 Nghien cu'u Gia dinh va Gidi Quyen , so 1, tr 31-43 CO tic dung tranh thai nhidu nam (DCTC Multiload nam; TCU la 10 nam) Khoa hgc da chung minh ring hieu qua tranh thai cila bien phap dat DCTC rai cao (99%), lai thuan tien cha ngudi sir dung Tuy nhien, DCTC ben canh nhung diem thuan lgi giup ngudi phu nil cd the thuc hien dugc KHHGD va cQng cd the tiep tuc sinh cd nhu cau mgt each dd dang, thi bien phap cOng cdn cd mgt so diem chua thuan Igi nhu: ngudi phu nil phai den ca sd y te' de dat va thao DCTC; can bd y te' phii dugc tap huan day dii vd chi dinh, chdng chi dinh, vd ky thuat va each theo ddi, cham sdc, cung nhu xii trf cd bai thudng xay ra; khdng cd tac dung phdng tranh cac benh lay qua dudng tinh due Danh gia ve thtrc trang va hieu qui sir dung DCTC cila phu nil tudi sinh de cd chdng se giiip cho cac nha quan ly dan so - ke' hoach hda gia dinh cd nhiing dinh hudng phii hgp de phat huy hieu qiia cila bien phap ddi vdi ngudi phu nCr ndi rieng va cac cap vg chdng tudi sinh de ndi chung Dia ban khao sat danh gia bao gdm 14 xa/phudng thudc 14 huyen, thi xa khu vuc phfa Tay phd Ha Ndi md rdng Sd lieu thdng ke vd cdng tie Dan sd - KHHGD, nam 2007 - 2008, tren dia ban cac xa thudc 14 quan/huyen/thi xa cho thay tinh hinh sir dung cac BPTT bing dung cu tir cung chiem khoing 60% - 70% sd cac BPTT hien dai Khu vuc dd thi nghien cuu danh gia bao gom thj xa Ha Ddng (vao thdi diem khao sil la thi xa) va thi xa San Tay vdi 200 trudng hgp (chie'm 14,3%) tdng sd miu nghien cuu Khu vuc ndng thdn bao gdm cac xa thudc cac huyen: Hoai Due, Dan Phugng, Thach That, Phiic Thg, Qud'c Oai, Chuang My, Lfng Hda, Thudng Tin, Phu Xuyen, Thanh Oai, Ba Vi va My Due vdi 1.200 trudng hgp (chiem 85,7%o) Dac diem nhan khau hoc - xa hoi mau khao sat danh gia Tinh hinh su dung Men phdp trdnh thai hien dai qua cac ndm (2007, 2008 vd 9/2009) Theo sd lieu sir dung DCTC cua phu nCr nam 2007-2008 tai cic xa dugc khao sat, 28,5%o sd xa cd ty le sir dung nam sau cao han nam trudc Khi xem xdt sd lieu thdng ke thing diu nam 2009 thi viec phu nu tiep tuc dat DCTC cao han ca nam 2008 chiem 50%o sd xa khao sat Do tudi phu nu dugc khdo sdt Trong tdng sd phu nu dugc khao sat, phu nil d tudi tir 25-34 chiem ty le cao nhai 47,6%; tudi tir 35-44 la 34,6%; tudi 45-49 la 11,9% va phu nil 15-24 tudi chiem ty le tha'p nhat (5,9%)) Doan KimThang 33 Bang L Ty le phu nu su dung DCTC tdng sd su dung cac BPTT hien dai tai cac xa khao sat (%) Naim 2007 Xa/Thi Iran Nam 2009 Nam 2008 (Hei thang 9/2009) (a) (b) (c) (a) (b) (cl (a) Van Con 1.77X 1.454 81,8 1,774 1,445 81,5 l,X15 20X 11,5 Tan Lap 1.974 1.X04 91,4 2.114 1X04 85„3 2,223 l,X62 83,8 Thach Hoa 1.424 1.159 81,4 1.470 1,242 84,5 1,464 1,257 85,9 Hiep Thuan 1.522 1.254 82,4 1.5.10 1,255 82,0 1,455 1,255 86,3 Sai Son 2.074 l,59X 77,0 2,199 1,57X 71,8 2,2X3 1,272 52,7 2,425 1,903 78,5 2,571 2,042 79,4 - Xuan Mai (b) (c) Phitcmg Tu 1.421 1.096 77,1 1,.142 1,039 77,4 1,550 1,157 74,6 Nguydn Trai l %4 1.050 76,9 1,492 1,170 78,4 1,593 1,2X1 80,4 Minh Tan 2.(00 1.X66 91,9 l,X72 1,629 87,0 1,924 1,743 90,6 Hdng Duong 1.5.M 1.160 75,8 1,514 1,137 75,1 1,565 l,17X 75,3 Tay Dang 1.7X6 1,42.^ 79,7 1,779 1,423 80,0 2504 1,767 70,6 Le Thanh l.,^70 1.2.10 89,8 1,42.1 1,165 81,9 1.4X9 1,2X5 86,3 ^ 1,931 - Diiimg Noi M7 Son Dong 1.621 252 18,7 1.6IX 1,25! 251 20,1 I.I5I 253 22,0 Chii thich: (a) Tiing so PN 15 • 49 sir dung B F r i hien tlai; (b) 'Tong so PN 15 - 49 sir dung DCTC; (c)Ty lesLtdungDCrC, Ddn too Phu nQ' dan tdc Kinh khao sit chiem ty le cao nhat 99,7%; phu nu' la ngirdi dan tdc khac 0,2% Cd 0,1% phu nu' dugc hdi khdng bay td vd phin dan tdc phdng van Tdn gido Cd 61,1%' phu nil' dugc hdi khdng theo tdn giao nio; dao Phat 31,5%; phu nil theo Thien chiia giao, Hda hao Tin lanh 4,9% Hgc van Phu nil cd trinh hgc van trung hgc co sd chiem ty le cao nhat 60,9%;; trung hgc phd thdng 22,7%; trinh Cao ding/Dai hgc 4,9%; tren Dai hgc 0,2% Phu nil khdng biet dgc, viet chiem ty le thap 0,2% 34 Nghien cuu Gia dinh va Gidi Quyen , so 1, tr 31-43 Tinh trgng hdn nhdn Trong sd 1.400 phu nu tham gia tra ldi phdng van, 99,5% hien dang cd chdng; 0,5% phu nO ly di/ly ihan/goa Cd 0,5%' sd phu nQ dugc hdi cd chdng di cdng tac xa tren thing Sd hien cd Trong sd phu nu dugc hdi, 65,9% hien cd con; 19,2% cd con; 10,4%c cd vi 4,4% hien cd nhidu han Sd trung binh cua mdt phu nu dugc hot khio sal la 2,19 Phu nu dugc hdi cd sd nhidu nhai la va it nhat la Nghe nghiep Phu nu dugc hdi la ndng dan chie'm ty le cao nhai 76,9%;; cdng nhan 6,2%; can bd doan the 2,4%; can bd nhi nudc bao gdm ci giao vidn 6,5%; budn bin dich vu 5,9%: va cic nghd khac 1,9% Thuc trang su" dung bien phap DCTC cua phu nur tai cac xa khao sat Tinh hinh sii dung Men phdp DCTC cua phu nd Kei qui cudc khio sit cho bidi 44.6% so phu nQ dugc hdi cd bidi ten loai DCTC TCU 380; 2,3% ke dugc ten bien phip DCTC Multiload, dd gin 1/2 sd phu nu dugc hdi khdng biet loai DCTC minh dang sir dung la gl (47,5%c) Khi dugc hdi: "Hien tai chi cd dang sir dung bien phip DCFC khdng?", 80,9% tdng sd phu nu dugc hdi ndi rang hien dang sir dung bidn phip DCTC dd tranh thai va KHHGD 18,1% cho biet hien tai khdng sir dung bidn phip DCTC Mdt sd lugng nhd (0,9%) khdng bay td y kien hdi ve van dd Trong sd 1.133 phu nQ sir dung DCTC cd 46,9% cho biet hg diing loai TCU 380A; 2,4%c ndi ring dung loai Mulliload;va 49,9%c khdng biet loai minh dang sir dung la loai DCTC ten la gi Ly sil' dung DCTC kha da dang cd 42,9% sd phu nu dugc hdi cho biet hg chgn sil dung DCTC \i muc dfch phdng trinh thai; 24,4%o cho biet sir dung DCTC vi an loan; 13.8% cho biet sir dung vi lien lai sinh hoat \'g chdng Khoang thdi gian ngu'di phu nu dugc hdi da sii dung bien phap DCTC cung cho thay nhung mi'rc khac giua cac nhdm phu nQ Trong sd 1.400 phu nu dugc hdi thi ngudi da sir dung DCTC lau nhii la 31 nam va Doan Kim Thang 35 Bleu L Tuong quan giua tudi phu nu va viec su dung DCTC (%) 90 80 70 DKhong sirdung 31 n V a n dang sirdung 60 42,1 50 40 30 50,8 227 20 331 10 "TF" 9.7 6.4 15-24 tuoi 25-34 tuoi 35-44 luoi 45 tuoi tro Ion ngudi su dung gin nhai la nam Trung binh cho cac phu nu dugc hdi ndi rang cd sir dung DCTC la 6.6 nam Do tudi cua phu nQ dugc hdi cung cd mdi quan he kha rd vdi viec sir dung bien phap DCTC Nhdm phu nu 25 34 tudi cd ty le tiep tuc tri viec sir dung DCTC cao nhai (50,8%) Thdi cua nguiri chdng, vai trd ttf vdn ciia edc dodn the vd viec tiep can thdng tin ve DCTC ciia ngudi phu nu Tra Idi cau hdi: "Trudc dat DCTC chi cd ban bac vdi chdng khdng?" cd 95,6% phu nQ cd ban bac vdi chdng; 3,6% khdng bin bac vdi chdng Trong sd nhu'ng ngudi phu nu cd ban bac vdi chdng trudc dat DCTC thi 98,1% ngu'di chdng ring hd vg dill DCFC Cdn cd 1,6% phu nfr dugc hdi cho biei hg "khdng rd thii ciia chdng" nhu the nao va 0,3% cho rang chdng hg khdng ring hd dat DCTC Ve thai cua ngu'di chdng biet vg dat DCTC: 96,5% phu nu dugc hdi ndi ring chdng hg cd biei hg sir dung DCTC, dd 87,4% phu nu cho biei chdng hg hai long hg diit DCTC va 1,6% cho biei "khdng rd thai ciia chdng" ve viec hg dung DCTC Nhil'ng phu nu hien cd su dung DCTC cho biet trudc dat DCTC hg cd dugc tu \'an la 86%; khdng dugc tu van: 13% Can bg tu \'an cho phu nu trudc hg dat DCTC chii yen hi can bd dan sd xa (40,6%); cin bg tram 36 Nghien ciiru Gia dinh va Gidi Quyen 21, so 1, tr 31-43 Bang Tuang quan giua nghe nghiep vdi tiep nhan thong tin ve DCTC (%) Nong d.in Nguon TT Cong nhan CBdoan Iht Can M NN Buon ban Khac N ''1 N "i N ',/, N •;; N 'S N ';; Tivi/Dal/Baii 172 40.2 11 41.9 in 11.1 12 42.1 27 1H.6 Ofi 2.\() CBTram y ii 6.14 fi«.5 42 56.x IK 6(1.11 44 57.9 1« 54.1 07 24.2 fill fifi.l so 67.fi 22 71 W 65.K 41 61.4 1« 75.1) 19.7 14 20.(1 (Ifi 25.(1 1(1.5 07 10.0 01 4.2 10.5 10 14.1 01 12.5 1IX)':1 70 24 m"i CB DSn s() SH iliian lh6 2,16 2.1.i 17 21.1) Kl ^y.^ Tir chfing 104 11.2 0.1 4.1 (11 1(1.0 Tir biin he 117 12.6 (12 2.7 01 10.0 74 l(XI',f 11) Nguon khac 06 11.6 T'ing sd 925 1(K)'; i(K)';; \5 m m 76 KXI';; y le xa (31,7%); cin b(D phu nu (19,9%) va cin bd nien la 0,2%c Ngudn tie'p can thdng tin vd bien phap DCTC cua phu nQ la kha da dang Da sd cac phu nu dugc hdi cho biet hg bie't thdng tin vd bien phap DCTC til' "cin bd dan sd xa" (66,1%^) va til "cin bcS tram y te'" (65,4%o) Ngoai hai ngudn thdng tin chil yeu dd, cac ngudn thdng tin khac cQng dugc phu nu tiep nhan nhu: Tivi/dai/bao (39,8%o); tu cac sinh boat doan the (25,0%); tu ban be (12,0%); va tu chdng ndi lai cho biet (10,6%o) Cung cd su khac biet vd tiep nhan thdng lin tir cac kenh khac vd DCTC so sinh giua phu nu khu vuc ndng thdn va dd thi Phu nu d cac khu vuc dd thi cd nhidu didu kien dd tiep nhan cic thdng tin vd BPTT dd cd DCTC cao han phu nu d ndng thdn Tuy nhien, su khac biet la khdng Idn lim Phu nQ d cac nhdm nghd nghiep khic ddu cd ty le cao viec tiep nhan thdng tin vd DCTC thdng qua mang ludi can bg dan sd xa/phudng Tuy nhien ve cac ngudn thdng tin cu the, thi d mdi nhdm nghd nghiep khic ngudi phu nu lai cd nhQ'ng uu tidn khac ve tiep nhan ngudn thdng tin Nhdm phu nu ndng dan danh uu lien nhieu han cho viec tiep nhan thdng tin tu can bd Tram y te xa (68,5%o); nhdm nu cdng nhan, can bd doan the, can b(5 nha nudc va nhQ'ng ngirdi budn ban dich vu lai cd ty le cao tiep nhan thdng tin tu cin bd y te xa/phudng (67,6%c; 73,3%; 65,8%c; 61,4%c) Trao ddi giua vg chdng gia dinh ve cac van de KHHGD cung nhu su dung bien phap tranh thai cdn kha han che d cac nhdm ddi tugng dugc khao sat Kenh thdng tin trao ddi true tiep tu ban be Doan K i m T h a n g 37 ty le cung kha thap, nhat la nhdm nu cdng nhan Hieu qua sur dung DCTC cua phu nur tai cac diem khao sat Sii dung Men phdp DCTC tdc dgng den sdc khoe ngudi phu nd 'Hieo kei qua khio sat, 65,4% sd phu nu dugc hdi cho biet dat DCTC khdng anh hudng gi tdi sue khoe ciia hg; 33,9% cho biet viec dat DCTC cd anh hudng tdi sue khoe va 0,7% khdng bay id y kien gi vd van de Trong sd nhung phu nu dugc hdi 15,2% ndi ring dat DCTC gay dau lung; 7,0%3 dau bung; 1,9% dau diu va cac bieu hien khac cung cd nhung ty le khdng dang ke Tra ldi cau hdi: "Lieu dat DCTC cd gay nhung didu gi anh hudng tdi chu ky kinh nguyet ciia ngudi phu nu hay khdng?", 71,6% cho ring sau dat DCTC thi kinh nguyet ciia hg vin ddu; 26,8% cho biet chu ky kinh nguyet khdng ddu; 0,7% khdng biet kinh nguyet cd ddu hay khdng va 0,9% khdng cd y kien gl So vdi trudc dat DCTC, cd 57,0%c sd phu nu dugc hdi cho biei chu ky kinh nguyet ciia hg "vin nhucu"; 32,1% cho biet chu ky kinh nguyet ciia hg "dii han trudc"; 8,4% cho biet chu ky kinh cua hg "ngin han trudc" va 1,5%o "khdng cd y kien" vd van dd niy Sir dung bidn phap DCTC la mdt cac bien phap dd trinh thai va KHHGD Tuy nhien cic tic ddng phu ciia mdi mdt bien phap ddu li mdi quan tam cua ngudi su dung cung nhu nha cung cap dich vu Tri ldi cau hdi: "Khi dat DCFC, chi cd cam tha'y khd khan, anh hudng gi den cdng viec hang va sinh hoat vg chdng hay khdng?", ket qua cho thay 93,0% sd phu nQ dugc hdi ndi ring dat DCTC khdng inh hudng gi dang ke de'n lao ddng san xuat; 94,2% ndi ring khdng inh hirdng gi den cdng viec gia dinh va 92,4% cung cho ring khdng cd inh hudng gi den sinh hoat tinh due vg chdng Khac vdi cic bien phap tranh thai nhu vien ud'ng trinh thai, bao cao su hoac cac bien phip trinh thai truydn thd'ng, bien phap dat DCTC ddi hdi phii cd sir can thiep giup dd ciia cic bac sy hoac cac nhan vien y te Do dd viec tie'p can vdi cic bac sy va nhan vien y te la can thiet cd nhung true trac DCTC gay Cd 19,8% sd phu nu dugc hdi cho biei hg da de'n gap cic bac sy hoac nhan vien y le cd nhung ric rdi dat DCTC gay Nghe nghiep ngirdi dugc hdi khao sit danh gii niy khdng cd khac biet nhidu tucmg quan vdi vide ngudi phu nu cd di gap bac sy hoac nhan vien y te hay khdng cd nhung van dd ric rdi xay dat DCTC Tuy nhien tudi ngudi phu nu cd su khac biet vd ty le di gap bac 38 Nghien cdu Gia dinh va Gidi Quyen , so 1, tr 31-43 sy hoac cac nhan vien y te Khi cd chuyen ric rdi xiy sir dung DCTC, 44,4%o nhdm phu nu 25 - 34 tudi cd "di gap bac sy hoac nhan vidn y te'"; 36,5%; nhdm 36 - 44 tudi cd "di gap bic sy hoac cac nhan vien y te'" Ty le phu nu di gap bac sy hoac nhan vien y le tha'p han d nhdm: 45-49 tudi (15,2%) va ty Id thip nha't la nhdm phu nQ trd - tudi (4,0%) Trong sd 19,8% sd phu nQ dugc hdi ndi ring "cd di gap bac sy hoac cac nhan vien y te"" cd cac van de ric rdi sir dung DCTC gay ra, thi van dd dugc dd cap nhieu nhai la: dau bung (15,2%o); dau lung (13,%c); rong kinh (9,4%o); viem nhidm (7,9%o); hu (5,4%c); rdi loan kinh nguyet (l,4%c) va m(3t sd bieu hien khac, nhung ft han Hieu qud viec sii dung Men phdp DCTC Tie'p tuc sic dung bien phdp DCTC Cd 82,4% sd phu nu nghien cuu dinh gia ndi ring hien tai hg vin dang su dung DCTC; 16,6% cho biet hien tai khdng su dung va 0,9%j khdng tra ldi Trong sd nhung ngudi hien tai khdng sir dung DCTC, cd 82,8%o cho biet hg nhd nhan vien y tethao ra; 12,4%o cho biet DCTC bi rai vdi nhidu nguyen nhan khic nhu: lao dgng nang nhgc, vd tinh bi rai cd quan he tinh due Viec tie'p tuc su dung bien phap trinh thai va muc dd thda man sir dung cic bien phap khdng chi phu thudc vao su sin cd va su lien dung ciia bien phap, ma cdn phu thudc vao tudi cua ngudi, cung nhu su tham gia vao qui trinh sinh de ciia hg Vi vay, tudi ciia phu nu' cd anh hudng tdi su thfch nghi va nang chap nhan sii dung BPTT nhai dinh nao dd Nhdm phu nu ludi 25-34 dang tham gia manh vao qua trinh sinh dd cd mile tie'p luc sir dung bien phap dat DCTC cao han (50,8%)) Cac nhdm phu nQ khic muc tie'p tuc sir dung tha'p han: 33,1%: d nhdm phu nu 35 - 44 tudi; 9,7% d nhdm phu nu 45-49 tudi va thap nhai la 6,4% d nhdm phu nu tre 15 -24 ludi Vd tuo'ng quan giua nghd nghiep phu nQ dugc hdi vdi viec tie'p tuc sir dung bidn phap DCTC, cho tha'y cd su khac biet giQa cic nhdm phu nQ la ndng dan, cdng nhan, can bd nha nudc, budn ban dich vu va cic nhdm khac Nhdm phu nu ndng dan vin tii sii dung DCTT cao nhat (77,2%), cac nhdm phu nu khac tiep tuc tri viec sii' dung DCTC tha'p han Xem xet ve sd hien cd ciia ngu'di dugc hdi tuang quan vdi viec tie'p tuc sir dung DCTC cho tha'y phu nu dugc hdi hien tai cd vin tidp tuc sii dung DCTC cao nhat (66,5% ); phu nu h'xcn lai chi cd con: Doan KimThang 39 l l , l % c h o a c d a con: 18,6%) Trong sd nhu'ng ngudi hien dang sir dung bien phap DCTC ed 86,1% cho biei hg khdng su dung loai DCFC khac; 13,9% cho biet hg cd sii dung loai khic nhu: Nova T; TCu 220C '/'//;/; tien dung ciia DCTC Cd 96,4% phu nu dugc hdi cho biet DCTC la lien sir dung, chi cd 0,9% cho ring bat tien 2,7% khdng bay td y kie'n cua minh hdi vd tinh tien dung cua bien phap Phu nu d cic nhdm nghd nghiep khac ddu cd ty le cao nhan xdt la DCTC lien sir dung Vd cac nhdm tudi ngu'di phu nu, ty le cho rang DCTC la lat tien dung la: 47,4% vdi nhdm 25 - 34 ludi; 34,9% nhdm 35 - 44 tudi; 11,7% nhdm phu nu 45-49 tudi va 6,0%o nhdm phu nQ 15 -24 tudi Cung cdn mdt ty le nhd tap trung d nhdm phu nu tie tudi neu nhung bai tien sir dung bien phap DCTC hoac khdng bay td quan diem eiia minh vd tfnh tien dung ciia bien phip DCTC niy Tinh an todn ciia DCTC linh an loan ciia DCTC cho sue khde cung la yeu td dugc ngudi sir dung quan tam 93,6% ndi ring hien tai hg thay dat DCTC la an loan cho sue khde; 1,1% cho ring dung DCTC la nguy hiem Tuy nhien cung cd 4,4% phu nu dugc hdi lai khdng bay td gi vd van dd Xem xdt van dd vd tfnh an loan ciia bien phip DCTC den sue khde ngu'di sir dung tuong quan vdi phu nu d cac nhdm nghd nghiep xa hgi khic nhau, cic ket qua cho thay phu nu d cac nhdm tudi khic ddu danh gia DCTC li bien phap cd tfnh an loan cao Day la dau hieu tdt de phu nil tudi sinh dd tidp tuc tri vice sir dung bien phap Llieii qud eua DCTC Dung cu til cung la mdt bien phap tranh thai cd hieu qua, an loan Tuy nhien hieu qua ciia DCTC lai chiu anh hirdng bdi cic dac didm ciia dung cu, ky nang ciia ngudi thao lac, cung nhu bdi dac tinh ciia ngudi sil dung nhu: tudi, sd lan sinh cua phu nu Theo cac nha y hgc thi hiu hei DCTC cd ty le tiep tuc sir dung cao nhu vdng TCu 380A cd hieu qua sir dung tdi 10 nam Trong cudc khao sat, 96,6% phu nu dugc hdi cho biet diing DCTC cd hieu qui viec phdng tranh thai; 0,6%c cho ring khdng hieu qua vi 2,1% ndi khdng biet hoac khdng bay td y kien gi vd van dd 40 Nghien cuTu Gia dinh va Gidi Quyen 21, so 1, tr 31-43 Khdng cd khac biet danh gia hidu qui ciia bien phap DCTC giua nhQng ngudi phu nu cd sd khac Phu nu cd tu con, con, vi nhidu han ddu cho ring su dung DCTC cd hieu qua cao tranh thai va ke hoach hda gia dinh Sif hdi Idng ve bien phdp DCTC Trong viec lira chgn bien phip tranh thai, ngudi sir dung thudng ra't can biet rd viec sil dung bien phip se anh hudng nhu the' nao tdi ddi sdng gia dinh cua minh Ddi mdt bien phap nao dd khdng dugc ngudi phu nu cha'p nhan chi dan gian vi nd khdng thuan tien vdi thdi quen hang va nhu vay gay nen su khdng hai long cho ngudi sir dung Trong trudng hgp niy DCTC dudng nhu lai la thuan tien va hieu qua va tao dugc su cim tinh han ddi vdi nhung phu nu ndng thdn? Mac dti vay, 95,0% phu nu dugc hdi nghien cuu ddu cho biei hg hai Idng vdi viec sil dung DCTC viec trinh thai va KHHGD Tuy nhien cung vi nhidu ly khac nen cdn 2,6%; sd phu nu dugc hdi khdng hai long vd bidn phap DCTC Cd 2,4% phu nu dugc hdi khdng td thai gi hdi vd viec sir dung bien phap DCTC nhu the nao Khi xem xdt tuang quan giua cac nhdm nghe nghiep ciia phu nu vdi muc hai long vd bien phip DCTC, cho tha'y ty le hai Idng ve DCTC kha ddng ddu d cac nhdm nghd nghiep khic cila phu nu Kei qua khio sat cung cho thay muc hai Idng ve bien phap DCTC la kha cao d cac nhdm phu nu cd sd hien cd khac Dung cu til cung la bien phap cho hieu qua tranh thai cao so cac bien phap tranh thai hien dai khac Viec tuyen truydn true tie'p de'ap dung cac cap vg chdng tudi sinh de la rai can thiet de gia tang ty le ngudi sir dung bien phap 76,0%c sd phu nu dugc hdi cho biet hg "cd khuyen nhung ngudi xung quanh sil dung"; 20,7%o phu nu dugc hdi ndi ring hg "khdng khuyen ai" sil dung bien phap Nhdm phu nu tu 25 - 34 tudi cd ty le khuyen nhung phu nu khac ciDng ddng sir dung DCTC cao nhai (48,8%); nhdm 35 - 44 tudi: 33,6%c; nhdm 45-49 tudi: 12,4%o va thap nha't la nhdm 15 - 24 tudi: 5,5%o Ket luan Thuc trgng su dung DCTC (i) Trong hai nam 2007 - 2008, ty le phu nu tudi sinh de cd chdng tai cic xa thudc cac quan/huyen phfa Tay Ha Ndi day tri viec sir dung DCTC kha dn dinh Ben canh dd, 28,5% sd dia phuang cd ty le sir dung DCTC nam sau tang cao han so vdi nam trudc £-rir D o a n Kim T h a n g 41 (ii) Trong tdng sd phu nu cd sir dung DCTC nam 2007- 2008, ty le dat lai DCTC la 13,9% dd 1/3 la cac loai DCTC ma bin than ngudi dugc hdi khdng ke dugc ten; mdt sd ft, khoang 15% cho biei dd la ' J^loai dung cu tl)'cung TCU 380A (iii) Ty le cao cac y kien phu nu cho bie't tac dung cila DCTC la de tranh thai Phuang phip tranh thai sir dung cho mdt so phu nu rat cd hieu qua, an toin va cd the thao de dang nhd su can thiep giup dd ciia cic nhan vien y te DCTC dac biet sir dung cd hieu qui ddi vdi nhung phu nu khdng bi cac benh lay nhiem qua dudng tinh due (STDs) va vila mdi sinh (iv) Nhdm phu nu ndng nhan cd ty le tri viee su dung DCTC cao nhai, dd cic nhdm phu nu khac lai khdng tri viec sir dung DCTC lau dai hoac li hg lira chgn cho minh cac BPTT hien dai khac phii hgp han vdi didu kien cila minh (v) Cic kei qui cQng cho tha'y thdi gian ngudi phu nu dugc hdi khao sat danh gia sir dung DCTC lau nhit la 31 nam va gin day nhai ia 01 nam Nhdm tudi phu nu 25 -34 tudi khao sat cd ty le sir dung DCTC cao han cac nhdm khac Ngudn thdng tin ve DCTC (i) Ngudn thdng tin mi ngudi phu nu dugc tiep nhan vd bien phap DCTC la kha da dang Tuy nhien cd hai kenh thdng tin ma phu nQ tiep nhan vdi ty le eao nhat li can bd dan sd va can b(3 Tram y id co sd Cac kenh thdng tin phi chi'nh thuc khac la trao ddi vg chdng va trao ddi ban be cd ty le tidp nhan thap (ii) Su khac biiSt tiep nhan thdng tin vd bien phip tranh thai ndi chung va DCT'C ndi rieng d hai dia bin ndng thdn va dd thi li khdng dang kd Hieu qud sii dung DCTC (i) Cac y kien phu nu sir dung DCTC cho ring, DCTC cd tie dung trinh thai cao (xap xi 100%o), khdng mat nhidu thdi gian sudung, lien dung va thdi gian cd the kdo dai ldi 10 nam ddi vdi TCU 380A (ii) Chap nhan sii dung DCTC nhu mdt bien phip KHHGD cd hieu qua cao, nhung 1/3 sd phu nO dugc hdi cung cho ring DCTC cdn gay mdt sd tic dung phu inh hud'ng den sue khde ciia ngudi su dung Anh hudng DCTC gay chii yeu li dau lung, sau dd mdt sd bieu hien khic la dau bung va mdt sd ngudi cam tha'y met mdi sir dung DCTC (iii) Cac y kien phu nu dugc hdi cung cho ring sir dung DCTC khdng cd anh hudng "i dang kd den lao dgng sin xuai, cdng viec gia dinh va dac 42 Nghien cufu Gia d i n h va Gidi Quyen , so 1, tr 31-43 biet la sinh hoat tinh due vg chdng Viec tiep tuc su dung vd tuyen truyen viec sd dung cdng ddng (i) Kei qua khao sat 1.400 phu nU tudi sinh de cd chdng tai 14 xa/thi Iran thudc cac quan/huyen phia Tay Ha Ngi cho tha'y cd gan 90%o sd phu nu dugc hdi vin tiep tuc sii dung DCTC tai thdi diem khao sat va thdi gian tdi Tuy nhien cung cdn 16,6%) phu nu' dugc hdi khdng tie'p tuc su dung DCTC nua da Idn ludi, viem nhidm phai sir dung bien phip khic (ii) Cd mgt ty Id nhd (>10%o) nhung phu nQ sir dung DCTC ndi ring DCTC bi rai nhidu nguyen nhan khich quan nhu: lao dgng nang, rai cd quan he vg chdng Sd phu nu mud'n tiep tuc dugc dat mdi DCTC ma loai dung cu tu cung dd la TCU 380A (iii) Viec tuyen truydn cho ngudi khac sit dung DCTC chii yeu tap trung cao d nhdm phu nu 25 - 34 ludi, nhdm phu nu dang sung man qui trinh sinh dd (chie'm gin 50%o sd ngudi dugc hdi) Nhdm phu nu' tre han (15 - 24 tudi) chua cd nhidu kinh nghiem KHHGD ndn viec tu va'n cho ngudi khac cdn han che Kien nghj va giai phap (i) Nhung nam gin day cic bien phap tranh thai hien dai dang dugc sir dung rdng rai cac Chuong trinh KHHGD d nudc ta, dd cd DCTC DCTC dugc nhidu cap vg chdng biei den vi day la mdt bien phap lau dai, tien Igi, ft tic dung phu va de su dung Tuy nhien mdi mdt bien phap tranh thai ddu cd nhung mat thuan lgi va bai lgi ma nd mang lai Khdng cd nhai mdt bidn phap nao phu hgp cho tat ca mgi ngudi sir dung va ddi vdi mdt sd nhdm ngudi thi mdt vai bien phap lai khdng sir dung dugc nhu'ng chdng chi dinh, dd ca DCTC cung vay De dua mdt su lira chgn thfch hgp nhat ddi vdi bien phap nao dd cho ngudi su dung, thi didu vd ciing quan trgng dd'i vdi ngudi quan ly chuang trinh KHHGD la can phai truyen thdng rd rang ve tinh hieu qua va an loan ciia bien phip Vd phan viec tuyen truydn de cac cap vg chdng tudi sinh de su dung DCTC cung khdng nim ngoai pham vi dd (ii) Do tudi ciia phu nQ cd anh hudng tdi sir thich hgp va kha nang chap nhan nhung bien phap tranh thai nhat dinh Cac nghien cuu cung cho thay ring DCTC thich hgp vdi phu nQ dung tudi va'da trai qua qua trinh sinh de DCTC dd'i vdi phu nu d lira tudi 40 trd len cd the sir dung lien tuc tai chd cho de'n man kinh Cdng tic truydn thdng vd cham sdc sue khde sinh sin va KHHGD cin tuyen truydn rting rai ndi dung den cac cap Doan Kim Th^ng 43 vg chong tudi sinh de (iii) Quan he ciia ngudi phu nu vdi chdng cung la mdt nhan td quyet djnh viec lua chgn bien phap tranh thai cu thd nao dd cho gia dinh hg Khao sal chi ring viec trao ddi thdng tin giua vg va chdng vd sir dung DCTC cdn rai han che Cin tang cudng kenh thdng tin dd cic cap vg chdng tudi sinh de sir dung BPTT cho cd hieu qua va tien dung nha't (iv) Cac thdng tin vd sir dung DCTC dugc phu nu khao sat tie'p nhan chil ye'u ttr cic can bd Dan sd xa/phudng va cic can bd Tram y te CO sd, vi gin vdi ngudi dan nhat Day li didu kien tdt dd cac cin bd dan sd cung nhu y te cd nhidu didu kien cai thien viec cung cap dich vu va nang cao chai lugng dich vu cham sdc cho cac khich hang ciia minh Ben canh viec tuyen truydn va cung cap dich vu, thi mdt hoat ddng rai cin thidt dd la tu van cho cac cap vg chdng tudi sinh de vd each sil dung cic bidn phap trinh thai dd phii hgp vdi mdi hoan cinh, dieu kien sue khde cila mdi ngu'di phu nu va cac cap vg chdng Di lam tdt dugc didu nay, cdng tic dao tao nang cao kien thuc cho cac can bd dan so cung nhu can bd y te can dugc trien khai va cd diu tu kinh phf thfch hgp (v) Su thuan lien cua bien phap tranh thai cung la nhan td quan trgng de ngudi sir dung dung lau dai bien phap dd Ddi mdt bien phiip khdng dugc mdt ngudi phu nu chap nhan don gian vi nd khdng thuan tien cho sinh hoat vg chdng ciia hg Do dd tang cudng truydn thdng vd bien phap la rai can thiet dc gia tang va tri sd ngudi sir dung (vi) Cudi ciing, cdng tac kiem tra giam sat kham sang Igc dd nam bat dugc tinh hinh sir dung cic bien phap tranh thai, dd cd bien phap DCTC can dugc lam thudng xuyen theo quy, nam dd cd nhung can thiep giiip dd kip thdi ddi vdi ngudi sir dung Didu cung cd nghia la bao dam cho chuang trinh Kl IIIGD dugc thuc hien tdt va nang cao chat lugng cudc sdn" cho ngudi dan.B Chil thich '" Dung cu ui cung (vong tranh thai) thuang dugc ggi la vong vl trirdc day no co hinh vong Iron hay hinh hanh xe Nd co tac dung khong cho trirng da ihu tinh liim td Hieu qua iranh thu thai dat 95-97% Day la bien phap tranh thai phu hgp vdi nhung phu nil da cd mot hoac da cd dii sd mong mudn Dung cu tir cung khdng phdng tranh dugc benh lay truydn qua dudng tinh due va HlV/AlDS  ... biet dgc, viet chiem ty le thap 0,2% 34 Nghien cuu Gia dinh va Gidi Quyen , so 1, tr 31-43 Tinh trgng hdn nhdn Trong sd 1.400 phu nu tham gia tra ldi phdng van, 99,5% hien dang cd chdng; 0,5%... vi lien lai sinh hoat 'g chdng Khoang thdi gian ngu'di phu nu dugc hdi da sii dung bien phap DCTC cung cho thay nhung mi'rc khac giua cac nhdm phu nQ Trong sd 1.400 phu nu dugc hdi thi ngudi da... cung nhu su tham gia vao qui trinh sinh de ciia hg Vi vay, tudi ciia phu nu' cd anh hudng tdi su thfch nghi va nang chap nhan sii dung BPTT nhai dinh nao dd Nhdm phu nu ludi 25-34 dang tham gia