1 INTRODUCTION Gender imbalance at birth (GIB) have appeared since the beginning of the 80s 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-first century, which took place at a faster speed, increasingly widespreaded and has reached a critical level Bac Giang is one of 10 provinces having the sex ratio at birth (SRB) high If this situation lasts for, there is no strong interference will cause consequences in many aspects of economic and social development of Bac Giang province in particular and the country in general Stemming from the above reasons, we performed the theme: "The status, the factors that influence gender imbalance at birth in Bac Giang province and some effective interventions" (2012 - 2013) with the following objectives: Describe the status and a number of factors influence gender imbalance at birth in Bac Giang province (2007-2012); Evaluate initially the effectiveness of some interventions to reduce the increase of gender 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 and practice of fetal sex selection (FSS); the situation of service providers After 19 months, implemented a number of interventions in the province and in villages studied of districts: Issued directive PPC, Planning and implementing the Directive, the media and interventions applying for service providers As a result, SRB is 117.4 in the province, down 2.3 percentage points; SRB of studied districts are lower than before the intervention; knowledge, attitude and practice of the FSS subjects obvious changes 2 The layout of the thesis consists of 145 pages: Introduction: pages; Chapter Overview: 35 pages; Chapter Objects and research methods: 22 pages; Chapter Results: 40 pages; Chapter Discussion: 43 pages; Conclusion: pages; Petition page; 31 tables; 28 charts; pictures; Appendix; 123 references (108 Vietnamese and 15 English documents) Chapter 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 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 population officer, 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 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 intervention studies (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, follows the formula, calculate the number of samples in each village and town to investigate is 194 x = 1.164 (couple), reality has collected 1.164 satisfactory questionaires (Luc Nam 387; Lang Giang 387; Viet Yen 390) + Select the entire sample of 319 married women performing abortion from weeks of age or older, the actual interview was 300 (per district 100); 108 owners provide reproductive health services, interviewed 100 (Luc Nam 33, Lang Giang 34; Viet Yen 33); each village have 10 in-depth interviews = 60; seminars in three districts, in 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 management measures (issues a directive of the PPC; plans, seminars); media; interventions for service providers (interdisciplinary inspection, testing and disseminating regulations and organizations signed not SSB) - Intervention in the research area: Seminar, group communication, direct communication consulting at home, praising represented women, building team; training; common provisions; flyers, pictures, posters ; Posting propaganda; provide information; 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 fully investigate, 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 actual interview is 99 (per district 33); 107 owners provide reproductive health services, actual collect 101 questionaires (Luc Nam 34; Lang Giang 33; Viet Yen 34) 5 2.2.3.3 The index evaluated the effectiveness of interventions The effectiveness for the SRB of studied province and district; effectiveness change knowledge, attitudes, practices of SSB; the provision of services; choice service 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 form, investigating the couple, owners of ultrasound, owners of abortion service provider, married women perform abortions from 08 weeks 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 no control group, did not perform on the same subject; short intervention period (19 months) Chapter 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 to 106.0); 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) Age group Sex 44 n 62 238 120,5 25 SRB 248,0 n SRB 1.098 119,0 923 Total 459 950 525 87 2.021 SRB under the birth mother's age [...]... 4.1 The status of GIB in Bac Giang province and affecting factors 4.1.1 The sex ratio at birth of Bac Giang province, from 1999-2011 SRB of Bac Giang provinve appears later (2004), most markedly since 2006, rapid increases; SRB increases at all births by birth order 4.1.2 Several factors influence GIB in Bac Giang province 4.1.2.1 Characteristics of the studied subjects - Birth mother’s age: Higher maternal... educated or economically better subjects; communication, consultation no fetal sex selection integrate the operations of the "Club of women not 3rd child," focus group media, direct communication consulting at home - The effectiveness of intervention: + The SRB in the province and the 3 studied districts in 2013 were lower than in 2011 (down 2.3 percentage points) The SRB in the births and 3+ birth rate... beginning to recognize, later to the subject's attitude toward fetal sex abortion and ultimately alters the FSS practice of subjects CONCLUSIONS Through research results, we draw some conclusions: 1 Status and some factors affecting GIB in Bac Giang province (2007-2012) - Status of SRB: Imbalanced SRB has appeared since 2004; SRB increased markedly since 2006, then increased continuously and fluctuated... health; replicate and maintain this kind of group communication activities, club activities, media, consulting directly at households and advocating people does not participate fetal sex selection 3 Need for further studies to evaluate the influence of the religious factor, the economic condition of the subjects to the sex ratio at birth and unshakeable effectiveness of the interventions. / ... 3,9 The third+ 221,9 166,7 -55,2 24,9 The births 119,0 112,8 - 6,2 5,2 Births 3+ birth rate 10,2% 8,0% -2,2% 21,6 The third+ birth rate, the number of boys / girls of all children born by birth order and of all births after intervention are lower than before intervention, EI from 1.2 to 24.9 %; especially the third+ birth, the sex ratio decreased 55.2%, EI=24.9%; the third birth rate falls by 2.2% and. .. markedly since 2006, then increased continuously and fluctuated around 120.0 level; rising from the first birth, continuing to rise in the second and suddenly increasing in births 3 or more - Several factors influence GIB: 23 + Age birth, maternal educational level, paternal residence habits, children carry father’s name and inheritance habits for boys + Knowledge of object: know FSS measures (28.0%); know... 26,5 The number of the desired sex of the child in the next birth is son decrease 15 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 Graph 3:19 Rate knows fetal sex by ultrasound Rate of the subjects knows fetal sex after intervention by ultrasound 63.9%, is down by 6.4% compared to pre-intervention,... rate of ultrasound in state medical facilities increased by 12.8%, EI=62.4% PETITION 1 Increase investment in resources, synchronous implementation, drastic and widespread interventions reduce GIB in the country, with the participation and commitment of the politic system 2 Perform well managements of the state of health; strict control of the facility providing care reproductive health; replicate and. .. by birth order of Bac Giang province 2009-2011 and affirm that FSS relates with son, daughter by birth order 4.1.2.2 Knowledge, attitudes and practices of fetal sex selection - FSS knowledge of the subject: + There are 29.0% of subjects said FSS measures; these subjects will look to the support services are available locally to FSS, increases the rate of abortion, knowing the fetal sex before birth and. .. abortion to a son: There are 61.7% of subjects answered there was pressure from the family about having an abortion to a son, this shows there are many subjects to be under pressure before deciding to FSS abortion at will 4.2 Efectivenes Evaluation of Some Intervention 4.2.1 Effective interventions on the scale of the province SRB effective for all provinces and 3 syudied districts: Provincial SRB is 117.4,