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

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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:
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 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 6 villages studied of 3 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 3 studied districts are lower than before the intervention; knowledge,
attitude and practice of the FSS subjects obvious changes.

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

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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 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 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 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


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investigate is 194 x 6 = 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 8
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; 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 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).


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2.2.3.3. The index evaluated the effectiveness of interventions
The effectiveness for the SRB of studied province and 3 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 6 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 3
RESEARCH RESULTS
3.1. Status, the factors affecting GIB in Bac Giang
3.1.1. SRB of Bac Giang province, period: 2007 - 2011


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- 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

<25
n

Male

SRB

241

25 - 34
n
508

Female 218 110,5 442

35 - 44

SRB
114,9

Total

n

SRB

287

>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 <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)
Sex

Secondary school
or lower
n

Male

561

Female

482

SRB

116,4

High school
or higher

Total

n

SRB

n

537

121,8

1098

441

923

SRB
119,0

Total
1043
978
2021

SRB of the mother's education level is secondary school or lower:
116.4; high school or higher: 121.8. overall SRB is 119.0.
- 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.


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- The number of son, daughter and sex birth order.
Table 3.5.The number of son, daughter under sex birth order (n=1,164)
Luc Nam
Lang Giang
Sex birth
order/sex
n
%
n
%
The first child
Son
211 54,7
203
53,2
Daughter 176 45,3
184
46.8
The second child

Son
104 55,9
121
53,1
Daughter 82
44,1
107
46,9
The third child
Son
42
71,2
54
71,0
Daughter 18
28,9
22
29,0
The first birth: SRB is 110.9; Second:

Viet Yen
n
%

n

Total
%

198

192

51,3
48,7

612
552

52,5
47,5

119
116

50,6
49,4

344
305

53,0
47,0

46
64,0
142
68,3
26
36,0
66

31,7
112.8; Third+: 215.1; Overall:

119.0; third+ birth rate is 10.3%.
3.1.2.2. Knowledge, attitudes and practices of FSS
- Knowledge of the subject of FSS

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)


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Luc Nam
Lang Giang Viet Yen
Total
n
%
n
%
n
%
n
%
Ultrasound, abortion
83
21,4

27
7,0
27 6,9 137 11,8
As of date
48
12,4
32
8,3
18 4,6
98
8,4
Empirical
53
13,7
9
2,3
16 4,1
78
6,7
Horoscope, immolate
7
1,8
9
2,3
5
1,3
21
1,8
Diet
43

11,1
46
1,9
15 3,8 104
8,9
Other
44
11,4
24
6,2
12 3,1
80
6,9
The objects know many ways to FSS, in which most are ultrasound for
Measures

sex selection abortions (11.8%).
Table 3.7. Understanding the affect of FSS and the prohibited
behaviors (n = 1,164)
Affect /Behavior

Luc Nam
n
%

Lang Giang Viet Yen
n
%
n
%

Total
n
%

Affects of FSS
No affect
62 16,0 62 16,0 23 5,9
Male excess, Female
88,
deficiences
315 81,4 313 80,9 345
5
Men difficult to get
77,
married
217 56,1 159 41,1 302
4
Others
1
0,3
1
0,3
4
1,0
The behaviors of fetal sex selection are prohibited by law
FSS propaganda
174 45,0 168 43,4 231 59,2
Notice FSS
232 59,9 221 57,1 284 72,8

Sex selection abortions
257 66,4 189 48,8 299 76,7
Do not know
51 13,2
67 17,3
22 5,6
12.6% of subjects said FSS does not affect society; 12.0%

147

12,6

973

83,6

678
6

58,2
0,5

573
737
745
140
do not

49,2
63,3

64,0
12,0
know

FSS behaviors prohibited by law.

+ Opinions of objects on reasons of FSS.
Table 3.9. Reasons for choosing FSS (n = 1,164)
Luc Nam Lang Giang
n
%
n
%
Pressure to be born son
There was pressure 205 53,0 50 12,9
No pressure
182 47,0 336 86,8
No answer
0
0
1
0,3
Reasons

Viet Yen
n
%
106
283
1

27,2
72,6
0,3

Total
n
%
361
801
2

31,0
68,8
0,2


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The reason for the behavior of fetal sex selection has been made
No penalty
306 79,1 250 64,6 317 81,3 873 75,0
Nobody reminder
99 25,6 92 23,8 60 15,4 251 21,6
Many support
services
314 81,1 199 51,4 302 77,4 815 70,0
Others
0
0,0

6
1,6
23
5,9
29
2,5
There are 31.0% answered there was pressure to be born son; there are
many 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)
Luc Nam Lang Giang Viet Yen
Total
n
%
n
%
n
%
n
%
Broadcasting
210 54,3 194 50,1 242 62,1 646 55,5
Newspapers, magazines 10
2,6
6
1,6
8
2,1 24 2,1
Posters, leaflets
23

5,9
12
3,1 32 8,2 67 5,8
Internet
4
1,0
0
0,0
0
0,0
4
0,3
Media group
77 19,9 147 38,0 56 14,4 280 24,1
Consult at home
59 15,2 28
7,2 42 10,8 129 11,1
Others
0
0,0
0
0,0
7
1,8
7
0,6
Type of effective media is not applied at local level: media group
Type of media

(24.1%); Consult at home (11.1%).

- 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)
Luc Nam Lang Giang
Viet Yen
n
%
n
%
n
%
There are intended
218 56,3 130 33,6 168 43,1
Expect son
109 50,0 85
65,4
88
3,4
Expect daughter
60 27,5 23
17,7
35
20,8
Not important
49 22,5 22
16,9
42
25,0
Not intended
160 41,3 254 65,6 221 56,7

No answer
9
2,3
3
0,8
1
0,3
There are 516 people (44.3%) intend to have more child;
Intended/ desired

Total
n
%
516 44,3
282 54,6
118 22,9
113 21,9
635 54,6
13
1,1
54.6% expect

son; 22.9% expect daughters (22.9%); 21.9% does not matter male or female.
- FSS practice of objects:


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+ Rate object has FSS in the last birth:

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

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


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- Condition know fetal sex before birth:

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:

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.


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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)

Lang Giang
Viet Yen
Total
Sex/ Reconigned Luc Nam
measure
n
%
n
%
n
%
n
%
Rate of object knows fetal sex before abortion
Not know
70
70,0
75
75,0
68
68,0 213 71,0
Know
29
29,0
25
25,0
28
28,0
82
27,4

No answer
1
1,0
0
0,0
5
4,0
5
1,6
Reconigned measure of fetal sex
Ultrasound
29 100,0 24
96,0
27
96,0
36
97,7
Prediction
0
0,0
1
4,0
1
4,0
2
2,3
There are 27.4% know fetal sex before abortion; in which 97.7% said by
ultrasound.

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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)
Lang Giang
Viet Yen
Pressure have Luc Nam
an abortion
n
%
n
%
n
%
Yes
65
65,0
62
62,0
58
58,0
No
35
35,0
37
37,0
32
32,0

No answer
0
0,0
1
1,0
0
0,0
There are 61.7% of subjects have the pressure to have

Total
n
%
185
61,7
114
38,0
1
0,3
an abortion in

order to be born son.
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
Sex
Male

Lang Giang
2.016

Female 1.745
Total

3.761

Luc Nam
2.209

115,5

1.814
4.023

Viet Yen
1.854

121,8

1.598
3.452

Scale of province
16.774

116,0

14.292
31.066

Graph 3:17. SRB before and after intervention

117,4


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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 %)
Table 3:25. Change knowledge about the influence of FSS
Before
(n=1.164)

Content

After
(n=400)

Compare (increase,
decrease)

12,6
8,3
- 4,3
83,6
91,8
+ 8,2
58,2
66,3
+ 8,1

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

No affect
Male excess, Female deficiences
Men difficult to get married

EI
34,1
9,8
13,9

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

Before
(n=1.164)

After
Compare
(n=400) (increase, decrease)

Yes

EI

44,3
48,8
- Have 1 children alive
83,5
88,7

- Having 2-3 children alive
16,5
11,3
- 5,2
31,5
No
54,6
51,3
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)
- 14,6

EI

Male
54,6
40,0
26,7
- Had son

9,3
3,6
- No son
45,4
36,4
9,0
19,8
Female
22,9
32,3
+ 9,4
41,0
- Had daughter
0,6
0,5
- No daughter
22,3
31,8
+ 9,5
42,6
Not important
21,9
27,7
+ 5,8
26,5
The number of the desired sex of the child in the next birth is son decrease.


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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, EI = 9.1%.


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Graph 3:20. Rate of the subjects knows fetal sex before birth
Rate of the subjects knows fetal sex before birth after intervention is
64.8%, 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
Unit: Percentage (%)
Before
(n=1.164)

After
(n=400)

Compare
(increase, decrease)

EI

The first

110,9

109,6

-1,3

1,2

The second

112,8

108,4

-4,4

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 EI=21.6% .
3.2.3. Efficiency at research areas across objects having abortion


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- Efficiency for service providers:

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

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 after
intervention was 41.4%, down by 20.3% compared to the pre-intervention,
EI=32.9%.
- Efficiency for the performance of abortions to FSS:


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Graph 3:24. Efficiency for sex selection abortion

Rate of subjects have abortion because fetus is a girl after intervention
by 4.0%, down by 6.7% compared to pre-intervention, EI=62.6%.
Chapter 4
DISCUSS
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 age is higher sex ratio of child.
- Education of subjects: Sex ratio of child have high school or higher
group (121.8) is higher than secondary school or lower group(116.4);
- The number of sons and daughters of the object and the sex ratio at
birth belong to birth order

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Overall sex ratio for all births of the studied subjects (119.0) is high and
equivalent results the scale of the province, in accord with general SRB result,
SRB 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 SRB.
+ FSS measures has best known as ultrasound, abortion (11.8%), less
others; This result shows that in order to restrict FSS, should focus more
closely control the service provider of ultrasound, abortion.
+ Remaining 12.6% of subjects said FSS not affect to society, 12.0% do
not know FSS behaviors are prohibited by law; these subjects will directly or
advocacy others to join FSS; This result shows that the task of propaganda is
very hard.
+ In the opinion of the subjects on FSS reasons: 31.0% of the subjects
have pressured to be born son, expressed preference for sons has been very
heavy, while in rural areas 21.4 %, urban 9.6%; this is a major obstacle to the
propaganda by Bac Giang, over 90% of the population live in rural areas.
In the opinion of the subjects, the monitoring of implementation of the
law of the authorities is limited, besides the FSS support services are
available, so the FSS behavior still real performed.
+ To restrict FSS: In addition to the common forms of media that the
subjects had access (64.3%), to enhance the media group, club activities
(24.1%), direct consult in households (111.1%).
- The FSS attitude of the subjects: Among 44.3% of subjects had

intended to have more babies, 13.5% had 2 children but still want more


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children, results matter alert recommended increasing birth rate 3 times or
more, the risk births would cause SRB LCGTTN rising; Results 54.6% of
subjects desired sex of the next child is a boy, showed preference for sons is
very strong in the community.
- FSS practice of subjects: In the last birth, there are 18.0% of subjects
said have FSS, these showed that there is a high percentage of subjects for
FSS of their children.
8.7% of subjects said an abortion because the fetus is a girl; based on the
ratio of abortion of the whole province, every year more than 7,000 women
abortion, there are more than 600 girls demolished, leading to differences in
the number of boys and girls are born, makes SRB of Bac Giang province
increases.
4.1.2.3. The situation of FSS service provision
The study results showed that 74.7% said prenatal fetal sex, 70.3%
know fetal sex via ultrasound, so the use of ultrasound to diagnose fetal sex is
very popular;
4.1.2.4. Status of Abortion in Bac Giang province through the survey of
married women have an abortion from 8 weeks of age and older, 2012
- The ultrasound before abortion and abortion reason:
Rate knows fetal sex before abortions: 27.4%, 97.7% said that through
ultrasound, this shows abortion rates to quite high, because most of the
ultrasound facility only know fetal sex on third months of pregnancy; this also
shows the subjects know fetal sex from ultrasound services are very popular.
Among subjects had an abortion, 10.7% of subjects said the reason
abortion when the fetus is a girl, only 1.7% of subjects said abortion when the

fetus is a boy. This rate has contributed to rising SRB in geographical research
and confirmed the support of the service providers for the purpose of abortion
for gender reasons.


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- The pressure to have an 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, down 2.3 percentage points compared to the pre-intervention (119.7);
2014 continued to decrease (115.7); First 6 months iedof 2015 was 115.0.
SRB of 3 studied districts is reduced, suggesting that the synchronous
implementation of interventions have been effective in reducing the SRB.
4.2.2. Effective intervention at studied areas through survey research
couples gave birth during the period from May to the end of August 2013
- Efficiency changes FSS knowledge, attitudes, practices
+ FSS knowledge of subjects: proportion of subjects know the FSS
consequences is increased... These changes affect to FSS practice and show
significant effect of media.
+ FSS attitude of subjects: intended additional births in subjects with 23 children alive, desired to born son has decreased more, the notion of
children sex is not important and effective to increase markedly, shows that
attitudes to have a son was a shift.
+ FSS practice of subjects: proportion of FSS in last birth decreases
markedly: 8.8%, down 9.2% compared to pre-intervention (18.0%).
After intervention, the FSS changes in knowledge, attitudes of the

subjects have a positive impact on FSS practice, reduce SRB.
- Efficiency for the status of service provider
The rate of subjects know fetal sex before birth also fall markedly,
especially in proportion to know fetal sex before birth through ultrasound,


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showing the status of fetal sex notification particular and conscious of FSS
service providers has made decisive moves.
Rate of the subbjects knows fetal sex through ultrasound also fall
63.9%, but still high, shows the control of service providers is not tight.
- Efficiency for SRB in the studied areas
The studied results showed: SRB of the 3 studied districts, overall SRB
of all births and each of births by birth order of the subjects in the studied
areas are reduced than before the intervention.
4.2.3. Effective intervention in the studied areas through survey research
married women have an abortion from 08 weeks of age or older, from May
through December 8/2013
- Rate knows fetal sex before abortion is reduced, showed that a clear
change of the service providers on FSS in consciously abide by the law.
- The ratio has been under pressure to have an abortion to a son fall,
contributing to reduce overall abortion rates, FSS abortion rates and SRB.
- The proportion of abortion because fetus is a girl after intervention :
4.0%, down 6.7% compared to the pre-intervention, shows that the impact of
the interventions has influence positive, step by step, 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
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:


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+ 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 many sex
selection methods: Ultrasound, abortion (11.8%), doctor's advice (9.9%); said
law prohibiting fetal sex notices (63.3%), abort the fetus because sex (64.0%);
said FSS has no effect (12.6%); the pressure to have a son (31.0%). Attitude:
16.5% had 2-3 children still intend to have more babies, 58.8% want a son to
family lineage. Practice: 18.0% subjects has FSS in last birth; 8.7% said
abortion when the fetus is a girl.
+ Easily access to FSS support services, knowing of prenatal fetal sex
(74.7%), said fetal sex by ultrasound (70.3%), said fetal sex before abortion
(27.4%), abortion when the fetus is a girl (10.7%), there is pressure to have an
abortion to a son (61.7%).
2. The initial efficiency of some interventions reduces the rate of increased
SRB in Bac Giang province (2012 -2013)
- The interventions:
+ State management, tight control of service providers.
+ Media changes community comprehension about the preference for
sons; FSS behaviors of childbirth preparation or without sons or 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 were reduced.
+ Knowledge of subjects markedly improves: The rate aware of the
consequences of GIB increased (rate said FSS does not affect decreased by


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4.3%, EI=34.1%); Know the behavior related to FSS is prohibited by law (rate
of subjects said laws prohibit fetal sex notification increased by 15.0%,
EI=23.7%).
+ Attitude of subjects markedly improves: Subjects have 2-3 children
still intend to have more babies fell by 5.2% (EI=31.5); desired sex of next
child is boy fell by 14.6% (EI=26.7%).
+ Practice of subjects markedly improves: the rate of FSS in last birth is
decreased by 9.2%, EI=51.1% ; rate of abortions when fetus is a girl is down
by 6.7%, EI=62.6%.
+ The FSS service providers is controlled better: Rate of knowing fetal
sex through ultrasound decreased by 6.4%, EI=9.1%; rate of knowing prenatal
fetal sex fell by 9.2%, EI=12.4%; rate of knowing fetal sex before abortion fell
by 14.3%, EI=52.2%; pressured to have an abortion to a son fell by 20.3%,
EI=32.9%; 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 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./.