Thực hành chăm sóc bà mẹ mang thai và trẻ em dân tộc thiểu số dưới 2 tuổi

36

Xa hgi hgc. so 2 (138), 2017

THirC H A N H CHAM SOC BA ME MANG THAI VA
TRE EM DAN T O C THIEU SO D I T O I 2 TUOI
NGUY£NH6NGTHAI'
Tdm tdt: Cdi thi$n qud trinh chdm sdc, nudi duong, bdo ve bd me mang thai vd tre
em dudi 2 tudi cd y nghia rdt quan trgng trong chiin luac phdt triin ngudn nhdn luc ddn
tdc thiiu sd, mdt trong nhiing uu tiin hdng ddu cua Chinh phii trong chuong trinh quoc
gia vi gidm ngheo bin vOng giai doan 2011-2020. Bdi viit phdn tich sd li4u cua du dn
nghien cuu 203 bd m? thugc 12 ddn tgc thiiu sd tgi 4 tinh dang nudi 330 tre dudi 5 tuoi
nam 2015. Cdc phdn tich cung cdp mgt s6 bdng chung vi dnh hudng cua ddi ngheg, kho
khdn trong tiip can cdc dfch v^ xa hgi ca bdn, phong tiic tap qudn lac hau vd khdc biet
gidi din vi^c chdm sdc nudi dudng tre em ddn tdc thieu sd giai doan ddu ddi tir 0 den 2
tudi, vd tit do dua ra mdt sd khuyin nghj, chinh sdch ho tra vd md hinh can thi?p nhdm
ndng cao sice khoe thi chdt va tinh thdn cua nhdm tre ddn tdc thieu sd nay.
Tit khda: tre em, sinh dd, ddn tde thilu sd, cham sdc sdc khde.

1. Gidi thif u
Giam ngheo, phat trien ben viing vung dan tdc mien nui, thu hpp khoang cdch gifia
cac nhdm dan tOc va dgc bipt la phat trien ngudn nhdn lyc dan tOc thieu sd (DTTS) la mpt
trong nhung uu tien hanh dau eua Chinh phu trong ede chuong trinh nghi sy quoc gia vS
djnh hudng gidm nghdo bin vung giai dogn 2011 -2020 (Chinh phd, 2011). Trong nhung
nam qua, Vipt Nam da cd nhieu ehinh sach, chuong trinh hS trg phat trien eho cdc eOng
ddng DTTS vd dd thu dugc nhfing thdnh tyu nhdt dinh. Ngudn nhdn lye cd vai trd ddc bi?t
quan trpng trong mpi chien luge phdt trien xa hOi. Yeu td con ngudi la ngudn lyc nOi sinh
cd y nghia quyet dinh trong tien trinh giam ngheo vd phat triln bin vung. Chinh phu va
Uy ban Ddn tOc nhdn thdc rd chdt lupng cham sdc tre em dudi 5 tudi cd vai trd quan trpng
trong phdt trien ngudn nhan lue DTTS.
Tuy nhien cho din nay, 54 dan tde thieu sd d Vipt Nam van chu ylu sdng d vimg cfi

dilu kien kinh t l xa hOi khd khdn va thudng bi tyt hdu ve nhilu chi tieu phat triln kinh tl
xd hOi so vdi mdt bdng chung todn qude. Ndm 2014 ed nude cd gdn 6% hp ngheo, trong
dd 46,6% la hO dan toe thilu sd (Bp Lao dOng, Thuang Binh va Xd hOi, 2015). Tre em
DTTS thudng gap nhilu khd khdn tid nggi tiong nudi dudng va ehdm sdc sdc khde. Cir 5
tre em DTTS sdng d vimg dde biet khd khan cd 4 em dang ehiu thipt thoi ve tiep can voi
Vi4n Xd hgi hgc, Vign Hdn ldm Khoa hgc xd hgi Vift Nam.


eac dich vy xa hOi ca ban nhu cham sdc y t l , dinh dudng, gido dye, nude sgch va vO
sinh, chd d va bao trg xd hOi (UBDT, IRC, UNICEF, 2015). Tinh trang suy dinh
duong the cdi cge d tre em DTTS cdn kha cao, tren 40% d cae tinh Lao Cai, Kon
Tum, va tren 50% d cac nhom ddn tOc thilu sd ngudi Mdng, Ba Na va Gia Rai
(UNDP, 2013). Theo kit qud Tdng dilu tra dan sd va nha d ndm 2009 tiii mdc chit trd
em d cae dan tOc thieu sd tuy cd gidm, nhung van cdn cao. Cy thi, ty sudt td vong tre
em dudi 5 tudi cda cac dan tgc Mudng, Tay, Thai, Mdng idn lugt Id 34, 36, 41 va 72
phan nghin, so vdi 19 phdn nghin d dan tOc Kinh (Tdng cue Thdng ke, 2011: 45). Do
dd, viee phdn tich tim hilu thyc trgng va nguyen nhan nhdm tilp tuc no luc nang cao
sue khde ba me, tre em DTTS la rat can thilt.
Bai vilt nay sd dyng dfi lipu td dy an nghien edu do Uy ban Dan tgc thue hien vao
nam 2015 tgi 4 tinh Ha Giang, Gia Lai, Ninh Thuan, Sdc Trdng' nhdm phan tich mOt sd
vdn dl ehinh trong vipc chdm sdc nudi duong ba mp khi mang thai va tre cm dudi 2 tuoi d
mdt sd cdng ddng ddn tOc thilu sd. Ve mdu khao sat, tai moi tinh kl tren lya chpn 1
huyen vd td moi huypn chpn 2 xa cd nhieu nhdm DTTS sinh sdng. Trong mdi xa se lya
ehpn ngau nhien 2 thdn/ban dl khao sat. Nhu vliy tdng cOng cd 16 thdn ban cua 8 xa tiong
4 tinh dugc ehpn vao mau nghien edu. Cdc xd dugc chpn vao mau deu cd nhieu tOc ngudi
cung sinh sdng va la xa d ^ biOt khd khdn hodc cd cac thdn/bdn ddc bipt khd khdn. Td 16
thdn/ban nay, nhdm nghien cihi dd len danh sach va lya chgn ngdu nhien 203 ba mp
DTTS dang nudi cdc con dudi 5 tuoi dl tham gia trd ldi bdng hdi dinh lugng, trong dd dd
thu thap thdng tin lien quan din cham sdc sdc khde 330 tie (cd 166 tre nam vd 164 tie nu)
dudi 5 tudi (trong dd cd thdng tin vl vice cham sdc khi tre dudi 2 tudi). Mau khao sat ed

12 DTTS, bao gdm 5 dan tOc Mdng, Dao, Tay Nting, La Chi va Cd Lao d tinh Ha Giang;
2 ddn tpc Ba Na vd Gia Rai d tinh Gia Lai; 2 dan tde Chdm va Raglay d tinh Ninh Thi4n;
2 ddn tdc Khmer vd Hoa d tinh Sdc Trang. Ben cgnh khao sat dinh lugng, dy an cdn tidn
hdnh tai dia ban nghidn euu nhilu phdng van sau va phdng vdn nhdm t|;p trung ve chu dl
nghien edu.
2. Cham sdc su-c khde b^ m$ dan tpc thiiu so khi mang thai
Hipn nay, tgi vdng DTTS va miin nui vipc chdm sdc thai vd ba mp mang thai
van ehiu anh hudng kha nhilu cda vdn hda phong tuc tap quan. Tinh trang tao hdn
tuy dd giam song van edn tuong ddi phd bien, dde bipt trong eac dan tOc sdng tgi
vung nui cao nhu Mdng, Dao, Ba Na. Tdo hdn dnh hudng xdu den sdc khde ba mp,
thai nhi do mang thai sdm cae bd mp chua phat triln day du v l the ehat, chua cd
dugc nhfing kiln thuc, k^ ndng v l chdm soc thai nhi vd trd nhd. Cdng tac k l hoach
hda gia dinh trong cdc DTTS da cd nhilu thdnh tich dang k l , nhung de nhilu con,
khoang each sinh eon ngdn van edn kha phd biln, dnh hudng xau tdi sdc khde eua
thai phy.

' Dy in "NhOng ylu to kinh tl, vin hda vi xi hOi inh hudng tdi diyc hinh bio vf vd chim sdc trfi em tu 0
din 5 tuoi ciia dong bio DTTS vi dl xudt nhOng giii phip, chinh sich h5 trg hoic md hhih can thif p phii
hpp vdi van hda din tOc t ^ dilu kifn cii thi|n chim sdc tre tho cua cic DTTS" do UNICEF tii trgr.


38

Thuc hdnh cham soc Da m? mang tnai va ire em...
Tinh trgng phi^ nu Ba Na, Gia Rai de ddy, de nhiiu Id phd biin, ldm cho tre em
thiiu dn, ty 1$ suy dinh dudng cao. Nguyin nhdn chinh la chi 28% cap va chdng dp
dung cdc bi$n phdp trdnh thai. Ddi vdi cdc bd me nhiiu tuoi, so con ciia hg phd
biin Id 6-7 con.

(PVS, nfi, 32 tudi, ngudi Kmh, hgc vdn eao ddng, ehuyen trdch dan so ^)

Cd tdi 70% phy nfi DTTS khdng dn gi them ngoai bfia com chung vdi gia dinh
tiong suit thdi gian mang thai. Ty le ndy rat eao tgi Gia Lai vdi 87% va Ha Giang voi
83%. Ty Ip phu nfi DTTS cd dn them hang ngay trong thdi gian mang thai chi Id 14%
song cd each biet rdt Idn giua eae vimg/cdc ddn tOe. Phy nfi Khmer d Sdc Trdng cd t^ le
bdi dudng hang ngdy trong thdi ky mang thai la 34% gdp 30 Idn so vdi phu nfi Ba Na/Gia
Rai d Gia Lai chi vdi ty 10 1% (xem them Bang 1).
Bing 1. T^ l | bi mf c6 i n them ngoii bO^ ctrm gia dinh khi mang thai
0071 vj: %
m Giang
(A/ong. Dao,
TayNmg, La
Chi, CdLao)
82,5

Gia Lai
{BaNa,
Gia Rai)

Ninh Thuan
{Cham,
Raglay)

Sdc Trang
{Khmer,
Hoa)

Chimg

86,7

58,1

51,4

70,3

Thinh thoang (thdng 1 l^n)

5,0

12,2

20,9

4,1

10,9

Thudng xuySn (tuSn 1 lin)

2,5

0,0

7,0

10,8

4,8

H ^ g ng&y

S,8

1,1

14,0

33,8

13,6

Khdng nhd

1.2
80

0,0

0,0

0,0

0,3

90

86

74

330

Khdng an th€m gl

N
Ngudn- Khdo sdi cua du dn tgi 4 linh, 2015.

Tap qudn udng rugu, hiit thudc la cua ddng bao DTTS d Gia Lai hay dn kieng
qua mue la nhfing phong tye ed hgi din sdc khde ba me mang thai va tre so sinh. Quan
niem phai lam viec nhilu eho de de, hay thdi quen khdng gidm lam cac vipc lao dong
san xuat ndng nhge trong thdi k^' mang thai cd thi tdc dOng khdng tot tdi sdc khde ba
me vd thai nhi.
Phu nu Mdng khi chua khdng nghi ddu, nd ldm din khi de thi thdi. Cd dira de ngoai
nuang. Niu nhu vgy thi chdng khdc dd cho va. Ngudi gid cdn bdo ldm cdc vi$c cho
de de. Chiia vdn lam cdc cdng vi?c binh thudng khdng kieng vi$c ndng ddu.
(TLN nam, 62 tudi, ngudi Mdng, hgc vdn 1, Gia lang)
Kit qud khdo sat cho thdy, 46% phu nfi van di ldm binh thudng khi mang thai. T^ 1§
ndy tai Gia Lai la 82%. Ngugc lgi, eo 38% ba me giam lam vipc ndng ho^c nghi ngai khi
mang thai, chu ylu tap tiimg d cdc DTTS d Nam BO nhu Khmer (61%), Chdm va Raglay
(52%). Tuy nhien, khi mang thai phu nfi dd ed y tilde tranh ldm cae edng viee dOc hgi nhu
phun thudc trfi sau, thude bao vp thyc v|it.
Cdng tdc y tl dy phdng tiong tiidi gian mang tiiai dd cd kit qud khd tit. Ty Ip phy
nfi kham tiiai dinh k^ va tiem ehung day du khi mang tiiai la 77%, cao nhdt la trong mlu


d Sdc Trang (96%) noi chu ylu la ba mp ngudi Khmer, tilp din Id d Ninh Thudn (88%),
Ha Giang (86%) vatiidpnhdt la tai Gia Lai (43%).
Thuc hien khdm thai dinh ky vd tidm ehiing ddy dd da gdp phan gidm ty 1? chit sinh
cda ca me va eon, gidm cae tai biln san khoa gdp phdn ddm bdo sdc khde cho ca mp va

con. Nhu vdy, ty le bd me kham thai, tiem chiing ddy dd toan mau nghien edu gan dat
dupe so vdi Chuong trinh mue tieu y tl qude gia "Din 2015 t^ 18 phu nfi dugc khdm thai
it nhdt 3 lan vao 3 thai ky dat 80%" vd cao hon kha nhilu so vdi kit qua ciia dy an "Chdm
sdc sdckhodsinhsan va cai thidntinhtiBngdinh dudng trd em 2013" vdi ehi 58% bdmp dugc
khdmtiiaidu 3 idntiongthai ky (Uy ban Dan tOe va BO Y tl, 2013).
Cac thong tin dinh tinh efing eho thay, chudn myc gia tri ciia con trai hay con gai it
anh hudng tdi quyet dinh mang thai va cham sdc thai. Cdng ding khdng ed nghi le gi dae
biet de cau sinh dugc con trai hay con gai, khdng ed cae nghi le hay thu thuat lya chgn
gidi tinh thai nhi. Do khdng hi qua nhieu sdc ep ve sd eon (ehi bi phat tiln nhung khdng
nop efing khd thu), nen neu ed nhu eau con trai hay eon gdi cd the hp se de din khi dugc
thi thdi.
3. Noi sinh de
Lua ehpn noi sinh vd ngudi dd dd da cd sy khac biOt khd Idn gifia cdc vdng miin va
gifia eac dan tgc. Trong mau khdo sat, ba mp DTTS d vung nui cao tai Ha Giang, Gia Lai
thudng lya chgn de tai nhd do ngudi nha hay ba mu dd, trong khi dd phy nfi DTTS d Sdc
Trdng vd d Ninh Thuan thudng lya chgn sinh de tai tram y tl xd hay benh vien huydn,
tinh. Dieu nay ham y ve chien luge van dOng tuyen truyen giam sinh de tai nha la mOt
thach thdc Idn ddi vdi edc DTTS sdng d mien ndi.
Do dilu kien dia ly ddc thu cua viing ddn tOc va mien mii, giao thdng khd khan,
eOng vdi thdi quen phong tyc tap quan, ty 1? de tgi nhd do ngudi nha hay ba my dd kha
cao tgi Gia Lai (85%) vd Ha Giang (47%) (Bdng 2). Mdc du ngudi nha/bd my (phdn Idn
khdng dugc dao tao) d& de song nhfing tai biln san khoa it xay ra. Dd la vi cac bd my
thudng cd tham nien hanh nghi tdi vai ehyc ndm vdi nhieu kinh nghiem.

Cdc bd dd rdt cd trdch nhi^m, cd khi true 1-2 ngdy khdng chgp mdt cimg sdn ph
dii cdc bd diu nhiiu tudi. Vdi kinh nghiem hdng chuc ndm hdnh nghi khi phdt hi
ca de kho hg di nghi gia dinh dua din benh vi?n.
(TLN phy nfi thdn, 52 tudi, hgc vdn Idp 9)
Tuy nhien, de tgi nhd van ham chda nhilu rdi do ban tgi cac co sd y tl vd cdn
ed nhihig giai phap giam thilu. Hon nfia, de tai nha cdn gay ra tinh trang lam gidy

ehdng sinh, giay khai sinh cham, ddn din nguy ca tre gdp nhilu khd khdn trong viOc
tilp can vdi cac djch vy xd hgi co ban sau nay. Giam thilu tinh trgng dd tgi nhd do
ngudi nha/ba my dd cdn Id nhipm vy cua cdc dia phuong de cd the dgt chi tieu "Ty
le phy nfi de do can bg dugc ddo tgo dd dat 96%" cua Chuong trinh Myc tidu y tl
Qude gia2012-2015.


40

Thitc hdnh cham sdc bd m? mang thai

vdtreem...

Bing 2. Noi sinh v i ngvdi Atk d£
Ban vf:%

Tgi nhi, do ngudi nhi, b i my do
T^i nhi, do y t^ thon bin dd
Tgi trgm y t l x3

H i Giang
(Mong. Dao. Toy,
Nitng, La Chi, Cd
Lao)
46,8
0,0
26,6

Tgi b^nh vi^n huyfn, tinh
N

Gia Lai
(BaNa,
Gia Rai)

Ninh
Thuin
(Chdm.
Raglay)

85,4

33,7

0,0

Sdc
Tring
(Khmer,
Hoa)

Chung

1,1
13,5

1,2
5,8

0,0

39,2

0,3
17,1

26,6

59,3

60,8

39,3

79

89

86

74

328

Ngudn: Khdo sal ciia du dn tgi 4 linh, 2015.

Ty Ip sinh d tiam y t l xa khd thdp (17%), thgm ehi chi 1% d Gia Lai. Trong khi do,
dd de Id mOt chdc ndng quan trpng ciia tiam y tl xd va hoan toan mien phi. Dilu nay dat
ra nhieu vdn de can gidi quyet cd ve tiang thiet bi, trinh dO chuydn mdn ciing nhu co chi
ldm vide cda y te tuyen xd. Vi dy, theo quy dinh, tram y t l xa chi ed mOt ngudi trye vao
budi tdi, nlu ngudi dd khdng du khd ndng dd de (dilu dudng vien, duge ta) thi vipc sinh

de ngoai gid hdnh chinh la mOt khd khan eho ba me tid dg vao ban dem md muon smh tai
tigm y te xa.
Ty le ba me lya chpn sinh con tgi bpnh vien huypn/tinh kha cao, 39%, nhdt la vdi
phu nfi Khmer, Chdm, Raglay (61% d Sdc Trdng). Ngodi 1^ do ha tdng va cac phuong
tien giao thdng dugc cdi thipn tgi Ninh Thuan vd Sdc Trdng, lya chpn nay cho thdy da c6
sy tiiay ddi trong nhgn thdc va thue hidn hanh vi sinh de khi nhilu gia finh va bd m?
mudn dda con ra ddi tiong dilu kidn tot nhat cd thi.
Kit qua efing cho thdy, khdng cd khac bipt Idn vl lya chgn noi sinh phdn tiieo gidi
tmh cua tie. Ty 1$ sinh de d nhd la 42% ti^ng sd ti-e nam va 45% trong so tre nfi. Ty 1?
sinh de d benh vien huypn/tinh Id 40% tiong so tie nam va 39% tiong sd tre nfi. Nhu V9.y
chua cd bdng chdng ve anh hudng cua gidi tinh thai nhi tdi su lya chpn nai smh tsortg
eOng dong DTTS.
4. Chdm soc sue khoe ba me vd tre em durdi 2 tuoi
4.1. Dinh dirdng cho tre em vd bd m^ nudi con
Ben cgnh nhfing dnh hudng eiia phong tyc tap quan, ehl dO dinh duong eho ba m?
DTTS nudi con cdn hi ehi phoi nhilu bdi dilu kipn kinh tl vd nhan thdc eua cpng ddng
tiong nudi dudng ti^ em. Cd tdi 68% ba mp hdu nhu khdng an gi tiiem ngodi bfia com
cung gia dinh tiong suit tiidi gian cho con bu. Ty Ip nay rdt cao d Gia Lai vdi 93%. Ha
Giang la 75%. Vdi bfia dn hdng ngay cdn chua du dinh dudng cho ngudi binh tiiudng,
ehua noi ddn nhu cau dinh dudng ciia ba m? nudi con, vipc tie bi suy dinh dudng la khd
tidnh. Nguge lai, t;^ Ip ba mp an them hang ngdy tiong thdi gian cho con bu cd khdc bi$t
Idn gifia cac tinh: Sdc Trang la 58%, tiong khi d Ninh Thu^n chi la 8% vd khdng ddng kl
d Gia Lai (Bang 3).


Nguyin Hong Thdi

41

Bing 3. Ty if bi m^ cd 9n thSm ngoii b&a 3n chung vdi gia dinh trong tbdi gian cho con bu

Dan vi:%
Chung

68,2

Sdc
Trang
(Khmer,
Hoa)
29,7

6,8

1,4

6,3

0,0

15,9

10,8

6,6

15,0

0,0

8,0

58,1

18,4

80

90

86

74

330

Ha Giang
{Mong, Dao, Taj/,
Nitng, La Chi, Co Lao)

Gia Lai
(BaNa,
Gia Rai)

Ninh Thuln
(ChUm,
Raglay).

Khong an thgm gl

75,0

93,3

Thinh thoang (thing/Ian)

10,0

6,7

Thudng xuyen (tuan/lan)

0,0

Hang ngay
N

68,1

Ngudn: Khdo sal cua du dn Igi 4 tinh, 2015.
Hau nhu khdng cd sy khde biet ve che dp dinh dudng eho ba me khi nudi con tiai
hay eon gdi. Ty Ip bd mp khdng an gi them ngodi bfia cam gia dhih hdu nhu khdng khdc
biet giua nudi eon tiai va nudi con gai. Ty le ba mp cd dn thdm hdng ngdy khi nudi eon
tiai la 20%, cao hon mOt chdt so vdi khi va nudi con gai (17%). Nhin chung, vile nudi
con trai hay nudi con gdi khdng cd dnh hudng tdi che dO dinh dudng eiia mp trong thdi
gian cho eon bu.
Cac ba me DTTS chd ylu nudi eon bdng sfia mp. Chi tiong trudng hgp khdng cd
sfia hay nhgn con nudi hp mdi nudi eon bang ngudn thdc dn ngoai sfia mp. Thdi gian eho
bu tuong ddi dai, 64% cdc bd me eho con bu tu 12 thdng trd Idn. Mdt sd noi tgi Gia Lai cd
thdi quen cho con bu tdi khi cd em. Trong mau khao sdt cd tre 4 tuoi van bu mp. Tap quan
tu nhien nudi con bdng siia me la phu hgp vdi kien thdc nudi eon hipn dgi. Tuy nhidn vipc

cho bu qua lau va tinh trgng khdu phdn dn cua cac bd mp khdng duge cai thien tiong thdi
k^ cho con bu dan din chdt lugng sfia mp khdng du dinh dudng.
Tre em DTTS duge eho dn thdm ngoai bu m? (dn ddm) kha sdm, 47% tre dn ddm
khi dugc tu 3-6 thdng. Dilu dang quan tdm la vipc cho trd "dn ddm" da sd theo kieu
tinyin thdng, ecrm gia dinh cd gi thi mp nha diit cho con. Cd 42% ba mp da cd y thdc ndu
chao cho con nhung ehi la chao gao, khdng bd sung thdm dinh dudng gi. Viee cho dn
them qua sdm vd dn cam nha khdng hgp ve sinh cd thi gay hau qua khdng tdt din sue
khde eua tre.
Tre con a day din 5-6 thdng Id dn com nhd rdi cd dua 1 thdng da cho dn cam nhd.
M? nd nhd rdi ddt cho nd dn. M? khdng dugc dn them gi ddu. An com ciing gia dinh
binh thudng. Di nuang thi mang ngd ndu (men men) di theo dn vdi nude sudi thdi.
Khdng cd gi dn thim ddu.
(TLN mp, 34 tiioi, ddn tOc Mdng, hpe vdn 2/12)
Cd khoang 1/3 (32%) ba mp mua cdc goi chao, bdt ddng sin vdi gid 2000 3000d/gdi v l pha vdi nude sdi rli eho con dn them ngodi bu mp. Du ehua dugc kilm dinh
chdt lugng, nhimg nhimg san pham ddng goi nhu the khd cd the bd sung dinh dudng
ngodi sfia mp cho tre.


42

Thuc hdnh chdm soc bd mg mang thai vdtreem...

Chi dp dinh dudng danh cho tie cdn phy fliuOc nhilu vao nhgn tiidc cda gia dmh,
eOng ddng va phong tyc tap qudn. D I dam bdo dinh dudng cho tie can phai tuydn tmyen
van dOng bd me, gia dmh vd cOng ddng thay ddi cd nhan thdc va thyc hanh.
Bd me gia dinh y thuc rdt kem vi chdm sdc dinh duang cho tre. Cdc budi thuc hdnh
ndu chao dinh duang dugc tiin hdnh dinh ky thudng xuyen, nhung ho khdng ldm.
Hg noi ban di ldm vi met khdng cd thdi gian. Khdng kiim dugc thtic dn di ndu
chdo dinh duang, mgc dii chung tdi da trinh dien bdng nhiing rau cd qud cua dia
phuong. Tdm cd cua dc hg cd thi kiim dugc du di ndu chdo dinh dudng cho tre.

Hg thich mua chdo ddng gdi han vi tiin han. Ga vit nhiiu hdi mua khdng bdn
nhimg a lgi chai hg sdn sdng thit di tiip khdch. Nhung bdo thit cho vg con dn cho
du dinh dudng thi khdng.
(TLN gido vien mdm non, nfi, ddn tde Nung, 32 tudi, hpc vdn Dgi hpc)
Cdng tac tuyen truyen tgp huan cho cdc bd mp ve thyc hdnh dinh dudng cho tre
dudi 2 tudi dd dugc thyc hipn song kit qud con han ehe. Sd lipu ciia dy an do Uy ban Ddn
tOc va Vien Dinh duong thue hien cho thdy "cd 59% cac bd mp cd tham gia day diieac
budi tiiuc hdnh dinh dudng va 24% tham gia khi khdng bdn". Tuy nhien, gifia viee co
tham gia tgp huan vd cd thyc hanh tiong thue t l vdn eon khoang each kha Idn. Vdi nhieu
ly do vipc thuc hanh nau chao dinh dudng eho tie dien ra khdng thudng xuyen tiong cOng
dong DTTS.
4,2. Yte dfjTphdng vd khdm chita b^nh
Cdng tdc y tl du phong, tiem chimg theo chuong trinh myc tieu qude gia cho tie
DTTS dudi 2 tudi dd dugc thuc hien kha tit, du ggp nhilu khd khdn do dia hinh phuc tgp,
eae thdn/ban d xa trung tdm va phong tyc tdp qudn cdn Igc hau. Tinh chung, 96% tie dudi
2 tuoi dugc tiem chdng day dd. Vdi 4% tie khdng dupe tiem ehdng day du vd ddng han
(tiem thieu mui nhdc lgi), hai ly do dupe dua ra nhilu nhdt la "khdng bilt !uc ndo va tiem
d ddu" (54%) va" bo mp di lam xa khdng dua eon di tidm duge" (31%). Hai 1^ do nay
ham y rdng, viec di lam nuong ray xa hay di cu di lam xa (Ninh Thudn, Sdc Trdng) la
nhihig ly do quan trgng nhdt anh hudng tdi ty 1? tie dugc tiem chung ddy du. Do vgy de
khdc phyc can ed nhung chinh sach tdng the phat triln kinh t l xa hOi tai dia phuong dl
dam bdo sinh ke cho cdc hd gia dinh. Kdt qua nghien cdu ghi nhgn khdng cd sy khac bi$t
gifia tie nam va nfi trong t>' le duge tiem chung ddy du. Tgi mgt sd vimg nui cao, viing
sdu, nhdn thdc cua cdc bd mp cdn thap cung cd dnh hudng tdi vipc tie dugc tiem chiing
ddy dd.
Cd hien tuong Id tiim miii ddu tre thudng biphdn ung nen s6t nh^. M? thdy v^y do
khdng hiiu, khdng tin vdo thudc nin cdc mui nhdc lgi Idn sau trdn khdng cho con di
tiim niia dnh hudng tdi hi^u qud cua tiem chung.
(PVS, nfi, y tl thdn ban, 38 tiidi, dan tOc Ba Na, hpc van 8/12)
Cdng tdc khdm chfia bOnh cho ti^ dudi 2 tuoi dd cd ehuyin biln khd tdt do chinh

sdch cdp BHYT mien phi cho tie dudi 6 tudi. Tinh chung, cd 82% trd khi bj dm dd sii


dung the BHYT kham chua benh tgi eac ea sd y tl eua nha nude nhu tram y tl xa, bOnh
vien cac tuyen. Trgm y tl xa Id noi ed ty 1$tiedin khdm chfia bdnh cao nhdt vdi 64%. Ty
Id chfia bdnh tai trgm y tl xa d mien nui cao ban so vdi viing thdp, cy the la 77% d Ha
Giang, 69% d Gia Lai, vd chi 46% d Ninh Thuan (Bang 4). LTutienlya chgn thd hai dh
khdm chfia bpnh cho tre la bpnh vien khu vuc, bpnh vipn huypn (18%). Song cdn su khdc
biet kha Idn gifia cdc vung miin ma nguydn nhdn ea bdn la do dieu kiOn dia ly va hg tdng
giao thdng. Ty le nay d mdu nghidn cdu Ninh Thugn la 35%, gdp 7 Idn d Hd Giang.

III

Bang 4. Noi khim chiis b^nh cho tre dirdi 2 tu5i Idii bj 6m

13,3

1,1

Sdc T i ^ g
(Khmer,
Hoa)
0,0

Thay ciing, thly mo

2,5

0,0

0,0

0,0

Y te thon bin

0,0

3,3

0,0

0,0

0,9

76,5

69,4

46,0

66,2

63,9

Benh vien khu virc, huyen

5,0

14,0

34,5

17,6

18,1

Phdng kham tu, nha thudc

1,2

0,0

19,5

16,2

9,1

N

79

90

87

73

329

Tv chila

Ha Giang
(Mong, Dao, Toy,
Niing, La Chi, CdLao)
15,0

TrtutlxixSi

Gia Lai
(BaNa,
Gia Rai)

Chung

0,6

7,6

Ngudn: Khdo sdt cua du dn lgi 4 linh, 2015.

Vdi cac benh thdng thudng, khoang 8% gia dhih vdn sd dyng cdc bdi thulc ddn gian
de chiia bpnh eho tie. Hipn tugng chfia bpnh bdng ciing bai hau nhu da duge logi bd song
ehua hoan toan triet dd.
Chiia benh bdng ciing Ii thi khdng cdn. nhung nhiiu gia dinh vdn kit hgp vua ch
tgi cdc trgm y ti viia cung tgi nhd. Tre dm thi ldm Ii cung niu khdng d& thi ma
din trgm. Ngudi bf b$nh ngng binh vi$n chua khdng khdi thi gia dinh vdn mdi th
den cung le.

(TLN cOng dong, nam, 46 tudi, ddn tOc Dao, trudng thdn)
Viec lya chgn ca sd khdm chfia bpnh cho tre nam va tie nfi co sy khac biOt nhung
khoang cdch rdt nhd nen khdng thi kit luan dd Id cd nhiing ddu hipu vl bdt binh ddng gidi
tiong lya chgn noi kham chfia bpnh cho tre dudi 2 tudi.
4.3, Bao vf vd chdm soc tre em dit&i 2 tuoi
Tai tdt ca cac dia phuong tham gia vao nghidn cdu, vipc thyc hanh bao v? chdm sdc
tre em dudi 2 tuli deu do gia dinh, cOng ddng dam nhiem. Khdng noi nao cd edc hinh
thue nhd trd cdng lap. Hai xd d Sdc Trdng la nai gdn do ed nhdm tre tu thyc song so tre
Khmer dudi 2 tudi dugc giri d do la khdng dang kl.
Thdi gian nghi khdng tham gia lao ddng sdn xuat sau khi sinh dl chdm sdc eon
nhd cd su khac biet kha ro rang cua cdc bd mp DTTS d vdng nui cao va d vung thdp
hon. Tgi Hd Giang vd Gia Lai ed tdi 69% ba mp di lam nuang rdy xa trong vong 3


44

Thuc hanh chdm soc bd mg mang thai vd tre em..

thang sau sinh, ty le nay tai Ninh T h u ^ , Sdc Trdng chi bdng 1/25 vdi khodng 2,5%.
Ngugc lgi, cd tdi 68% ba mp Khmer nghi ban 9 thang khdng tham gia vdo hogt dOng
san xudt sau khi sinh con. Vd t j len ndy rat thdp d Hd Giang vdi 2,6% va Gia Lai vdi
8% (Bang 5).
Bang 5. Ty 1$ b i mf b i t Ska tham gia lao d$ng sin xuit theo sd t h i n g sau sinh
Nmh Thugn
(Chdm,
Raglay)

Sdc Tring
(Khmer,
Hod^

Don vj: %
Chung

H i Giang
(Mdng, Dao, Tdy,
Niinz La Chi, C& Lao)

Gia Lai
(BaNa,
Gia Rai)

Dudi 3 thing

69,2

68,2

2,4

2,7

36,4

Tir 3-6 thing

24,4

12,5

25,9

11,0

18,5

Til 6-9 thing

3,8

11,4

37,6

16,4

17,6

dang nghi chua di lim

2,6

8,0

32,9

68,5

26,8

Khdng nhd/khdng hik

0,0

0,0

1,2

1,4

0,6

N

78

88

85

73

324

TrSn 9 thing,

Nguon: Khdo sdt cua du dn lgi 4 tinh, 2015.

Cdc bd me vung ndi cao phdi di ldm nuang ray xa khi mdi smh dupe td 3-6 thang
thi khd bao dam viee bdo vp va cham sdc eon. Ty Ip phdi mang con Idn nuong ray khd cao

d Gia Lai (89%) va d Ha Giang eiing nhu Ninh Thudn (45%). Vdi lya chpn nay, cd tdi
88% tie da tung bi muoi, cdn triing dOc dot vd 60% cdm do ndng mua. Mdt khac, vipc dl
con d nhd cho anh chi hay dng ba tidng khi bd mp di lam rdt phd bien d Sdc Trang (93%),
va tiep den la Ninh Thuan (53%). Do thilu vdng bd mp trdng nom cac tai ngn thuang tich
hay xdy ra nhdt vdi tie thdi ky nay la: edn triing, mu5i ddt chd cdn (35%), nga tren cao
xudng (12%) vd bdng Ida, nude sdi (8%).
Nhu vgy, trong giai doan trd dudi 2 tudi du dugc bdo vp cham sdc dudi hinh
thdc ndo trong 2 logi hinh ke tren diu kha rdi ro. Tham chi d mOt sd dia bdn khao sdt
dd cd trudng hgp tre hi chet do rdn dOe cdn, da Id, dudi nude. Do d dia phuang khdng
cd md hinh trdng tre hipn dgi nhu nhd tre nen vipc cai thiOn chdt lugng cham sdc bdo
vp tre DTTS trong giai doan nay gSip rat nhilu khd khdn. Ddy la khoang trong bi bd
ngd trong bdo v? chdm sdc trd DTTS can nhanh ehdng cd bipn phap, gidi phap khdc
phyc. Kit qua khao sat djnti tinh eung cho thdy, trong dilu kipn ddc thd d miin n^i
phia Bdc gdn bidn gidi, vipc dk eon nhd d nha thilu vdng bd mp cdn co nguy co bj bdt
cdc. Ngoai ra, d mdt vai DTTS cdn tdn tai phong tyc t|ip quan anh hudng tieu cyc tdi
an toan vd chdm sdc sdc tre em, chdng hgn tap tyc ban, cho lam con nudi (ngudi nhan
nudi phai tra mOt sd tiln) hay dii eon. Anh em hg gdn nlu ed con mgt b l cd thi dii
eho nhau. Nlu ddi con td qua be thi nhihig dda tire thudng hay cdi xuong, ho?ic cd thi
cd nhimg anh hudng tdi tam l;^ tinh cam. Dieu nay edn dugc su quan tam cda cdc co
quan chdc ndng vd ed eae bipn phdp, ehinh sach can thipp. Sau day Id trudng hgp cu
thi mua eon ve nudi:


Em 24 tudi ddn tdc Niing. Ldy chdng 7 ndm khdng co con. Chdng Id con trai du
nhdt. Em nhgn nudi chdu gdi hi$n dang hoc mdm non tgi trudng ndy. Ngudi ch
con Id ddn tgc La Chi. hai vg chdng bd nhau. Ngudi La Chi hay cho con hon cd
ddn tgc khdc. Em mua chdu tir be, mua mdt 6,2 tri?u. Sau dd ldm le sang tin dd
Ngudi DTTS da ldm Ii sang tin ddi hg Id khdng liin quan gi v&i nhau nda (vdi b
me de). Bd m? bdn con hien nay lgi ldy chdng dang d cung xd nay. Ddn tgc La C
sdng nhiiu a xa Bdn Dudi cd tgp qudn niu kinh ti khd Ididn la bdn con. Hg quan

ni$m day chi Id khdng nudi dugc nin giei di.
(PVS, me nhdn con nudi, 24 tudi, hpc vdn 7/12, ndng nghiep)
5. Ketlu^n
Trong cdng ddng cdc DTTS, do dilu kiOn kinh tl khd khdn, phong tyc tgp qudn Ige
hgu, nhgn thuc ve sue khde ba m? va tre em eon thap nen che dO dinh dudng, nghi ngoi
cho cdc bd me mang thai va nudi con bd chua dugc ddm bdo ldm anh hudng tdi sue khde
cua bd mp va ty le tie hi suy dinh dudng cao. Cdn phdi cd chuong tiinh ddo tao, tap huan
nhdm thay ddi nhan thue, thuc hdnh vd cung cdp cac sdn phdm dinh dudng cho bd mp
tiong thdi ky mang thai va cho con bu. Nhd nude nen cd chinh sdch tang cudng hS trg
tien/san pham dinh dudng cho eac ba mp thuOc hO DTTS ngheo trong 6 thang cud! thai ky
va 6 thang sau sinh.
"Hnhtiangsinh de tgi nha cdn ph6 biln cd thi din din cdc tai biln sdn khoa vd tinh
trang phap ly cua tid (ldy chdng sinh, khai sinh, bdo hiem y td) dugc lam rat ehdm vd cdn
nhilu sai sdt. Trong khi dd, chdc ndng dd de cuatigmy tl xd chua dugc thue hien tot do
cd khdch quan va ehd quan. Tap quan dn kieng sau sinh, nhd com cho tid dn td rat sdm,
thoi quen mua cdc loai chao bOt ddng gdi sdn vdi gia 2-3 ngdn ddng/gdi, cho con dn dam
thay cho thuc hanh ndu chao dinh dudng cdn dugc nghien edu danh gia them de dam bao
chi do dinh dudng cho trd.
Trong cpng ddng cac DTTS, chua cd bdng chdng vl bat binh dang gidi trong nudi
dudng ehdm sdc, bao ve, kham chfia bdnh gifia tie trai va tre gai trong sudt thdi gian
mang thai va khi tre td 0-24 thang.
Chinh sdch cdp bao hilm y te cho trd dudi 6 tudi dd dem lgi hiOu qud caotiongviee
chdm sdc sdc khde cho trd em. Tuy nhien, do nhilu nguydn nhdn khac nhau van edn ti 10
dang kl trd DTTS dudi 6 tuli (tiong do cd cd tre dudi 2 tudi) chua co bao hilm y te, hode
bi sai cac dfi lieu tiong the. Dilu nay gay kho khdn cho tre bi benh ndng khi phai khdm
chfia bpnh tgi tuyen tinh va trung uong.
Cdng tac y tl du phdng cho ba mp va tre em DTTS da duge thyc hiOn khd tdt. Ty 10
cac ba mp thuc hien tidm chdng vd kham thai djnh k5' dd dgt duge myc tidu chuong tiinh
qude gia y tl giai doan 2012 - 2015. Tre sa sinh dugc tiem chung kha day du, diing thdi
dilm, du so mui theo quy dinh. Tuy nhien do dilu kien dia hinh vd nhdn thdc ehua ddy

du, cdng tac tiem chdng eho tie em DTTS cdn gdp nhieu tid nggi ed the anh hudng tdi
chat lugngtidmchung.


46

Thuc hdnh chdm soc bd m? mang thai vd tre em...

Cdng tdc bao vp, giao due ti^ em DTTS td 1 din 2 tudi hdu nhu cdn hi bd ngd. Tgi
vung DTTS vd mien mii, gdn nhu khdng cd eae md hinh giao dye cdng lap va tu tiiuc eho
nhdm tre nay. Toan bO vipc cham sdc bdo vp, gido dye tre nhdm tudi nay phy thugc vao
gia dhih va hg hang. Dd dl nha cho ngudi nha tidng hay mang theo len nuong ray diu c6
nguy ea dang k l eho sue khde va an toan tie nhd. Day la van de ma Nha nude, ehinh
quyIn cac cdp edn nhanh ehdng cd nhung chinh sdch, md hinh can thiOp de dam bao
quyIn tie em va tgo dilu kien eho tre dupe phat trien todn dien. Ben cgnh dd, can ed tiiem
nghien euu tim hilu vd dua ra eac gidi phap tich hgp de dng phd vdi cac tap tuc Igc hgu
cdn tdn tgi d mdt sd DTTS cd thi dnh hudng tieu eye den su an toan va phat trien toan
dien eua tie nhd.
Tai li^u t h a m k h a o
Bo Lao ddng Thuong binh v i X i hoi. 2015. Quy^t dinh so 1294/QD-LDTBXH phS duy§t k^t qui dilu tra,
ri soil hO ngheo, hg cin nghSo nam 2014, ngiy 15/9/2015.
Chinh phu. 2011. Nghj quySt so 80/NQ-CP ngiy 19/5/2011 ciia Chfnh phii ve djnh hudng giim n ^ 6 o bin
vOng thdi kSf tir nim 2011 d6n nim 2020.
Chinh phii. 2012.Quyet dmh 1208/QD-TTg ngiy 4/9/2012 cua Thu tudng Chinh phii PhS duy§l Chirong
trhih m^c ti6u qude gia Y t l giai do^n 2012 - 2015.
Plan. 2013. Gidi thi?u chuong trinh chim sdc v i phit trien tri tho toin di^n. Xem link
int_chuong_trinh_giao_duc_plan_vn.pdf
Bd Y tk 2013. Bio cio "Du i n Chim sdc siic khde sinh sanh v i cii thifn tinh tr^mg dinh dudng 2013" A\rc
hifn tai 4 tinh: Son La, Quing Ngii, Dik LSk, KiSn Giang. Vy Tong hop - Oy ban Dan lOc vi
Vi^n Dinh dudng.

Tong cyc Th6ng ke. 2011. Miic sinh va miic chil o Vi$l Nam: thuc irgng, xu huong vd nhiing khdc biit.
Tdng dilu tra Din s6 v i Nhi d Vi^t Nam nim 2009.
UBDT, IRC, UNICEF (Uy ban Din t§c, Cdng ty Tu vdn v i Nghien cihi Phit triln, Quy Nhi ddng Lifin h i ^
quoc). 2015. Ngiifeo da ehieu tre em Vi^t Nam vimg dan tdc thilu so - Thyc trang, bi&i dgng vi
nhimg thich thOrc. Bio cio nghien cihi. H i N$i.
UNDP. 2013. Mifc liiu ihien nien ky: Gidm ly 14 id vong cua Ire em.