Public Sector Strengthening

Families and Society Newspaper: Husband and wife "plan” family together

Since early morning, the yard of Son Thinh Regional Clinic (Van Chan district, Yen Bai province) has been crowded with people. Today, the healthcare team of Marie Stopes Viet Nam (MSV) arrived

Joy in a small village 

Lo Thi Xuan (a Dao ethnic minority woman) and her husband came here very early this moring having driven a motorbike for 3 hours, travelling tens of kilometers from Nam Kiem village, Nam Bun commune, Van Chan district. Today, they are one of 30 married couples in Van Chan district to have a tubal ligation.
Xuan is 30 years old and has 4 children: the eldest is 11 years old and the youngest is 21 months. She explained: "I got pregnant unintentionally but I did not want to have an abortion”. When asked "Do you feel your health has gotten worse after you gave birth to 4 children?” she nodded with sorrow. She resumed work just one month after each delivery. This involves working in the terraced fields, rooting up cassava as a hired labor or fetching firewood in the forest to sell. Her husband also has to work to pay off a loan as they had to borrow money to pay for their children’s hospitalization some years ago.
After giving birth to their 4th child, with the hard life of a big family and with patient counseling with the grassroots population collaborators, Xuan’s husband agreed to her having a tubal ligation. However, due to the long distance from their house and with a small baby, this had not been possible before. Today, the couple is very happy because they can arrange time to come this place together for the procedure so that they can feel at ease to work and nurture their children, and most importantly, to protect their health.
Counselling on RH - FP to community women
This time, beside Xuan, almost 30 other women will also undergo the procedure. Most of them are aged 25- 40 years. Trieu Thi Sinh, population collaborator in Nam Cai village, Nam Lanh commune – who mobilized these women to have sterilization showed her joy at the event: "it took me even several months to mobilize some cases. Their families objected because they thought it was “prohibiting childbirth”. Fortunately, “their mind brightens” after that, and they allow their daughters and wives to have sterilization". 
Talking with us, Ban Kim Tu and his wife – Trieu thi Vuong (Nam Toc village, Nam Lanh commune) told us that they have 2 children and that is how many children they would like. "in my village, many people have a 3rd and 4th child. It’s miserable! My wife cannot take pills regularly and I do not use any contraceptive method because I have to do hard work. I think tubal is the best for us".
It is a common feeling amongst couples in the mountainous districts of Van Chan district. Ha Thi Mong Hoai – The Director of Van Chan District Health Center said: ‘Van Chan has 18 particularly challenging communes. In each locality, they use different contraceptive methods depending on their conditions and customs. While the people in the low land prefer temporary contraceptives (condoms, pills), people in the mountainous areas feel more at ease with the long acting and permanent contraceptives (IUD, sterilization, etc.). 
Hoai added: in the last 5 years, the villagers’ awareness about FP is much better than before. Contraceptive prevalence in the district is about 65%, but it is lower in the high land (around 40- 45%).
Awareness change for the people in the mountainous areas 
Every year, Yen Bai province organizes 2 visits to the communes, however, some needs cannot be met. Additionally, the interval between the 2 campaigns is rather long, so “unplanned pregnancy” still occurs. In these areas, transportation is very difficult and access and provision of FH services in CHSs is very limited. The health sector can address such need with provision of condoms and pills.
That’s why, according to Hoai, with 2 campaigns of RH/FP service provision, the people in Van Chan district require an additional 23 mobile visits every year from MSV program “providing tubal ligation and IUD insertion”. This is confirmed by the results of the recent annual review of the district population sector. "it’s important that the villagers’ awareness is improved. E.g., today, all women are accompanied by their husband to this evnt" – Hoai shared with joy.
"The people in the remote and disadvantaged areas want to use contraceptive methods but they still partly fail for different objective reasons. The success of the temporary non-clinical contraceptive methods requires correct use and correct timing. Thus, if they are not used correctly they often suffer contraceptive failure namely: unwanted pregnancy. If they want to go to the prestigious health facilities, it’s problematic for them to travel due to difficult transportation requirements and long distances" – said Dr. Nguyen Duc Anh, MSV clinical quality assurance Manager.
Yen Bai is one of 33 provinces/cities in the country where MSV implements its female sterilization and IUD insertion program. The program is implemented has been implemented this poor mountainous area since 2009. Dr. Duc Anh said: "We apply a new method of female sterilization. The advantages of this method include the use of local anesthesia rather than medicines for pre-anesthesia or general anesthesia. The technical duration for one case is only 8-15 minutes. After the operation, the clients can be fed and moved and go back home some hours later. Post-operative clients do not need bandage change or further healthcare. Another important difference of this method is the use of “vocal local”. Staff members talk with the clients continuously to help them “temporarily forget their pain" during the operation".
According to Dr. Nguyen Van Nam, Manager of the MS Nghe An clinic who accompanies us to Yen Bai, most healthy clients can use female sterilization except those clients with uterine fibroma or scarring from previous surgery or those who have contraindications for this method and require general anesthesia. These women have to go to a higher level facility. In addition, before and after receiving services, every client receives counseling on self-care by the specialists. They are also given contact details person to call for further support if needed”, said Dr. Nam.
"The current contraceptive prevalence of the whole country in the mountainous areas is still low. While the provincial contraceptive prevalence is 70%, it is only 40-50% in the mountainous communes. Many local people cannot speak Vietnamese. When the health staff from the district goes to commune level for facilities, they have to work through grassroots persons in charge, collaborators or peer educators to ensure effective communication".
Dr. Luong Kim Duc
(Vice Director of Yen Bai DOH/Director of Yen Bai Provincial Office for Population and Family Planning)
"Another differentiation is “vocal local”. Health staff always talk with the clients to help them forget their temporary pain during the operation".
Dr. Nguyen Duc Anh
(MSV – clinical quality assurance Manager) 
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