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Researches Community health care

Trần Thị Ngọc Bích  et al.

Place of publication: Health Strategy and Policy Institute
Year of publication:  2011
To improve the quality of Vietnamese population, in Chapter 3 on quality of population, Population Ordinance in 2003, Article 23 (reproduction support measures) stipulates: “The Government encourage and create conditions for young male and female to have health check before getting married…”. This shows that the Government has been implementing policies to encourage and support young man and woman to have health check before marriage to screen genetic diseases, ensure healthy newborns and contribute to improve the health, physical status of the future generation. According to this regulation, pre-marital health check is being implemented in encouragement angle. 
The Vietnam’s Law on marriage and family, article 13 on “Marriage registration settlement”; Article 18, Government Decree 158/2005/NĐ-CP on registration and management of residence and Circular 01/2008/TT-BTP, which provides implementation guidelines for Government Decree 158/2005/NĐ-CP, in the part on marriage registration procedures, there is no regulation on health check paper submission when registering marriage. 
At present, most people do not understand the purpose and importance of pre-marital health check. The percentage of pre-marital health check is almost zero. It is impossible to control genetic inborn defect births. Due to no pre-marital health check many couples contract infertility diseases, which are not always non-curable. Infertility cases keep increasing in recent years. According to obstetric specialists everyday many people visit for ob-gyn examination, including young people. They do not come for pre-marital health check but for gynecological diseases. These gynecological diseases can be treated as many other common illnesses. However ignorance of such diseases may lead to infertility or still birth. Even HIV may be controlled by safe sex measures together with response to risks of mother-to-child transmission. According to reports by the National OB-GYN Hospital, each year there are about 100 pregnant women contracted with HIV without knowing before visiting the hospital for ANC. Health statistics 2009 show that the genetic abnormality children account for 4% and at least 1% of children have serious abnormalities in genetic substances. 
So far there has been no official study in this field. Therefore the understanding of knowledge and attitude of young people in 18-25 age group towards pre-marital health check is very necessary, especially in the current conditions. 
1. To understand the knowledge and attitude of young people in 18-25 age group towards regulations on pre-marital health check;
2. To learn about the current situation of health check for men and women before marital registration in study locations;
3. To make recommendations to health check for men and women before marriage.
Study methods: Quantitative and qualitative methods. 
Quantitative method: used to evaluate the knowledge, attitude and practice (KAP): Interview with questionnaires with young people aged 18-25 years old, single and married in the last 1-2 years (200 questionnaires).
Qualitative method: In-depth interview with young people aged 18-25 years old, single or married in the last 1-2 years, justice staff at commune level, grassroots health workers and population responsible staff at commune/ward level (24 in-depth interviews).
Main findings
In this study, in the survey location, knowledge of pre-marital health check among interviewed 18-25 age group in Ba Dinh district is lower than that in Soc Son District. Ba Dinh is a downtown district of Ha Noi. Probably young people can access to diversified information sources and many entertainment channels. Besides young people in the city have many activities or participate in many courses for educational improvement. Therefore they may not pay special attention to channels on reproductive health care for young people. The fact that the Government do not obligate pre-marital health check is the reason which makes young people ignore the issue. Although interviewed young people in Soc Son District have better knowledge of pre-marital health check compared with those interviewed in Ba Dinh district, they may know from their own study, understanding and findings from various information sources rather than direct, clear and official communication. 
Most interviewed young people in Ba Dinh and Soc Son Districts understand the necessity of pre-marital health check and ready to have pre-marital health check upon their lovers’ request. However some of them are afraid to request their lovers to go for pre-marital health check. Some others, especially those in Ba Dinh district believe in their health status and find not needed to have pre-marital health check.
Due to better knowledge and attitude towards pre-marital health check, more interviewed youth in Soc Son District seek for pre-marital health check compared with the group in Ba Dinh district. Nonetheless health check is mainly focused on female youth. According to traditional perception, married women must deliver births. Therefore young female are often worried about this issue and if there is any family member who experienced difficulties in birth delivery, they will go for obstetric examination before getting married. For young male, pre-marital health check means blood test for HIV, Hepatitis B and some other sexually transmitted diseases. 
Interviewees say they have pre-marital health check but in fact they get the regular health check package and young female get additional overall obstetric examination. Comparing with pre-marital health check package of some international hospitals, there are many missing contents in pre-marital health check by young people in Ba Dinh and Soc Son districts.
The young people in Ba Dinh and Soc Son districts take part in this study with the wish to ask the Government to encourage pre-marital health check. Only few believe that it should be mandatory to ensure good health and physical status for younger generations. To make young people know and carry out pre-marital health check, according to interviewed youth, the Government should enhance communications, paying attention to examination issues, pre-marital health check for young women and men, counseling hotline. Particularly there should be services of pre-marital health check and contact/address information should be provided for young people. 
To date public health facilities in Ha Noi almost have no pre-marital health check service but only regular health check and gynecological examination. These services cannot meet the requirements of pre-marital health check. Some private health facilities start to deliver such service package but prices are high and package is incomplete. Moreover, in Ha Noi there are many communication activities or counseling centers or hotline on health, marriage and family. Nonetheless all above-mentioned only carry out the functions of counseling on family life organizations, how to behave in the wife or husband role, contraceptive methods, etc. In some OB-GYN hospitals in Ha Noi like the National OB-GYN Hospital, Ha Noi OB-GYN Hospital there is no registration for pre-marital health check because the hospitals do not have such services. Young people visiting these hospital for regular health check. Therefore to promote the knowledge and behavior of pre-marital health check, in the future it is needed to pay special attention to the followings:
Strengthen communication – education on the importance, significance and benefits of pre-marital health check for adolescents and youth. The communication should be enhance on communication channels that young people can easily access such as school-based communication and education, communication via youth organizations, development of leaflets, booklet and especially a hotline. Communication contents should focus on examination issues, pre-marital health check, addresses of service delivery and prices.
MOH needs to early introduce pre-marital health check service package to hospitals, health centers, health facilities and others nationwide.
It is needed to conduct study in wide scale, regions, geographical areas to make wider, more intensive recommendations in this field before the Government decide on compulsory or encouraged pre-marital health check.

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