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Researches Population
SURVEY, EVALUATION OF COMMUNICATION – EDUCATION ON POPULATION, REPRODUCTIVE HEALTH AND FAMILY PLANNING IN SEA, ISLANDS AND COASTAL LINE AREAS

Nguyễn Đức Mạnh et al.

Place of publication: Health Strategy and Policy Institute
              General Office for Population, Family Planning
Year of publication: 2010

Background
The survey and evaluation is conducted according to Decision 238/QD-TCDS dated 27/10/2009 by the Director General of the General Department of Population, Family Planning (GDPFP) to meet the implementation requirements of Project 52, in accordance with Prime Ministerial Decision 52/2009/QD-TTg dated 09/4/2009, which approves the Project on Population control in sea, islands and coastal line areas in 2009-2020.
Objectives
To evaluate the current situation of communication – education on population/reproductive health/family planning (PFP-RH) in sea, islands and coastal line areas.
To evaluate the level of knowledge, attitudes and behaviors on PFP-RH among groups in sea, islands and coastal line areas.
To identify unique features, impacting PFP-RH activities in sea, islands and coastal line areas.
To identify PFP-RH needs in sea, islands and coastal line areas.
To recommend communication – education solutions on PFP-RH that are relevant and effective for groups in sea, islands and coastal line areas.
 
Methods 
Secondary data collection and analysis;
Field data collection methods: Quantitative (questionnaires); Qualitative (in-depth interview, group discussion);
Peer review.
The survey is conducted in 8 provinces, 16 districts, 30 communes and 2 living quarters in 5 areas of (1) coastal line; (2) lagoon, wetland, mangrove; (3) sea surface/boat/fishing port/fishing villages; (4) islands; and (5) coastal economic zones (industrial parks, processing zones, tourism spots). Questionnaires total 2,590 (including 1,636 couples, 809 adolescents/youth, 64 staff at 3 levels, and 81 counselors), with 88 in-depth interviews and 48 group discussions.
Results and conclusions 
Current situation of PFP-RH and needs in sea, islands and coastal line areas:
PFP-RH communication-education personnel: 
Lack of staff, in many districts there are only 1 – 1.5 staff working in communication area. At commune/ward level there is a great difference in the male/female ratio (responsible staff: 19.5% men/80.5% women; population collaborator: 15.2% men/84.8 women). Staff capacities remain weak, especially at commune/ward level. They are highly enthusiastic but incentives are not relevant.
At the time being, provinces have high training needs, in quantity and in improving staff capacities, including skills of communication, counseling, interaction and multisectoral collaboration, especially for commune/ward staff.
Impacts of communication – education channels: 
Communication – education channels have been well promoted, especially with population responsible staff, population collaborators, Women’s Union, local government authorities; and PFP counseling centers. The provincial TV network, especially the commune/ward public loudspeaker system have promoted impacts. The information needs among couples via TV, radio, commune/ward public loudspeaker system, especially community-based population collaborators have been met. Adolescents/youth have high needs for information via TV, radio, commune/ward public loudspeaker system and schools. 
Level of knowledge, attitudes towards PFP-RH policies: 
Implementation of population policies: From 88% to 92.9% couples in reproductive ages and from 88% to 94.6% couples in 05 unique geographical areas understand and agree with the policy of family size with 1-2 children. However there are still 26.1 couples with more than 3 children.
Implementation of fetal sex selection ban: There remain 39.5% couples and 35.8% adolescent/youth not knowing about the ban of fetal sex selection.
Regulation on age of getting married: There remain 15.2% of adolescent/youth do not know that the regulated age of women is more than 18 and 13.4% do not know that the marrying age for man is more than 20. In sea surface/boat/fishing port/fishing villages, 28.7% adolescent/youth believe that the male marriage age is more than 18 and 30.% say that the female marriage is 20. 
RH/PFP: There are 49.0% - 90.9% couples knowing about 9 contraceptive methods however they only focus on 3 methods, including IUD, contraceptive pills and condoms. Modern methods consist of implant medicine, vaginal membrane, emergency contraceptive pill and others are less known. 
RH for adolescent/youth: More than half (57.1%) adolescent/youth do not know about 5 adolescent/youth RH care contents. About 76.1% - 100% adolescent/youth agree with safe sex and unwanted pregnancy prevention.
Safe motherhood (SM): About 63.0% - 94.1% couples have good understanding of  9/11 SM contents. There are still 28.6% couples in sea surface/boat/fishing port/fishing villages visiting traditional healers and birth attendant for examination and counseling. 
Prevention of sexually transmitted diseases (STDs): About 83.2% - 88.5% couples know about HIV/AIDS, syphilis and gonorrhea; 50% do not know about genital wart, flagellate,... About 60% - 94.2% of couples know how to practice measures to prevent STDs and reproductive track and HIV/AIDS. 83.2% - 97.3% adolescent/youth know about HIV/AIDS and 70% know about gonorrhea and syphilis. Up to 71% - 92% adolescent/youth practice HIV and drug use prevention. Nearly all adolescent/youth do not have pre-marital sexual relation. 
Safe abortion: About 56.5% - 90% couples know about consequences of abortion. About 10% of women had abortion. 
Current status of communication media/facilities
The main communication – education media in provinces are TV, radio, commune/ward public loudspeakers system, banners and poster. 10 provinces lack public loudspeakers system, 22 provinces do not have boat/canoe for communes, and 20 provinces do not have mobile communication vehicle for districts. 90% - 100% of unique geographical areas need communication facilities. Particularly there is a shortage of boat/canoe. 
Current status of communication products
In 05 areas there are only 5/9 communication products with impact levels ranging from average to good, including poster; leaflet/flies; guiding documents, banner and cultural performance scripts. There are 4 products with less impact, including flipcharts, audio and video CD, newspaper/magazines and movies. Current needs include (1) guiding documents, (2) posters, (3) leaflet/flies, (4) cultural and art performance scripts, (5) banner, (6) newspaper/magazine, (7) movies, (8) video CDs, tapes, and (9) flipchart.
Current status of communication messages/contents
In 05 geographical areas, people have opportunities to receive 16 communication contents and messages on RH-PFP at different levels. Couples receive 8/16 contents, adolescent/youth receive 12/16 contents. Communication messages are received at high level. Low receiving level communication messages/contents consist of pre-marital health check, unwanted pregnancy risks; adolescent/youth safe abortion, newborn care, STDs. Needs for communication contents/messages focus on pre-marital health check, unwanted pregnancy risks; adolescent/youth safe abortion, newborn care, STDs, reproductive track diseases, safe abortion.
Current status of communication equipment: 
Sea, island and coastal line provinces only have 3/6 types of equipment, provided for more than 50% of the locations. Other equipment and areas are newly provided with low percentages, 10% - 46.5%. Medium and good level impact equipment is recognized at high level, lowest at 82.1. Budget for equipment is modest, spent with waste and poor efficiency. 
Current status of communication budget at grassroots level: 
Supportive expenditures for responsible staff and collaborate are very low compared with given tasks. Provinces have high budget support demand to increase paid, allowances for communication – education staff and allocate budget to procure equipment for communication activities.
Impact levels of geographical, natural environment, socio-cultural and economic factors to perception, attitude and behaviors among couples and adolescent/youth.
Impact levels of geographical, natural environment factors
First is many storms. Second is difficult topography, difficult transport. Third is separated and isolated terrain. Fourth is polluted environment. Fifth is too much rain. Sixth is hot and sunny. Seventh is natural erosion of audio and video facilities. Eighth is salty environment with lack of fresh water. Ninth is hard climate. 
 Impact levels of socio-cultural factors
First is that people prefer son. Second is low education, early school dropout. Third is gender inequity. Fourth is that people like to have many sons. Fifth is early child labor. Sixth is high migration. Seventh is non-hygienic living. Eighth is family. Ninth is integration culture. Tenth is religion.
Impact levels of socio-economic factors: 
First is unstable income. Second is low/no income. Third is lack of information. Fourth is lack of communication facilities. Fifth is long time in the sea. Sixth is hard work. Seventh is far working places. Eight is professional risks.
 
Solutions 
Solutions on communication – education personnel: 
Consolidate, supplement and appropriately distribute communication – education staff among district in sea, island and coastal line areas; encourage men to work as population responsible staff and collaborator in disadvantaged areas; take use of experienced staff in communication – education are; integrate training/retraining/refreshment courses on capacity building for communication/counseling/services staff with target programs and projects.
Communication – education channels: 
Strengthen the implementation of small group counseling in the community and family; promote the active role of local authorities and socio-political organizations like the Fatherland Front, Youth Union in communication – education activities on RH-PFP.
Solutions on communication – education facilities: 
Cover the commune/ward public loudspeaker system and TV; invest in constructing sustainable advertisement/communication works, taking into account the hard sea climate conditions; equip shortwave radio for responsible staff; hire communication supportive devices.
Solutions on communication products: 
Based on the needs of each priority area, provide: firstly guiding documents; secondly poster; thirdly leaflet/flies; fourthly cultural and art performance scripts; fifthly banner; sixthly newspapers/magazines; seventhly movies; eighthly video CDs/tapes; and ninthly flipcharts.
Solutions on communication contents/messages
Include contents on no sex discrimination and no gender inequity, pre-marital health check; safe abortion; reproductive tract infections; sexually transmitted diseases; HIV/AIDS. Continue to strengthen contents/messages on few children family model, safe motherhood, adolescent/youth reproductive healthcare; Communicate and disseminate regulations on marriage age in the Law on Marriage and Family. Integrate contents on anti environment pollution and eliminate non-hygienic living habit; communicate and advocate against early school drop-out and early child labor among couples.
Recommended solutions on communication equipment: 
Prepare plans or allocate budget to hire communication equipment for PFP communication activities. 
Solutions on communication expenditures at grassroots level
Support appropriate budget and travel means for communication/counseling/service staff, population responsible staff and collaborators; develop allowance scheme for population responsible staff and collaborators according to that applied in national target programs and projects.
 
Recommendations
Create all possible conditions for the people to access to RH/PFP services, especially in lagoon/mangrove and coastal line areas.
Improve people’s knowledge, strengthen information and dissemination at communes/wards; provide information; disseminate knowledge, skills for people.
Quickly cover power grid to coastal areas and islands, especially in islands communes by different power sources; supply fresh water to areas in serious shortage like islands. 
GDPFP needs to conduct more studies on communication and education on RH-PFP in sea, islands and coastal line areas to have bases for planning adjustment and interventions in a timely manner within the RH-PFP communication and education field. 
 

19/11/2013
Health Strategy and Policy Institute  
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