RHIYA Vietnam by Design 41109

Viet Nam: Final Report

RHIYA Monitoring and Evaluation

Reproductive Health Initiative for Youth in Asia (Rhiya)

Viet Nam: Final Report RHIYA Monitoring and Evaluation EU/UNFPA Reproductive Health initiative for Youth in Asia (Rhiya) 2003-2007

Coordinator / Lead Editor: Thierry Lucas Lead Researchers & Authors: Andrea Irvin, Olivier Weil Principal Research & Editing: Jason Edwards National Research staff: K. R. Bimal Chapagain, Khodezatul Faiz, Sarah Javeed, Nam Truong Nguyen, Eduardo R. Nierras, Kalinga Tudor Silva, Naomi Walston Designer:

Acknowledgements Special thanks are due to Maria-Jose Alcala, Ugo Daniels, Galanne Deressa, Mary-Odile Lognard, Mary Otieno, Bruno Schoumaker, Sylvia Wong for their key inputs, suggestions, and views, and to Tauhid Alam, Dr. Ruh Afza, Lim Tith, Vimol Hou, Suzie Albone, Phonexay Sithirajvongsa, Krishna Prasad Bista, Hom Raj Sharma, Abdul Hamid Khan, Nadir Gul Barech, Eshani Ruwanpura, Chandrika Subasinghe, Bui Dai Thu, Thanh Tung, Carine Henoque, and Munira Nasser for their tremendous support throughout the documentation process. Our thanks are also due to the many individuals and organisations who collaborated in this effort, for their productive support, advice and participation, particularly RĂŠgine Mandy and Vincent Piket, from the European Commission AIDCO Unit D2. We would specially like to thank J. Bill Musoke for his key support and timely guidance throughout this documentation process.

4 | Carine Henoque ÂŠ Young women in a group Lao PDR

Editorial Team

Introduction

“When they want to use (contraceptives)… they just get them from pharmacies. Maybe… that’s all that I know.” (Male, 5th grade pupil, Thanh Xuan Bac Ward, Hanoi).

4 | Carine Henoque © Young women in a group Lao PDR

Viet Nam: Final Report

ietnam is the 14th most populous nation of the world, with a population that reached 83 million people in 2005. The 15-24 age group accounts

for 21% of the total population and more than 17

million people. The country has achieved considerable socio-economic improvements over recent decades, with substantial efforts made in the educational and health system. From 1990 to 1999, the GDP per capita increased threefold, and life expectancy is now around 70 years. Nonetheless, despite significant progress, poor households has decreased but remains high: 28.8% in 2002, as compared with 37.4% in 1998 and 58.0% in 1993. In spite of the poor economic conditions of large parts of the population, the Vietnamese health care system is more advanced than those in most developing countries. An efficient system of primary health care has been set up around the country and, as a result, child and infant mortality has decreased sharply in the last decades. Vietnam was one of the first countries to adopt a population policy to reduce population growth and, since the 1960s, families have been encouraged to have one or two children. These population policies have resulted in a rapid decline in fertility, with a total fertility rate ranging from 1.4 children per woman in urban areas to 2.0 in rural settings (DHS 2002). Education, which is widespread in Vietnam, has also contributed to declines in mortality and fertility in Vietnam.

Introduction

Vietnam is still a poor country. The proportion of

The high rates of unwanted pregnancies and abortion are major issues in sexual and reproductive health in Vietnam. Abortion rates are thought to be increasing among young unmarried females, especially in urban areas1. Improving information on and access to contraception among young people is thus extremely important. As in many countries, HIV/AIDS is another major concern. Although the prevalence of HIV/AIDS is relatively low, it has increased steadily since the 1990s and is expected to continue so. Several studies have shown that, although HIV/AIDS was well known in Vietnam, young people still have incorrect beliefs about ways of prevention and ways of transmission of HIV/AIDS, and that condom use is still low among

4 | Carine Henoque ÂŠ Young women in a group Lao PDR

Viet Nam: Final Report

young Vietnamese people.

Khuat Thu Hong, 2003, Adolescent reproductive health in Vietnam. Status, Policies, Programs and Issues, Policy Project, The Futures Group, Washington D.C.

Map of RHIYA project sites in Viet Nam

Projects Youth Union UCNEV LMF RAFH MSI VINAFPA VAM

Hanoi

Hai Phong

Introduction

Hoah Binh

Da Nang

KHAN HOA

Ho Chi Minh City

Presentation of RHIYA activities in Vietnam The Reproductive Health Initiative for the Youth in Asia (RHIYA) supported two projects in Vietnam in both the urban and the rural areas of seven provinces: Hanoi, Hoa Binh, Hai Phong, Thua Thien Hue, Da Nang, Khanh Hoa, and Ho Chi Minh City.

Viet Nam: Final Report

1) The Vietnam Youth Union project called “Advocacy & Behaviour Change Communication”, aimed at improving healthy behaviour, practices and awareness among young people by creating an environment that enables the implementation of adolescent reproductive health services. The project focussed on behavioural change and advocacy activities for young people, key stakeholders and decision-makers at the local and central levels. The project carried out activities including peer education, theatre groups, activities of communication and promotion in the communities. 2) The Vietnam Family Planning Association (VINAFPA) project, called “Promotion of Health Services and Health-Seeking Behaviour”, aimed to provide youth with friendly services, including counselling, and increase youth and adolescents’ use of reproductive health services. The VINAFPA project organized information exchange meetings and a knowledge-based contest on adolescent sexual and reproductive health (ASRH). The organization also conducted follow-up meetings for local authorities and related organizations to support projects providing services to adolescents. VINAFPA also runs youth‑friendly centres. Twenty youth-friendly service corners have been set up, providing clinical and non-clinical services on sexual and reproductive health.

Since they were complementary and acted in different ways to reach the same audiences, these two projects took place in the same locations. As a result, it is not possible to isolate the target groups of the two projects.

Monitoring and Evaluation of RHIYA in Vietnam

Introduction

A common framework for the monitoring and evaluation of the RHIYA programme was adopted in all the RHIYA countries based around a core set of indicators developed following a programme-wide consultation process. It uses a combination of various data sources to track the projectsâ&#x20AC;&#x2122; activities and to measure changes in knowledge and behaviour during the course of the projects. Four distinct types of data are used for the monitoring and evaluation of RHIYA: (1) routine data collected from partner NGOs; (2) data on knowledge, attitudes and behaviour collected through population-based surveys in RHIYA project areas at the beginning (baseline) and at the end (endline) of the projects; (3) qualitative data obtained through interviews and focus groups with various types of stakeholders (e.g, young people, service providers, parentsâ&#x20AC;Ś); and (4) data from clients of service delivery points collected through several client exit surveys. This information was entered into the web-based Project Tracking and Reporting System (PTRS) used across the RHIYA and used to generate quarterly and annual reports at both project and country level. A detailed presentation of the M&E tools is given in the comparative report.This section refers only to general principles and to specificities of the M&E in Vietnam.

Routine Data Routine data were collected from 22 service delivery points (SDPs) established by the RHIYA partner NGOs and from the two NGOs. Every quarter, SDPs and NGOs would send data on routine indicators to the RHIYA Umbrella Project Support Unit (UPSU). The data were then aggregated and entered quarterly into the web based Project Tracking and Reporting System (PTRS). Some difficulties were encountered in routine data collection in Vietnam, as the NGOs did not transmit the data on a regular basis at the start of the project. As a result, despite the fact that the project started early 2004, data are available only for the years 2005 and 2006.

Baseline and Endline surveys Baseline and endline quantitative surveys were organized in the RHIYA project areas in June-July 2004 and June-August 2006. The Institute for Population and Social Affairs (previously called the Population Centre) at Hanoi University conducted both surveys.

Viet Nam: Final Report

The three generic core questionnaires (one for males aged 15-24, one for females aged 15-24 and one for males and females aged 10-14) developed by the Institute of Demography of the Catholic University of Louvain (UCL) were translated into Vietnamese and pre-tested by the Population Center. An interviewer manual was also developed in Vietnamese following the questionnaire. Interviewers of the same sex as the respondents were hired, trained and supervised by the Population Centre. In total, about 1,200 respondents were interviewed for each survey, including married and unmarried people. For the endline survey, it was decided to drop the youngest age group from the sample and, as a result, only youth aged 15-24 were interviewed. Both surveys are representative of the RHIYA project areas, and used a two-stage random sample. In the first stage, 3 areas in each of the 22 communes were selected randomly (66 primary sampling units). In the second stage, approximately 20 households per area were selected. All the eligible respondents from each household were interviewed. For the baseline survey, control areas were chosen. The objective was to compare intervention areas and control areas in the endline survey. Due to time and budget constraints, the control areas were not surveyed in the endline survey. As a result, data on the control areas were discarded from the baseline data files for the baseline-endline comparisons. The baseline qualitative survey included in-depth interviews and focus group discussions in four provinces. Participants were selected from the community and from schools. Twenty-two focus group discussions were organized (with married and unmarried youth of both sexes, pupils of different ages and parents), as well as 16 in-depth interviews (with local leaders, leaders of the local health centres, school leaders and Youth Union leaders). For the endline qualitative survey, 56 in-depth interviews were conducted with the service users (unmarried young males and females aged 15-24), and with service providers in the RHIYA projects (e.g., health staff, peer educators, counsellorsâ&#x20AC;Ś).

Client Exit surveys Two client exit surveys were organized in Vietnam by the Population Centre. The surveys were organized in July 2005 and July 2006 in 11 of the 22 youth-friendly corners. The two generic core questionnaires developed by the Institute of Demography of the Catholic University of Louvain (UCL) were used. The questionnaires were translated into Vietnamese, pre-tested and adapted. A take-all approach was used to select the respondents: all respondents were interviewed as they were leaving the SDP. A total of 108 respondents aged 15-24 were interviewed during the first survey and 212 were interviewed during the second survey.

4 | Carine Henoque ÂŠ Young women in a group Lao PDR

Routine Data Results

he routine data were collected on a continuous basis, aggregated and sent every quarter to the RHIYA. Umbrella Project Support Unit (UPSU) where they were recorded on the web-based PTRS. The UPSU used routine data for monitoring the activities of the NGOs. These data are used in the report to illustrate the type and number of activities that were organized by the NGOs, as well as the number of people who were covered by those activities. These indicators are by no means exhaustive, but do provide a general picture of the activities and the audience of RHIYA. As mentioned previously, routine date are available only for 2005 and 2006 in Vietnam. Activities organized in 2004 are thus not included in these results. Males

Figures are Totals

Females

25000 20000 15000

Viet Nam: Final Report

10000 5000 0

8990

23596

2005

12140

23776

2006

Figure 1: Number of consultations held in Vietnam under RHIYA

The first routine indicator measures the number of consultations carried out in 2005 and 2006 as part of RHIYAâ&#x20AC;&#x2122;s projects. This indicator includes consultations of all kinds (treatment, test and counselling) and types (phone and referral) regarding STIs (including HIV/AIDS) and family planning (including abortion). This indicator shows that the number of consultations under RHIYA in Vietnam is quite impressive: almost 35,000 young people consulted in 2005 and this number climbed even higher in 2006 (about 38,000 consultations). Young women were much more likely to consult than young men. As in most of RHIYA countries, in Vietnam, peer educators were one of RHIYAâ&#x20AC;&#x2122;s cornerstones. They provided young people with information on sexual and reproductive health via peer contact. Peer educators have had more than 30,000 such contacts in 2005, a figure which increased to 48,000 in 2006. Here again, females made more contacts than males.

35000

Males

Figures are Totals

Females

30000 25000 20000 15000 10000 5000

12316

15849

16774

2005

29908

2006

Various types of activities were organized by NGOs to inform young people and to sensitize gatekeepers and political leaders about sexual and reproductive health issues. In 2005 and 2006, NGOs organized more than 1,400 of such advocacy events as part of RHIYA, and government officials coordinated approximately another 1,000 activities (including some advocacy events). In 2005 and 2006, more than 20,000 gatekeepers, including school teachers, community leaders and parents were made aware of reproductive health (RH) issues through a wide variety of events. These events range from advocacy events to sports days and rallies, from theatre shows and karaoke to other big events, â&#x20AC;Ś

15000

2005

Figures are Totals

12000

9000

6000

3000

9263

13447

Figure 3: Number of gatekeepers involved in RHIYA activities

2006

Routine Data Results

Figure 2: Number of contacts by peer educators

1000

2005

Figures are Totals

2006

800

600

400

200

702

701

667

Advocacy Events

421

With Government Officials

Training activities were also an important component of RHIYA in Vietnam. Training took place mostly in 2004 (no figures available) and in 2005, the first two years of the project. Data for 2005 and 2006 show that more than 4,700 professionals or volunteers benefited from these training sessions. Peer educators and volunteers constituted a large proportion of the people trained as part of RHIYAâ&#x20AC;&#x2122;s projects.

2005

Figures in hundreds

2006

1200 1000 800 600 400 200 0

1077

353

562

Counsellors

1005

187

Volunteers

744

703

Others

Figure 5: Number of staff and volunteers trained under RHIYA 4 | Carine Henoque ÂŠ Young women in a group Lao PDR

Viet Nam: Final Report

Figure 4: Number of events organized as part of RHIYA

Results of Baseline and Endline Quantitative Surveys

s mentioned previously, a baseline and an endline survey were conducted two years apart in RHIYA project areas. As the same questionnaires and the same sampling methodology were used in both surveys, indicators can be compared very precisely between baseline and endline. Although changes between baseline and endline surveys may reflect influences other than those of the RHIYA projects, significant changes between the two surveys (as it is the case for most indicators) can most probably be attributed in part to RHIYA activities. Comparisons between participants and non‑participants are also sometimes used to provide additional evidence of RHIYA’s effects. Although participants are a select sub‑group of the population, their better knowledge of reproductive health issues is also a sign of RHIYA’s impact on young people in Vietnam.

Viet Nam: Final Report

First, we present the profile of the respondents in both surveys. Then, the results are presented in four separate sections, including most of the results of the baseline and endline surveys, along with tests showing the statistical significance of changes from baseline to endline.

Males

Females

Education

Marital status Standard of living Total Total

Baseline

Endline

15-19

380

402

20-24

227

209

15-24

607

611

15-19

391

399

20-24

228

206

15-24

619

605

low

medium

317

210

high

846

985

ever married

never married

1 179

1 154

low

163

better off

1 063

1 155

15-19

771

801

20-24

455

415

15-24

1 226

1 216

Table 1: Number of persons interviewed during the baseline and endline, by background characteristics.

4 | Carine Henoque © Young women in a group Lao PDR

In this report, most results are presented by background characteristics using several demographic and socio-economic variables. Results will also be presented in some cases by participation status (see later for details). All results are compared by gender and age group. Gender is of obvious importance in terms of reproductive health. The needs of males and females are often different in terms of medical services and information, and gender gaps in knowledge and behaviour also often reveal greater vulnerability among women. Age and marital status are also of major importance, as knowledge levels, behaviour and needs in terms of reproductive health vary strongly with these characteristics. For example, unmarried (young) people are usually less likely to be sexually active, but those who are sexually active may be more at risk of unwanted pregnancy or sexually transmitted infections. Age is measured using two five-year age groups (15-19 and 20-24) allowing comparisons between adolescents and young adults. Marital status compares people who have never been married to others who have. Two major socio-economic variables are also used for comparisons: education and standard of living. Less educated and poorer people are usually less knowledgeable and more at risk of reproductive health problems. A major challenge to improving reproductive health among young people is thus not only to improve education and standards of living but also to change the knowledge and behaviour of the least-educated and the poor. Baseline-endline comparisons by education and standard of living are therefore essential in assessing whether the poor and the uneducated have benefited from RHIYA. Education is measured using three groups: (1) no schooling at all or some primary school education; (2) completed primary or some secondary education; (3) completed secondary and higher education. To compare levels of knowledge and behaviour by level of poverty, a standard of living index was computed using a set of questions regarding the respondent’s household belongings (electricity, radio, TV, bicycle, motorcycle, car/truck/van, telephone and refrigerator). Two groups are compared (the same categories are used in the 7 RHIYA countries): respondents are considered “poor” if their household had fewer than 4 items of the list of 8, and “better-off” if they owned 4 items or more. As shown in Table 1, approximately 1,200 respondents were interviewed for both surveys. The youngest age group was more numerous than the oldest. In part, this reflects Vietnam’s population structure: 15-19year-olds represent 11.2 % of the population, while the 20-24 age group accounts for only 10.1%.

Results of Baseline and Endline Quantitive Surveys

Respondents’ profile and characteristics

T able 2 shows participation rates in RHIYA activities, by background characteristics. The participation rate was measured by asking young people if they had heard about RHIYA and, if they had, if they had ever participated in any RHIYA activities. Overall participation rate was about 50% with males and females participating in similar proportions. This does not contradict routine data results that show a higher involvement of females in consultations, as is shown in the figure below regarding participation in RHIYA activities. There is a high level of homogeneity in participation rates across socio-economic groups, and a slightly higher participation rate among younger respondents.

4 | Carine Henoque © Young women in a group Lao PDR

Viet Nam: Final Report

Participant profiles were similar at baseline and endline. The percentage of people classified as living in households with a low standard of living was around 13% at baseline and decreased slightly in the two years following the survey. The number of respondents with no schooling or only some primary education was also very low. In consequence, results for respondents with low levels of education and standard of living are to be analyzed cautiously, given the small number of cases. Respondents with a high level of education (completed a secondary education or higher) account for two thirds of the sample, both for endline and the baseline surveys. This percentage is much higher than that found in the 2005 DHS survey (10.2% for female youth aged 15-19, and 27.7% for females aged 20-24 in DHS 2005; similar figures for males). Although RHIYA’s target population is not expected to represent the country, this higher proportion of educated people reflects the fact that the RHIYA’s target populations are located in more urban areas. Another characteristic of the RHIYA sample in Vietnam is the relatively low percentage of married respondents. This also reflects RHIYA’s target population, which is more urban and educated than the general population of Vietnam.

Male

Female

Education

Marital status Standard of living Total Total

Total endline

Participants

Participation rate (%)

15-19

402

204

20-24

209

15-24

611

294

15-19

399

222

20-24

206

15-24

605

311

low

medium

210

106

high

985

495

ever married

never married

1154

579

low

better off

1155

572

15-19

801

399

20-24

415

208

15-24

1216

605

Table 2: Profile of participants in RHIYA activities and participation rate, by background characteristics

Results of Baseline and Endline Quantitive Surveys

Viet Nam: Final Report

Estimating RHIYAâ&#x20AC;&#x2122;s coverage in Vietnam

Participation rates can give an idea of the coverage of the programme: the total target population of the sampled area was 213,436 people, of whom around 21.9% are expected to be between 15 and 24 years old. 46,742 young people were living in RHIYA target areas and were targeted by the programme. Out of this population, 50% have been in touch with RHIYA, which means that Rhiya has reached around 23,371 young people aged 15 to 24. This information is in keeping with routine data figures of the number of consultations and peer educator contacts.

4 | Carine Henoque ÂŠ Young women in a group Lao PDR

Results of Baseline and Endline Quantitive Surveys

Knowledge about reproduction and contraception In this section we focus on young people’s knowledge about reproduction and contraception. Two simple indicators of knowledge of reproduction are analyzed, and several indicators of knowledge of contraception, access to information and discussions about contraception are then presented. Knowledge of the fertile period

Viet Nam: Final Report

Knowledge of the fertile period is an indicator of young peoples’ elementary knowledge of reproductive physiology. Knowledge of the fertile period is critical for sexually active young people who do not use contraception but wish to avoid pregnancy. Such information was provided in RHIYA project areas through awareness-raising activities over the entire duration of the project. Knowledge of the fertile period was assessed in baseline and endline surveys with two questions. Each respondent was first asked if he/she knew if there was a period in a woman’s cycle when she was more likely to get

Baseline

Gender

4 | Carine Henoque © Young women in a group Lao PDR

Age group

Education

Marital status

Males

49.9

Females

72.4

15-19

55.3

20-24

71.4

low

35.0

medium

50.5

high

67.1

ever married

(71.1)

never married

60.9

Standard of living

low

47.9

better off

63.3

Total

15-24

61.3

Table 3: percentage of respondents who knew about the fertile period, by background characteristics

pregnant. Respondents who answered positively were then asked when a woman was most likely to get pregnant. Table 3 and Figure 6 show the percentage of respondents who knew about the fertile period. 100

Baseline

Figures in Percentages

Endline

72.4

Males

85.3

Females

Figure 6: Percentage of respondents who knew about the fertile period

Endline

Significance

Participants

Nonparticipants

Significance

61.0

***

68.4

53.7

***

85.3

***

90.4

79.9

***

69.5

***

77.5

60.1

80.0

***

84.9

76.2

***

(50.0)

65.2

***

73.6

56.3

***

75.3

***

81.2

69.1

***

91.8

***

(96.2)

(88.2)

72.2

***

78.9

65.1

***

63.9

***

(72.7)

(53.6)

***

73.6

***

80.1

67.0

***

73.1

***

79.7

66.3

***

Significance levels (one-tailed tests): *: p<0.10; **:p<0.05; ***:p<0.01; ns: not significant. Figures in brackets are based on less than 50 cases.

Results of Baseline and Endline Quantitive Surveys

49.9

Baseline

Gender

Age group

Education

Viet Nam: Final Report

Marital status

males

18.3

females

40.1

15-19

25.6

20-24

35.6

low

16.7

medium

19.9

high

33.7

ever married

(33.3)

never married

29.1

Standard of living

low

23.9

better off

30.1

Total

15-24

29.3

Table 4: Percentage of respondents who are able to correctly identify this period, by background characteristics

The percentage of young people who know that there is a fertile period significantly increased between the baseline and the endline, for both sexes and for all age groups. The percentage went from 61% to 73% for the sample. These increases were very similar across socio-economic groups and for both gender. As a result, differences observed at the baseline were still visible at the endline. For instance, females remain much more knowledgeable than males, with 85% of women responding correctly at the endline as compared to only 61% of men. Participants were also significantly more knowledgeable than non-participants. These results indicate that RHIYA has certainly had a strongly positive effect on respondentsâ&#x20AC;&#x2122; knowledge. Respondents were also asked when the fertile period in the womanâ&#x20AC;&#x2122;s cycle occurred. The percentage of respondents who are able to correctly identify this fertile period was much lower than the previous indicator, but there was also a large improvement between the baseline and the endline. Approximately 40% of respondents were able to identify the fertile period at the endline, as compared to only 30% at the baseline. Again, men were less knowledgeable than women. The level of knowledge was also higher among the more educated and people aged 20-24.

Significance

Participants

Nonparticipants

Significance

26.0

***

31.6

204

***

55.9

***

60.1

51.5

37.1

***

42.7

30.7

***

48.2

***

54.7

43.0

***

(15.0)

(0.0)

(18.8)

32.9

***

35.8

30.1

43.1

***

48.9

37.2

***

57.4

***

(53.8)

(61.8)

40.0

***

45.9

34.0

***

31.1

(45.5)

(14.3)

***

41.4

***

46.3

36.5

***

40.9

***

46.3

35.5

***

Significance levels (one-tailed tests): * : p<0.10; **:p<0.05; ***:p<0.01; ns: not significant. Figures in brackets are based on less than 50 cases.

Baseline

Figures in Percentages

Endline

60 50 40 30 20 10 0

18.3

Males

40.1

55.9

Females

Figure 7: Percentage of respondents who were able to correctly identify the fertile period

The qualitative survey confirms the positive impact RHIYA has on young peopleâ&#x20AC;&#x2122;s knowledge of the physical development period.

Results of Baseline and Endline Quantitive Surveys

Endline

4 | Carine Henoque ÂŠ Young women in a group Lao PDR

â&#x20AC;&#x153;Previously, young women did not know why their breasts were growing, and it scared them. They thought that they were sick. Since friendly corners have opened and girls have learned that this is natural, they have become more confident.â&#x20AC;?

Viet Nam: Final Report

(Service Corner staff member, Cham Mat, Hoa Binh).

Gender

Age group

Education

Marital status

Standard of living Total

Baseline

Endline

Significance Participants

males

63.6

76.6

***

80.3

females

77.2

83.5

***

86.8

15-19

65.6

76.7

***

82.4

20-24

78.7

86.5

***

86.6

low

36.7

(40.0)

(25.0)

medium

53.6

68.6

***

74.5

high

79.2

83.2

86.1

ever married

(75.6)

90.2

(92.3)

never married

70.3

79.5

***

83.2

low

55.8

75.4

***

(84.8)

better off

72.7

80.3

***

83.6

15-24

70.5

80.0

***

83.6

Significance levels (one-tailed tests): *: p<0.10; **:p<0.05; ***:p<0.01; ns: not significant. Figures in brackets are based on less than 50 cases.

Table 5: Percentage of respondents who were able to spontaneously name at least two modern contraceptive methods, by background characteristics

Knowledge of contraceptive methods Learning about contraceptive methods is crucial in young people’s decisions not only to use contraception but to chose an appropriate method. The diffusion of various forms of information via a variety of channels is thus an important element in improving the sexual and reproductive health of young people.

Results of Baseline and Endline Quantitive Surveys

Young people’s knowledge of contraception was first measured by asking respondents if they knew that there were methods for a woman to avoid or delay pregnancy. People who answered positively were then asked to name the methods they were aware of. Knowledge of contraception thus refers to respondents who were able to spontaneously name a contraceptive method. In Table 5, knowledge of at least two modern methods is presented by background characteristics. Knowledge by method types (the Pill, condom and other methods) is reported in Table 6.

73.2

80.2

70.4

***

86.4

(43.8)

63.1

80.5

***

(88.2)

76.0

***

(64.3)

77.2

***

76.6

4 | Carine Henoque © Young women in a group Lao PDR

NonSignificance participants

Knowledge about contraception increased notably between the two surveys. At the endline, 80% of young people were able to spontaneously name at least two contraceptive methods, compared to only 70% two years earlier. Results show that the improvement was higher among young males than among females. The difference between men and women was large at the baseline (63.6% for males as opposed to 77.2% for females), and the RHIYA contributed in part to narrowing the gap between males and females. The improvement in knowledge of contraception was also stronger among people with a medium education level and with a low standard of living. Knowledge of contraception is also higher among RHIYA activity participants than among non-participants, especially for people aged 15-19. These results clearly show that the RHIYA has contributed to informing young people about contraception. 100

Baseline

Figures in Percentages

Endline

Viet Nam: Final Report

63.6

76.6

77.2

Males

83.5

Females

Figure 8: Percentage of young people who know at least two modern contraceptive methods at the baseline and the endline, by gender

100

Baseline

Figures in Percentages

Endline

55.8

75.4

Low

72.7

80.3

Better off

Figure 9: Percentage of young people who know at least two modern contraceptive methods at the baseline and the endline, by living standard

Results of Baseline and Endline Quantitive Surveys

â&#x20AC;&#x153;Now I can see, in most cases, they get the contraceptive methods (condoms or the pill) from private health clinics, and from pharmacies. In pharmacies, they sell many of them.â&#x20AC;? (Single female, age 17, Cham Mat, Hoa Binh province.)

30 Daily Pill

Gender

Age group

Education

Viet Nam: Final Report

Marital status

Baseline

Endline

males

62.0

74.9

females

77.7

82.5

15-19

64.2

74.7

20-24

79.3

86.2

low

41.1

(50.0)

medium

54.6

65.6

high

77.3

82.0

ever married

(81.4)

91.8

never married

69.6

78.0

Standard of living

low

60.8

75.4

better off

71.2

78.8

Total

15-24

69.9

78.7

Figures in brackets are based on less than 50 cases.

Table 6: Percentage of respondents spontaneously naming the contraceptive pill, the condom and other methods, by background characteristics

Table 6 shows that the condom remains by far the best known method, even if the contraceptive pill is also well known. Young people mention any other method (IUD, implants, injections) less frequently. The condom was mentioned by 90% of respondents at the baseline survey, and as much as 96% of respondents named the condom at the endline survey. The percentage of respondents able to name the contraceptive pill also

100

Figures in Percentages

Baseline

Endline

80 60 40 20 0

69.9

78.7

Pill

90.5

96.1

Condom

35.5

27.5

Other

Figure 10: Contraceptive methods most commonly mentioned at baseline and endline

31 Other

Baseline

Endline

Baseline

Endline

88.3

95.7

27.7

22.1

92.7

96.5

43.1

32.9

87.7

95.9

32.8

25.3

95.1

96.6

40.0

31.6

64.3

(61.1)

15.0

(15.0)

82.6

92.8

27.1

18.1

95.2

97.5

40.2

29.7

(88.4)

91.8

(44.4)

44.3

90.7

96.3

35.1

26.6

79.1

93.4

30.7

16.4

92.2

96.3

36.2

28.1

90.5

96.1

35.5

27.5

increased significantly. However, the percentage of respondents who named methods other than condom and the pill (mainly IUD) decreased for all subgroups. This may result from the fact that the IUD is less recommended for young people, and therefore this method has been less emphasised during RHIYA projects than condoms and the contraceptive pill.

Baseline

Figures in Percentages

Endline

40 30 20 10 0

33.3

25.3

IUD

2,5

Implants

7,5

5,6

Injections

Figure 11: Other contraceptive methods most commonly mentioned at baseline and endline

Results of Baseline and Endline Quantitive Surveys

4 | Carine Henoque ÂŠ Young women in a group Lao PDR

Condom

“Young people are relatively well‑informed. For example, in a talk, when I asked what one should do to avoid pregnancy within 72 hours after sex without a condom, young people answered in chorus that they should take Postinor (an emergency anti‑conception tablet). This proves that they have made quite a great improvement in their knowledge of birth control”.

Viet Nam: Final Report

(Service Corner collaborator, Khanh Hoa).

Service providers were asked about young people’s knowledge during the qualitative survey. They also mentioned the increasing awareness of emergency contraception, which is more and more widespread in Vietnam.

Gender

Age group

4 | Carine Henoque © Young women in a group Lao PDR

Education

Marital status

Baseline

Endline

males

79.4

87.1

females

84.2

92.2

15-19

79.0

89.3

20-24

86.6

90.4

low

56.7

(45.0)

medium

73.8

87.1

high

86.5

91.2

ever married

(86.7)

93.4

never married

81.7

89.5

Standard of living

low

72.4

85.2

better off

83.3

89.9

Total

15-24

81.8

89.6

Access to information contraception and sources of information

The degree of increase among males and females was similar; differences between males and females remain small. Of particular interest is the strong improvement among the younger age group. This clearly shows that younger people have benefited from RHIYA. Differences between participants and non-participants confirm the contribution of RHIYA to improving access to information on contraception.

Significance

Participants

Nonparticipants

Significance

***

89.5

84.7

***

94.9

89.4

***

92.0

86.0

***

92.7

88.5

(100.0)

(31.3)

***

93.4

80.6

***

91.9

90.3

***

(96.2)

(91.2)

***

92.1

86.9

***

(93.9)

(75.0)

***

92.1

87.5

***

92.2

87.0

***

Significance levels (one-tailed tests): *: p<0.10 ; **:p<0.05; ***:p<0.01; ns: not significant. Figures in brackets are based on less than 50 cases.

Table 7: Percentage of respondents who perceive that information about contraception is easy to obtain, by background characteristics

Results of Baseline and Endline Quantitive Surveys

Easy access to information about contraception is a pre-condition for increasing young peopleâ&#x20AC;&#x2122;s knowledge about contraceptive methods and, ultimately, for better use of contraception. Respondents were asked in both surveys if they thought access to information about contraception was easy, difficult or impossible. Overall, results show that information about contraception is perceived as widely available. Information on contraception is perceived as largely available by almost 90% of the respondents, with a significant improvement since the baseline.

34 100

Baseline

Figures in Percentages

Endline

79.4

87.1

84.2

Males

92.2

Females

Viet Nam: Final Report

Figure 12: Percentage of respondents who perceive access to information about contraception as easy, by gender.

Health worker/ Peer educator/Youth counsellor/Teacher Baseline Endline

Gender

Age group

4 | Carine Henoque ÂŠ Young women in a group Lao PDR

Education

Marital status

Partner

Sign.

Baseline

males

20.4

48.6

***

50.0

females

27.3

52.4

***

30.3

15-19

24.8

52.6

***

25.0

20-24

22.4

46.5

***

36.6

low

13.3

(15.0)

11.1

medium

20.2

55.7

***

42.1

high

26.0

50.2

***

41.2

ever married

(24.4)

55.7

***

(35.6)

never married

23.8

50.3

***

Standard of living

low

25.2

55.7

***

33.3

better off

23.7

50.2

***

36.1

Total

15-24

23.9

50.5

***

35.6

Table 8 Percentage of respondents who discussed contraception in the last 6 months, by persons with whom respondents talked and by background characteristics

Discussion on contraceptive methods

(only for the married)

Relatives

Baseline Endline

Friends & colleagues

Endline

Sign.

Baseline Endline

Sign.

90.9

***

19.4

43.7

***

42.5

65.0

***

86.0

***

39.6

59.7

***

45.2

67.4

***

100.0

***

27.6

50.6

***

38.3

64.4

***

85.5

***

33.0

53.7

***

53.4

69.6

***

(33.3)

15.0

(30.0)

***

30.0

(30..)0

95.0

***

24.0

51.9

***

36.9

65.7

***

86.8

***

32.7

52.1

***

47.6

67.0

***

86.9

***

(26.7)

82.0

***

(24.4)

62.3

***

29.7

50.1

***

44.7

66.5

***

83.3

***

27.6

54.1

***

35.6

67.2

***

87.3

***

29.9

51.5

***

45.2

66.1

***

86.9

***

29.6

51.6

***

43.9

66.2

***

Significance levels (one-tailed tests): *: p<0.10; **:p<0.05; ***:p<0.01; ns: not significant. Figures in brackets are based on less than 50 cases.

Results of Baseline and Endline Quantitive Surveys

Discussion of contraception is a key factor in increasing knowledge and use of contraception. Discussion with health workers, counsellors and peer educators is a primary way for young people to get reliable information about contraception. Reaching beyond direct contact with RHIYA projects, discussion about contraception with friends, colleagues and relatives may be particularly relevant for the diffusion of information about contraceptive methods. Communication between spouses/partners is also an important step towards eventual use of contraception. In both surveys, respondents were asked if they had discussed contraception in the last six months with various people. Results are shown in Table 8 for four major categories of people.

The percentage of young people who discussed about contraceptive issues increased significantly for all types of interlocutors in the two-year lapse. At the endline, more than half of the respondents had talked with health workers, counsellors, teachers and peer educators in the six months preceding the survey, as compared to just one respondent in four at the baseline survey. Increases were equally strong among males and females and across socio-economic strata. These results indicate that discussions have contributed to a better knowledge of contraception among young people in RHIYA’s project areas. Table 8 also shows that two thirds of young people discussed contraception with friends and colleagues, the group of choice for this kind of discussion, in the preceding six months and half talked about contraception with relatives. A large increase occurred between the baseline and the endline, showing that discussion among friends and relatives has gained momentum and is now an important means of diffusing information. Finally, discussion among partners also increased greatly between the baseline and the endline. Only one young person in three had discussed contraception with his or her partner in the six months preceding the baseline survey, compared to 9 out of 10 at the endline.

Baseline

Figures in Percentages

Endline

80 60 40 20 0

23.9

50.5

Health worker

35.6

86.9

Husband/ Partner

29.6

51.6

Relatives

43.9

66.2

Friends & Colleagues

Figure 13: Percentage of respondents who discussed contraception in the last 6 months, by persons with whom respondents talked.

Access to contraceptive methods Access to contraception is a pre-requisite for its use when needed. It was not possible to measure access in the survey, as this would have required organizing surveys in health services, pharmacies, etc. It was therefore decided to measure young people’s perception of access to contraception. This was done by asking respondents if they thought it would be easy, difficult or impossible for them to obtain and use contraception.

4 | Carine Henoque © Young women in a group Lao PDR

Viet Nam: Final Report

100

Baseline Endline

Gender

Age group

Education

Marital status

Standard of living Total

Significance

Participants

Nonparticipants

Significance

males

64.4

88.1

***

90.1

85.9

females

63.2

89.1

***

93.2

84.6

***

15-19

58.6

86.3

***

89.9

81.9

***

20-24

72.5

93.0

***

96.1

90.6

***

low

50.0

(75.0)

(100)

(68.8)

medium

50.5

82.4

***

88.7

75.7

***

high

69.9

90.2

***

92.3

87.9

***

ever married

(84.4)

100

***

(100)

never married

63.1

88.0

***

91.4

84.6

***

low

54.0

88.5

***

(97.0)

(78.6)

***

better off

65.3

88.6

***

91.4

85.6

***

15-24

63.8

88.6

***

91.7

85.3

***

Significance levels (one-tailed tests): *: p<0.10; **:p<0.05; ***:p<0.01; ns: not significant. Figures in brackets are based on less than 50 cases.

Table 9: Percentage of respondents who perceive that it is easy to get and use contraception, by background characteristics

Table 9 shows a significant increase in the percentage of people who think access to contraception is easy: from 64% at the baseline to 89% at the endline. A significant improvement in the access of contraception is perceived by all categories of people, but especially among the youngest age group. At the endline, some differences across socio-economic groups remained. For instance, more educated people are more likely to report that access to contraception is easy, and gender differences are very small. The differences between participants and non-participants were also significant, both for access to information and access to contraception itself.

Results of Baseline and Endline Quantitive Surveys

The public free-delivery channel “only serves married people”

4 | Carine Henoque © Young women in a group Lao PDR

Viet Nam: Final Report

(Married female, Cham Mat, Hoa Binh).

Qualitative information from individual in-depth interviews and youth focus group discussions showed that private pharmacies and private health care centres/clinics were frequently mentioned the places to find contraception. This was a much more frequent answer than public facilities where contraception is free; but which were said to serve only married people.

“Anyway, they only distribute to married people”

“Just go to a pharmacy to get it. It is just like buying cigarettes” (Male married youth, 15-24 age group, Cham Mat, Hoa Binh.)

“Nowadays, with pocket money, we can get all of these…methods. Even at night when pharmacies were closed if you knock on the door, they will still sell them to you. It’s a market-oriented economy we’re living in” (Single male, Cham Mat, Hoa Binh).

Results of Baseline and Endline Quantitive Surveys

(Single male, Cham Mat, Hoa Binh).

“For me, pre-marital sex is bad but we should sympathise with females. They are very trusting.” Female, 9th grade pupil, Ward 6, District 3, Ho Chi Minh City

This section focuses on sexual behaviour and contraceptive use among young people. Respondents were asked whether they had ever had sexual intercourse, and those who had were asked how old they were when they first had intercourse. Other questions on the nature of their first and last sexual encounter and on the use of condoms and contraception were also asked. Questions on pregnancies and births were also asked, especially to measure adolescent pregnancy levels.

Sexual behaviour Table 10 indicates that from 7.7% to 11.6% of young people in the RHIYA’s project areas in Vietnam have ever had sexual intercourse. There is a slight increase between baseline and endline, which may reflect an increase of sexual activity among young people, but may also be due to slight differences in sample compositions. The percentage is expectedly lower among the youngest group (2.2% in the baseline and 2.7% in the endline) and is comparable for males and females. Although one might expect under-reporting of sexual relationships among young people, this percentage is relatively low in comparison to other RHIYA countries. The median age at first intercourse was measured with the life table method at more than 25 years for both males and females. The quantitative surveys also show that prevalence of premarital sex is low (about 5%). Given that this is a traditionally under-reported issue, the actual proportion is expected to be higher. Premarital sex is almost exclusively reported by young males: 9.5% of unmarried young males report that they have had sexual intercourse, as compared to less than 2% among young females (n=12). In keeping with results from the quantitative survey, group discussions with youth revealed that many young people considered the appropriate age for first intercourse was between 18 and 24. The participants were also of the opinion that males were more active than females in sexual intercourse.

4 | Carine Henoque © Young women in a group Lao PDR

Viet Nam: Final Report

Sexual behaviour, contraceptive use and pregnancy

Baseline

Endline

females

6.5

9.9

15-19

2.2

2.7

20-24

17.1

119

28.7

low

23.3

25.0

medium

12.0

13.8

high

5.1

107

10.9

ever married

100

never married

4.2

6.9

low

9.2

21.3

better off

7.5

128

11.1

Total

15-24

7.7

141

11.6

Median age at first

males

>25

females

>25

Age group

Education

Marital status

Standard of living

Table 10: Number and percentage of sexually active respondents, by background characteristics.

Results of Baseline and Endline Quantitive Surveys

Viet Nam: Final Report

“Of course, it cannot be accepted because we don’t know if marriage will happen or not. Even when marriage happens, the female is on the losing side.” (Female, 9th grade pupil, Ward 6, District 3, Ho Chi Minh City).

“In my opinion, pre-marital sex is unacceptable at any age.” (Female, 9th grade pupil, Thanh Xuan Bac ward, Hanoi).

“I think that between the ages of 18 and 24, people may have pre-marital sex if they agree to do so. But younger people should not.”

“I think both males and females like pre-marital sex but males are more likely to propose having it as they are more active in this regard.” (Female, 9th grade pupil, Thanh Xuan Bac ward, Hanoi).

“Probably 80% of the initiative for sex comes from males.” (Single male, Huong Toan commune, Huong Tra district, Thua Thien Hue)

“In general, both like it but men are a bit more active in initiating sex.” 4 | Carine Henoque © Young women in a group Lao PDR

(Married female, Cham Mat, Hoa Binh).

The attitude of youth towards pre-marital sex was not unanimous. Some respondents opposed pre‑marital sex while others reported it as dependant on the situation. Other people said that they totally accepted pre-marital sex and thought it was “as normal as eating or drinking.” As in many other countries, opposition to premarital sexuality main concerns women.

Results of Baseline and Endline Quantitive Surveys

(Single male, Huong Toan commune, Thua Thien Hue)

“I think that pre-marital sex is a big problem. I do not agree with it because it violates Eastern people’s morals. It is different for Westerners. Eastern people are conservative but Western people are open in their sexual relations… I oppose it because females bear the disadvantages more. If pre-marital sex happens, marriages will not be good later.”

“If a female gets pregnant and has an abortion, it will effect the female’s health. Besides, the male will not treat the female with respect afterwards.” (Single male, Huong Toan commune, Huong Tra district, Thua Thien Hue).

“Acceptance and non-acceptance exist together. If people have sex only out of curiosity or leisure and not for love, it is not acceptable. If the person is in love with his or her partner and will get married later, pre-marital sex is acceptable… If they have plans for marriage in the next month, pre-marital sex can be accepted, but if they love each other and do not get married after two or three years, pre-marital sex cannot be accepted.” (Single male, Huong Toan commune, Huong Tra district, Thua Thien Hue)

4 | Carine Henoque © Young women in a group Lao PDR

Viet Nam: Final Report

(Single male, Huong Toan commune, Huong Tra district, Thua Thien Hue)

Results of Baseline and Conclusion Endline Quantitive Surveys

â&#x20AC;&#x153;Pre-marital sex is not bad if it does not have any consequences.â&#x20AC;? (Single male, Cham Mat, Hoa Binh)

Viet Nam: Final Report

4 | Carine Henoque © Young women in a group Lao PDR

“I think that pre-marital sex is a normal need. If one has sufficient knowledge about sexuality, it will not cause any problems. But if people do not understand [about sexuality], they may have to bear the consequences later.” (Single male, Huong Toan commune, Huong Tra district, Thua Thien Hue)

Use of contraception Adolescent fertility is a major social and health concern. Young mothers are more likely to suffer from complications during pregnancy and childbirth due to physiological immaturity. An early start to childbearing also tends to reduce educational opportunities for young women. The use of effective methods of contraception is thus a major concern among sexually active young people. Condom use is also of great importance as a means of protection against HIV/AIDS and other sexually transmitted infections. All the sexually active respondents were asked if they had ever used a method to delay or avoid getting pregnant. Those who had were then asked if they had used any specific modern method. This information makes it possible to assess the use of modern methods of contraception, which shows the cumulative success of programs encouraging the use of contraception. Current use was measured by asking respondents if they or their partner had used a modern method the last time they had sexual intercourse. Current contraceptive use is more prone to changes in behaviour and remains the preferred indicator of the success of behaviour change programmes. These indicators were calculated only for the sexually active and, as previously stated, with only 95 respondents at baseline and 141 at endline survey, this sub-sample is small in Vietnam. Consequently, it does not allow to measure significant changes for all subcategories. Table 11 shows a significant improvement for all the sexually active young people, with the percentage of â&#x20AC;&#x153;ever usersâ&#x20AC;? rising from 62% to 82% between the baseline and endline. The prevalence of contraception reflects also increased sharply in Vietnam, from 47% at baseline to 66% two years later. This is largely due to an increase in condom use among young males and females, demonstrating the effect of RHIYA on changes in behaviour in addition to changes in knowledge.

Results of Baseline and Endline Quantitive Surveys

4 | Carine Henoque ÂŠ Young women in a group Lao PDR

“Children out-of-wedlock will suffer. Their peers will tease them, saying things like “you are a child without a father.” (Single female, Huong Toan commune, Huong Tra, Thua Thien Hue).

ever used any modern method of contraception

Gender

Education

4 | Carine Henoque © Young women in a group Lao PDR

Viet Nam: Final Report

Age group

Marital status

Baseline

Endline

Significance

males

(78.2)

87.7

females

(40.0)

75.0

***

15-19

(64.7)

(54.5)

20-24

61.5

87.4

***

low

(35.7)

(80.0)

medium

(65.8)

(82.8)

high

(67.4)

82.2

ever married

(46.7)

82.0

***

never married

76.0

82.5

Standard of living

low

(33.3)

(84.6)

better off

67.5

82.0

Total

15-24

62.1

82.3

***

We can see that males are much more likely to have used a contraceptive method than females. This may be linked with the fact that young males are more likely to have sexual relations before or outside marriage, and tend to use condoms in such relations. Table 12 shows that condom use is indeed much higher among young males and among unmarried people, confirming this hypothesis.

Baseline

Endline

Significance

(61.8)

77.8

(27.5)

50.0

(47.1)

(50.0)

47.4

68.9

***

(21.4)

(60.0)

(50.0)

(69.0)

(53.5)

65.4

(31.1)

50.8

62.0

77.5

(26.7)

(61.5)

51.3

66.4

47.4

66.0

***

Significance levels (one-tailed tests): *: p<0.10; **:p<0.05; ***:p<0.01; ns: not significant. Figures in brackets are based on less than 50 cases.

Table 11 : Percent of respondents who reported having ever used a modern contraceptive method before and the last time they had intercourse, by background characteristics.

“Parents would be worried that pre‑marital pregnancy and childbirth affect the family, economy and cause them to lose people’s respect.” (Female pupil, 9th grade, Thanh Xuan Bac ward, Hanoi).

Results of Baseline and Endline Quantitive Surveys

used a modern method of contraception at last intercourse

100

Baseline

Figures in percentages

Endline

61.8

77.8

27.5

Males

Females

Viet Nam: Final Report

Figure 14: Percentage of sexually active respondents having used a modern method of contraception at last intercourse, by gender.

When looking at the type of contraception used, we notice that men are much more likely to have used condoms than women. However, the condom is the most commonly used method, followed by the contraceptive pill, for both males and females.

Method used at last intercourse: pill

Gender

Age group

Education

Marital status

Baseline

Endline

Significance

males

(14.5)

25.9

females

(12.5)

13.3

15-19

(23.5)

(9.1)

20-24

11.5

22.7

low

(0.0)

medium

(18.4)

(6.9)

high

(14.0)

25.2

ever married

(8.9)

(9.8)

never married

18.0

28.8

Standard of living

low

(0.0)

(23.1)

better off

16.3

20.3

Total

15-24

13.7

20.6

Significance levels (one-tailed tests): *: p<0.10; **:p<0.05; ***:p<0.01; ns: not significant. Figures in brackets are based on less than 50 cases.

Table 12 Percentage of sexually active respondents having used a modern method of contraception at last intercourse, by type of method and by background characteristics.

Pregnancy and birth

Results of Baseline and Endline Quantitive Surveys

Early childbearing is an important issue, as it is usually linked with high maternal and child mortality. All female respondents were asked if they had been pregnant before and all male respondents if they have children. A relatively small percentage of the women had already been pregnant. This is related to the relatively late marriage age in the RHIYA project areas, where education levels and status are higher than those of the general Vietnamese population. Especially for women, first sexual intercourse is closely associated with marriage. At baseline, around 5.5% of women had been pregnant, while at endline the percentage rose to 7.6%. Although there may have been a slight increase in adolescent pregnancy, the difference between baseline and endline is most probably due to differences in sample compositions. Table 13 shows that, at 0.3%, pregnancy and birth outside marriage are rare.

Baseline

Endline

Significance

(52.7)

70.4

(7.5)

18.3

(29.4)

(36.4)

34.6

50.4

(21.4)

(40.0)

(34.2)

(44.8)

(37.2)

49.5

(8.9)

(19.7)

56.0

70.0

(20.0)

(46.2)

36.3

48.4

33.7

48.2

4 | Carine Henoque ÂŠ Young women in a group Lao PDR

Method used at last intercourse: condom

Baseline

Endline

males

0.7

0.0

females

5.5

7.6

low

16.7

(15.0)

medium

5.0

8.6

high

1.4

2.5

ever married

(77.8)

75.4

never married

0.3

0.0

low

4.9

9.8

better off

2.8

3.5

Males

>25

Females

>25

Gender

4 | Carine Henoque ÂŠ Young women in a group Lao PDR

Viet Nam: Final Report

Education

Marital status Standard of living Median age at first child pregnancy

Figures in brackets are based on less than 50 cases.

Table 13 Percentage of women who have been pregnant and of men who have children, by background characteristics and median age at first pregnancy (fatherhood).

Baseline

Figures in Percentages

Endline

0.9

1.25

15-19

20-24

Figure 15: Percentage of women who have ever been pregnant, by age group.

When looking more closely by age group at the percentage of women who have been pregnant before (Figure 16), we see that the percentage of teenage pregnancies is extremely low. In consequence, the median age at first pregnancy or at fatherhood is above 25 years old. The low level of adolescent pregnancies can be related to the fact that premarital sexual relationships are not accepted for young females, which tends to reduce premarital pregnancies. However, the low level of adolescent pregnancies may also be due to underreporting of pregnancies that were terminated by an induced abortion, which is frequent in Vietnam.

“In my opinion, it is hard to accept people [who have pre-marital pregnancy]. Pre-marital childbirth is unacceptable.” (Single female, Huong Toan commune, Huong Tra, Thua Thien Hue).

The qualitative surveys registered respondents’ opinions on whether premarital pregnancy and childbirth should be avoided or not. A commonly held belief is that pre-marital pregnancy leads to an unhappy life, the root of all difficulties for the young mother and her child and the start of economic difficulties and reduced social status for her family.

“I think that they would be expelled from school and condemned by society.” (Female pupil, 9th grade, Thanh Xuan Bac ward, Hanoi).

“Pre-marital pregnancy may make the husband suspect that the child is not his.” (Female pupil, 9th grade, Thanh Xuan Bac ward, Hanoi).

“Sure, they [old people] will fiercely oppose that [pre-marital pregnancy]” (Vice Rector of Secondary School, Cham Mat, Hoa Binh)

Results of Baseline and Endline Quantitive Surveys

Viet Nam: Final Report

“Males getting their partners pregnant is just normal.” (Married male, Cham Mat, Hoa Binh)

Some participants in focus group discussions pointed out that opposition to these practices varies from one family to the next, and depending on the girls’ ages.

“I think that it depends on the age of the girl. Pregnancy at young ages may be more tolerable as it is often a result of emotional immaturity. It is less acceptable at older ages as the girl is more emotionally mature.” (Female pupil, 9th grade, Thanh Xuan Bac ward, Hanoi).

Results of the survey also reveal a clear gender inequality in attitudes towards pre-marital pregnancy and childbirth. Male youth tend to think pre-marital pregnancy and making their partners pregnant is “normal”, while young females are more likely to be opposed to pre-marital pregnancy.

4 | Carine Henoque © Young women in a group Lao PDR

“I think the society is more against girls.” (Head of Health Centre, Huong Toan commune, Huong Tra, Thua Thien Hue)

“Through talks with villagers, I also feel the changes. For example, previously, in rural areas young people would often hold urgent weddings to cover up for pregnancies. But today, with RHIYA’s influence, this has dramatically gone down.” “Previously, adolescents frequently had abortions. But now this rate has fallen a little, but only a little, not entirely.” (Vice Chairman of Phuoc Ninh quarter, Da Nang).

Local authorities also stressed the positive impact RHIYA has on the reproductive health of young people in the intervention areas who are changing their sexual practices: youth are going from unsafe sex and relations that causes unplanned pregnancy to safe sex and relations that do not lead to pregnancy.

Results of Baseline and Endline Quantitive Surveys

Knowledge of HIV/AIDS and other STIs

Viet Nam: Final Report

At about 0.5% of HIV-positive persons, Vietnam is a country with low prevalence of HIV/AIDS. However, the HIV/AIDS epidemic is a serious health and development concern in the country. Sex workers account for two thirds of people infected with HIV (source: UNAIDS). Providing young people with reliable and accurate information on HIV/AIDS and other sexually transmitted infections is a key element in the fight against the epidemic. This work was done as part of RHIYA’s projects via peer education, media broadcasting of information, counselling sessions, etc. The two surveys included a series of questions to assess the level of knowledge young people have of HIV/AIDS and other STIs, as well as how these infections can be transmitted and prevented. Comparisons of the baseline and endline surveys show positive and significant changes in knowledge of HIV/AIDS and STIs over the duration of the project.

“I think that it is normal for unmarried men to have children.” (Single male, Huong Toan commune, Huong Tra, Thua Thien Hue). Gender

Age group

4 | Carine Henoque © Young women in a group Lao PDR

Education

Marital status

Baseline

males

98.5

females

98.9

15-19

98.7

20-24

98.7

low

88.3

medium

98.1

high

99.6

ever married

(97.8)

never married

98.7

Standard of living

Low

96.3

better off

99.1

Total

15-24

98.7

Awareness of HIV/AIDS Respondents were asked whether they had heard of HIV/AIDS. They were first asked to name sexually transmitted infections they had heard of; those who had not spontaneously mentioned HIV/AIDS were then asked if they had heard of HIV/AIDS. Data on awareness of HIV/AIDS by background characteristics of respondents is presented in Table 14. Awareness of HIV/ AIDS is almost universal in Vietnam. Ninety-nine percent of respondents raised the issue during the baseline survey two years ago. Knowledge of this infection is nearly 100% for all categories: the increase between the two surveys (around 1%) is too small to be significant.

Discussion of HIV/AIDS indicates the degree of openness about this issue among young people in Vietnamese society. Discussion is an important way of improving knowledge of HIV/AIDS and a step towards changing behaviour. Discussion with health workers, counsellors and peer educators is particularly important in this respect, as it is a major means of obtaining reliable information on HIV/AIDS. Discussion with friends, colleagues and relatives can be instrumental in raising young peopleâ&#x20AC;&#x2122;s awareness about HIV/AIDS, indirectly and beyond those directly in contact with the RHIYA project. Finally, spousal communication is also an important element in HIV/AIDS prevention. In both surveys, respondents were asked if they had discussed HIV/AIDS in the last six months with various kinds of people. Results are shown for four major categories in Table 15.

Endline

Significance

Participants

Nonparticipants

Significance

99.2

993

99.0

99.3

99.4

99.3

99.1

99.5

99.3

100

98.7

(90.0)

(100)

(87.5)

99.5

100

99.0

99.4

99.2

99.6

100

(100)

99.2

99.3

99.1

96.7

(97.0)

(96.4)

99.4

99.5

99.3

99.2

Significance levels (one-tailed tests): *: p<0.10; **:p<0.05; ***:p<0.01; ns: not significant. Figures in brackets are based on less than 50 cases.

Table 14 Percentage of respondents who have heard of HIV/AIDS (spontaneous and prompted answers) by background characteristics

Results of Baseline and Endline Quantitive Surveys

Discussions on HIV/AIDS

Health worker / Peer educator / Youth counsellor / Teacher Baseline Endline

Gender

Age group

Education

Viet Nam: Final Report

Marital status

Sign.

Husband / partner (only for the married) Baseline Endline

males

23.7

49.9

***

41.7

72.7

females

33.3

54.0

***

42.4

72.0

15-19

30.9

55.2

***

25.0

50.0

20-24

24.6

45.8

***

43.9

74.5

low

6.7

(10.0)

11.1

(66.7)

medium

22.1

55.2

***

36.8

80.0

high

32.6

52.2

***

64.7

68.4

ever married

(26.7)

45.9

***

(42.2)

72.1

never married

28.6

52.3

***

Standard of living

low

24.5

49.2

***

33.3

83.3

better off

29.2

52.1

***

44.4

70.9

Total

15-24

28.5

52.0

***

42.2

72.1

Table 15: Percentage of respondents having discussed HIV/AIDS in the last six months, by people with whom respondents talked and by background characteristics.

As was the case for contraception (Table 7), the percentage of young people having discussed HIV/AIDS-related issues increased significantly over the project duration. At endline, 52% of the respondents had discussed with health workers, counsellors, teachers and peer educators in the six month preceding the survey, compared to just 28.5% in the baseline survey. This is true for discussions with all the categories of people: health professionals, partners, relatives and friends or colleagues.

100

Baseline

Figures in Percentages

80 60 40 20 0

28.5

Health worker

42.2

72.1

Husband/ Partner

31.8

51.5

Relatives

48.7

71.1

Friends & Colleagues

Figure 16: Percentage of respondents having discussed HIV/AIDS

Endline

Baseline Endline

Sign.

Baseline Endline

Sign.

21.4

44.5

***

47.3

70.7

***

42.0

58.5

***

50.1

71.4

***

31.3

51.3

***

45.9

69.9

***

32.7

51.8

***

53.4

73.3

***

20.0

(35.0)

26.7

(60.0)

***

27.8

52.4

***

41.0

72.9

***

34.2

51.7

***

53.1

70.9

***

(28.9)

57.4

***

(24.4)

57.4

***

31.9

51.2

***

49.7

71.8

***

28.8

50.8

***

42.3

75.4

***

32.3

51.5

***

49.7

70.8

***

31.8

51.5

***

48.7

71.1

***

Significance levels (one-tailed tests): *: p<0.10; **:p<0.05; ***:p<0.01; ns: not significant. Figures in brackets are based on less than 50 cases.

Friends and colleagues are the category young people prefer to speak with: 71% of respondents discussed HIV/AIDS with their friends and colleagues in the six months preceding the endline survey, while only 51% discussed with a relative and 52% with a health professional. This shows that discussion among friends is an important way of diffusing information on HIV/ AIDS, even more so that it is for contraception. Young women are slightly more likely to discuss HIV/AIDS with their friends than they were two years before. Finding ways of increasing communication between friends about reproductive health issues (in addition to the use of peer educators) might be an efficient way of diffusing information among young people. There are few gender differences: the proportion of males and females is similar for discussions with friends and colleagues and with spouses, while women are more likely to discuss with their relatives and, to a lesser extend, with health workers.

The qualitative survey confirms that youth often discussed HIV/ AIDS with friends and siblings, but are more reluctant to talk about this with their parents.

Results of Baseline and Endline Quantitive Surveys

Sign.

Friends & colleagues

4 | Carine Henoque ÂŠ Young women in a group Lao PDR

Relatives

“It is possible to discuss HIV/AIDS with our siblings – brother with brother, sister with sister – when their ages are not substantially different.”

Viet Nam: Final Report

(Single male, 16-24 age group, Hoa Binh).

“In our group, we can openly share [information about HIV/AIDS] even with boys but especially with close friends.” (Single female, 16-24 age group, Hoa Binh)

Results of Baseline and Endline Quantitive Surveys

“My brother is not much older than me so we can openly share [information about HIV/AIDS]” (Male pupil, 9th grade, Thanh Xuan Bac Ward, Hanoi)

Viet Nam: Final Report

Knowledge of methods of transmission and prevention of HIV/AIDS Improving knowledge about methods of transmission and prevention of HIV/AIDS is necessary in order to change behaviour and to limit the spread of the virus. The extent of young people’s knowledge was assessed through a series of prompted questions, in which the interviewer read a list of correct and incorrect statements about HIV/AIDS transmission and prevention. Responses to the statements about prevention were used to calculate the proportion of people who know methods to avoid the transmission of HIV/AIDS. Only one question related to transmission of HIV/AIDS is available for baseline-endline comparisons in Vietnam (“limiting to one the number of sexual partners”), given that the two other questions were removed from the core questionnaire.

“I have never discussed such issues [HIV/AIDS] with my parents. I only talk with my older sister.” (Female pupil, 9th grade,

Age group

Education

Marital status

Endline

Significance

males

82.0

88.7

***

females

81.9

91.6

***

15-19

79.4

88.6

***

20-24

86.4

93.0

***

low

55.0

(65.0)

medium

75.4

86.7

***

high

86.4

91.4

***

ever married

(80.0)

93.4

Never married

82.2

89.9

***

Standard of living

low

69.9

91.8

***

better off

83.8

90.0

***

Total

15-24

82.0

90.1

***

Significance levels (one-tailed tests): *: p<0.10; **:p<0.05; ***:p<0.01; ns: not significant. Figures in brackets are based on less than 50 cases.

Table 16: Percentage of respondents by knowledge of methods to avoid HIV/AIDS, by sex, age group, educational level, marital status and standard of living.

T able 16 shows the proportion of respondents who know that having only one sexual partner would prevent HIV/AIDS. This percentage increased from 82% to 90% in the endline. Here again, we should highlight the few gender differences.

Gender

Baseline

Results of Baseline and Endline Quantitive Surveys

Thanh Xuan Bac Ward, Hanoi)

Gender

Viet Nam: Final Report

Age group

Education

Marital status

Baseline

Endline

Significance

males

69.9

76.4

***

females

64.1

73.4

***

15-19

64.1

75.5

***

20-24

71.9

73.7

low

45.0

(35.0)

medium

52.4

66.7

***

high

74.0

77.5

ever married

(44.4)

57.4

never married

67.9

75.9

***

Standard of living

Low

54.0

49.2

better off

69.0

76.3

***

Total

15-24

67.0

74.9

***

4 | Carine Henoque ÂŠ Young women in a group Lao PDR

% of respondents who think it is not possible to contract HIV/AIDS... ... through mosquito bites

74.9

81.9

***

... by sharing food with an infected person

85.5

91.4

***

... through witchcraft / supernatural means

85.5

91.4

***

A healthylooking person can have HIV

n.a.

89.7

Significance levels (one-tailed tests): *: p<0.10; **:p<0.05; ***:p<0.01; ns: not significant. Figures in brackets are based on less than 50 cases.

Table 17: Percentage of young people who do not hold misconceptions about HIV/AIDS, by background characteristic.

â&#x20AC;&#x153;She may think that she knows what AIDS is and that AIDS is incurable but she has never asked us why AIDS is incurable. Probably because she is too young and she is afraid to ask such a question.â&#x20AC;?

Improving knowledge about the transmission of HIV is necessary to changing behaviour and limiting the spread of the disease. Indeed, misconceptions about the means of transmission, such as mosquito bites or other uncontrollable events, may act to discourage behavioural changes, as some people may not take effective precautions to avoid HIV/AIDS if they believe they will be infected regardless. The extent of knowledge about means of transmission among young people was assessed through a series of prompted questions, in which the interviewer read a list of correct and incorrect statements about AIDS transmission. Table 13 presents the percentages of respondents who do not have any of four common misconceptions: HIV/AIDS can be transmitted by 1) mosquito bites, 2) witchcraft or supernatural means, and 3) sharing food with an HIV/AIDS infected person 4) a healthy looking person can have HIV/AIDS. Misconceptions about HIV/AIDS are still an issue, despite significant improvement since the baseline survey for all categories. Eight youth in 10 know that HIV/AIDS cannot be transmitted by mosquito bites or witchcraft (no differences between males and females); 9 in 10 know that HIV/AIDS cannot be transmitted by sharing food with a person who is HIV/AIDS-positive. Interestingly, the changes from baseline to endline are most impressive for the youngest group (ages 15-19), while changes are hard to detect for the older age group. In all, more than two third of respondents do not hold any of the three misconceptions about HIV/AIDS.2

Only the first three misconceptions are included in the composite indicator, because one question was not included at baseline.

Results of Baseline and Endline Quantitive Surveys

(The mother of 9th grade pupil, Ward 6, District 3, Ho Chi Minh City)

“One should not receive food or drink from strangers.” (Male pupil, 5th grade, Ward 6, Dist 3, Ho Chi Minh City)

“HIV can be transmitted through talking through mouths and breathing.” (Female pupil, 5th grade, Ward 6, Dist 3, Ho Chi Minh City)

“HIV can be transmitted though breathing.”

Viet Nam: Final Report

(Female pupil, 5th grade, Thanh Xuan Bac Ward, Hanoi)

These positive results from the quantitative surveys should not conceal the fact that misconceptions about HIV/AIDS are still prevalent among young people, as shown by some interviews in the qualitative survey.

T he equality between males and females must be highlighted here. Both genders’ knowledge is similar and this reflects the input in the young girls’ education in the last decades.

100

Baseline

Figures in Percentages

Endline

80 60 40 20 0

69.9

76.4

Males

64.1

73.4

Females

Figure 17: Percentage of young people who do not hold misconceptions about HIV/AIDS

Results of Baseline and Endline Quantitive Surveys

“Be careful when walking outside. One should keep away from strangers because even a stranger who looks healthy may already be infected.” (Female pupil, 9th grade, Ward 6,Dist 3, Ho Chi Minh City)

“I know about AIDS from the TV, newspapers and radio.” (Female pupil, 5th grade, Ward 6, Dist 3, Ho Chi Minh City)

“Nowadays, all young people know about HIV/AIDS because it is mentioned on the TV, newspapers and radio.”

Access to information on HIV/AIDS Access to appropriate information about HIV/AIDS is critical in the fight against the disease. The better young people are informed, the more protective measures they will take. Young people are particularly vulnerable, especially the unmarried, as they are not targeted by family planning programmes. Respondents were asked in both surveys if they thought access to information on HIV/AIDS was easy, difficult or impossible. Overall, results show that information on HIV/AIDS is perceived as widely available: 95% of respondents are of the opinion that access is easy. Males and females have similar perceptions of their access to information. Information on HIV/AIDS is also perceived to be more easily accessed than two years ago by all the categories of respondents.

The qualitative part of the survey showed that TV and radio are considered as major source of information on HIV by young people. The quantitative survey showed that discussions with health workers, peer educators, teachers and counsellors are also a major way of getting information, that can complement mass media by providing more detailed and specific information.

Viet Nam: Final Report

(Married male youth, 20-24 age group, Cham Mat, Hoa Binh)

â&#x20AC;&#x153;I think 90% of young people know about HIV/AIDS, mainly from TV. I also learnt a lot from TV.â&#x20AC;?

Gender

Age group

Education

Marital status

Standard of living Total

Baseline

Endline

Significance

males

85.8

94.8

***

females

87.2

96.0

***

15-19

84.8

95.0

***

20-24

89.5

96.1

***

low

58.3

(60.0)

medium

76.0

94.8

***

high

92.4

96.2

***

ever married

(73.3)

93.4

***

never married

87.0

95.6

***

low

77.9

93.4

***

better off

87.9

95.5

***

15-24

86.5

95.4

***

Significance levels (one-tailed tests): *: p<0.10; **:p<0.05; ***:p<0.01; ns: not significant. Figures in brackets are based on less than 50 cases.

Table 18 Percentage of respondents who think it is easy to obtain information on HIV/AIDS, by sex, age group, educational level, marital status and standard of living.

Results of Baseline and Endline Quantitive Surveys

(Female, 16-20 age group, Thua Thien Hue)

Knowledge of STIs other than HIV/AIDS

Viet Nam: Final Report

Prevention of STIs other than HIV/AIDS is also a key issue in improving the reproductive health of young people. STIs can have serious consequences for young women, such as higher levels of foetal mortality and sterility. STI infections also increase the risk of infection by HIV, and the prevention of STIs is also a strategy for preventing the spread of HIV/AIDS. To assess the knowledge of STIs in the RHIYA project areas, respondents were asked whether they had heard of sexually transmitted infections other than HIV/AIDS. They were first asked to name sexually transmitted infections they had heard of, and people who had not mentioned any STI were then asked if they knew that infections (apart from HIV/AIDS) could be transmitted through sexual relations. The indicator used in this report includes spontaneous as well as prompted answers.

Gender

Age group

Education

Marital status

Baseline

Endline

Significance

males

89.3

98.0

***

females

94.5

98.8

***

15-19

90.3

98.4

***

20-24

94.7

98.6

***

low

70.0

(80.0)

medium

85.8

97.6

***

high

95.7

99.0

***

ever married

(88.9)

98.4

never married

92.1

98.4

***

Standard of living

low

84.0

98.4

***

better off

93.1

98.4

***

Total

15-24

91.9

98.4

***

Significance levels (one-tailed tests): *: p<0.10; **:p<0.05; ***:p<0.01; ns: not significant. Figures in brackets are based on less than 50 cases.

Table 19 Percentage of respondents who have heard of STIs, by background characteristics.

Knowledge of STIs is lower than that of HIV/AIDS. Here again, males’ and females’ knowledge is comparable, while education is a slightly discriminating factor. When asked whether they had heard about sexually transmittable diseases, 98.4% of respondents answered positively; this is an increase from the baseline figure of 92%.

Baseline

Figures in Percentages

Endline

100 80 60

40 20 0

89.3

Males

94.5

98.8

Females

Figure 18: Percentage of respondents who have heard of STIs, by gender.

Results of Baseline and Endline Quantitive Surveys

Sources of information on STIs As with HIV/AIDS, discussion of STIs indicates the degree of openness about this issue and is an important way of improving knowledge of STIs and changing behaviour. Respondents were asked if they had discussed STIs other than HIV/AIDS with various types of persons in the six months preceding the surveys. Results are shown for three major categories of persons in Table 21. As was the case for HIV/AIDS and for contraception, the percentage of young people having discussed STIs in the past six months increased significantly between the baseline and endline.

Viet Nam: Final Report

As with discussions about contraception and HIV/AIDS, discussions about STI are more common with friends and colleagues than with any other group of persons. Interestingly, women have more discussions with their relatives than men. The less educated are less likely to discuss with professionals (health workers, peer educators, counsellors, etc.), showing a challenge to reach the less disadvantaged.

Health worker Peer educator/ Youth counsellor/Teacher Baseline Endline

Gender

Age group

Education

Marital status

Standard of living Total

Sign.

Partner (only for married respondents) Baseline Endline

Sign.

males

18.8

44.7

***

41.7

72.7

females

26.3

48.1

***

24.2

70.0

***

15-19

24.1

48.9

***

25.0

50.0

20-24

20.0

41.4

***

29.3

72.7

***

low

5.0

(10.0)

***

0.0

(66.7)

***

medium

18.9

49.0

***

21.1

80.0

***

high

25.2

46.6

***

52.9

65.8

ever married

(20.0)

50.8

***

(28.9)

70.5

***

never married

22.6

46.2

***

low

21.5

52.5

***

22.2

100

***

better off

22.8

46.1

***

30.6

67.3

***

15-24

22.6

46.4

***

28.9

70.5

***

Significance levels (one-tailed tests): *: p<0.10; **:p<0.05; ***:p<0.01; ns: not significant. Figures in brackets are based on less than 50 cases.

Table 20: Percentage of respondents having discussed STIs in the last six months, by persons with whom the respondents talked, by backgrounds characteristics.

“In the past, information, education and communication on HIV/AIDS were not intensive or extensive and so youth did not know about it. Now, programmes on HIV/AIDS are popular and women, youth and even children as small as 5-6 years old all know about it.”

Baseline Endline

Friends & colleagues

Sign.

Baseline Endline

Sign.

17.5

38.0

***

35.6

62.4

***

35.7

49.3

***

41.8

57.9

***

25.9

42.2

***

34.9

58.1

***

27.9

46.3

***

45.3

64.1

***

10.0

(25.0)

16.7

(45.0)

20.8

40.5

***

31.5

55.7

***

30.0

44.6

***

42.9

61.3

***

(20.0)

55.7

***

(28.9)

55.7

***

26.9

43.0

***

39.2

60.4

***

23.3

50.8

***

28.2

59.0

***

27.2

43.2

***

40.4

60.2

***

26.7

43.6

***

38.7

60.1

***

Relatives

Results of Baseline and Endline Quantitive Surveys

(Commune health worker, Cham Mat, Hoa Binh)

Percentage of respondents who know...

Viet Nam: Final Report

Gender

Age group

Education

Marital status

Baseline

Endline

males

13.0

18.0

females

16.3

12.6

15-19

14.3

14.4

20-24

15.4

17.1

low

8.3

(0.0)

medium

7.6

11.4

high

17.8

16.4

ever married

(17.8)

14.8

never married

14.6

15.3

Standard of living

low

8.6

16.4

better off

15.6

15.2

Total

15-24

14.7

15.3

Prevention of STIs Improving knowledge about ways of preventing STIs is, like for HIV/AIDS, a necessary step towards changing behaviour and limiting the spread of infection. Knowledge of prevention methods was assessed through a series of prompted questions in which the interviewer read a list of ways of prevent STIs. Table 21 shows the proportion of respondents who were able to identify two or three correct prevention methods (abstaining from sex, using a condom at every intercourse, and being faithful to a single

two prevention methods

Significance

Baseline

Endline

Significance

***

45.0

51.1

55.3

58.0

46.4

53.2

***

56.5

57.1

20.0

(10.0)

34.4

46.7

***

58.2

57.1

(42.2)

52.5

50.5

54.7

37.4

42.6

52.1

55.2

50.2

54.5

Results of Baseline and Endline Quantitive Surveys

three prevention methods

Table 21 Percentage of respondents who know three or two STI prevention methods, by background characteristics.

partner). Knowledge of three prevention methods is very low. Despite a small improvement, the progress between the two surveys is not significant, although confirmed for males (from 13% to 18%). The percentage of respondents who know two preventions methods is much higher (about 50%), and has slightly (but significantly) increased between baseline and endline.

4 | Carine Henoque ÂŠ Young women in a group Lao PDR

Significance levels (one-tailed tests): *: p<0.10; **:p<0.05; ***:p<0.01; ns: not significant. Figures in brackets are based on less than 50 cases.

4 | Carine Henoque ÂŠ Young women in a group Lao PDR

Viet Nam: Final Report 76

Client Exit surveys

wo client exit surveys were conducted one year apart among users of the medical services at 11 Service Delivery Points of the 22 targeted by RHIYA. The objective of the client exit surveys was to measure clientsâ&#x20AC;&#x2122; profiles and degree of satisfaction with RHIYA services, as well as certain indicators of knowledge about sexual and reproductive health.

Gender

Age group

Education

Marital status Total

CES 1

CES 2

males

females

155

15-19

20-24

121

low

medium

high

ever married

167

never married

108

212

Table 22 Profile of the clients of the two client exit surveys, by background characteristics.

4 | Carine Henoque ÂŠ Young women in a group Lao PDR

Viet Nam: Final Report

The client exit survey was conducted based on a “take all” approach, and the selected clients for the surveys were representative of the clients of the services. Table 1 shows the characteristics of the clients aged 15-24. In the first survey, as many men as women were interviewed, while in the second survey, the number of women was much higher than the number of men, reflecting their higher propensity to use RHIYA services. This is confirmed by the routine data, which revealed the same finding. Clients aged 20-24 were more numerous than those aged 15-19, and married people were also more numerous than married people. The comparison with the respondents of the baseline and endline surveys also show that the clients were less educated than the general population of young people in the target areas.

Client Exit Survey 2

24 10

45 5

26 Client Exit Survey 1

Figures in Percentages Medical Services Counselling

Other (...)

Figure 19: Purpose of visit to the SDP, Client Exit Survey 1 and Client Exit Survey 2.

Figure 19 shows that most clients came for medical services, counselling and information on family planning. The purpose of visits have changed a little between the first and the second client exit survey. Visits for leisure activities such as karaoke and theatre (included in ‘other’) have increased twofold. However, medical services and counselling remain the main purpose of visit.

Client Exit Surveys

Viet Nam: Final Report

Service is open to all young people regardless of gender, marital status, race, religion or sexual orientation Service has drop-in times when young people do not have to make an appointment Business hours are at time when young people can attend Service was affordable for young people Service was easy to obtain Received desired information and services Would recommend the service to a friend Felt that they would come back for another visit Had sufficient privacy during consultation Service provider was easy to understand Waiting time was reasonable

4 | Carine Henoque ÂŠ Young women in a group Lao PDR

Clients were asked a set of questions concerning their satisfaction with the services they had received and their perception of the youth friendliness of the youth centre. All indicators of satisfaction and youth friendliness show that the satisfaction is very high among service users in both surveys. For most of the topics raised, clientsâ&#x20AC;&#x2122; satisfaction is up to 100%. Changes are therefore not significant between the first CES and the second CES. Figure 20 shows the changes between the first and the second client exit surveys for the following indicators:

All these question-related topics received answers showing from 98% to 100% satisfaction. The only topic that dissatisfied youth was how they were treated by the service provider. In this respect, despite a small improvement, much could be done to improve the clients’ satisfaction, as shown in Figure 22. CES1

Figures in Percentages

CES2

60 50 40 30 20 10 0

Male

Female

Client Exit Surveys

Figure 22: Percentage of clients saying that the service provided treated them well, by gender.

This relatively low level of satisfaction towards service providers’ attitudes - may be linked to constant rotations of local health providers, an issue that has been brought up by local NGOs. However, this must not obscure the high level of general satisfaction. As stated previously, clients are nearly 100% satisfied with the services they received.

4 | Carine Henoque ÂŠ Young women in a group Lao PDR

Viet Nam: Final Report 82

Conclusion

Viet Nam: Final Report

n Vietnam, RHIYA has increased young people’s knowledge and lead them to have more appropriate reproductive health behaviour. This is shown by the changes between the baseline and the endline surveys and is reinforced by the difference between participants and non-participants. Knowledge has improved for all indicators and for all the categories of people. The surveys also show that Vietnam is different from the other RHIYA countries in several respects. In contrast to the other countries where females are clearly disadvantaged, the gender gap is small in Vietnam, and the level of males’ and females’ knowledge is similar for many topics (contraception, HIV/AIDS, STIs). Compared to other RHIYA countries, information on STIs is also relatively widespread in Vietnam. Finally, another interesting feature in Vietnam is that young people discuss about contraception and STIs (including HIV/AIDS) with a large panel of persons, which is very positive in adopting a responsible sexuality.

According to routine data, the volume of activities and the number of young people in contact with RHIYA in Vietnam was substantial. More than 2,500 events were organized by the partner NGOs, around 70,000 consultations were offered as part of RHIYA in 2005 and 2006, and peer educators had more than 70,000 contacts with young people over the course of the project. The number of people who benefited directly from RHIYA thus amounts to several tens of thousands. Results of the surveys suggest that RHIYA has also influenced young peopleâ&#x20AC;&#x2122;s knowledge and behaviour beyond those directly involved in RHIYA activities, for example, through discussions with friends, colleagues, relatives and partners. Although the RHIYA projects ended in 2006, their effects will in all likelihood be long-lasting. RHIYA has helped raise the awareness of political leaders and gatekeepers about sexual and reproductive health issues by involving them in the organisation of various activities. The training of hundreds of peer educators and NGO staff members in the field of sexual and reproductive health is another RHIYA achievement that will leave a permanent impact. Overall, the monitoring and evaluation tools all show that, even though all the changes are not fully attributable to RHIYA, RHIYA has significantly contributed to improved sexual and reproductive health awareness and behaviour in project target areas. Despite the positive effects of RHIYA on all the categories of people, including the more vulnerable populations, some issues remain to be tackled. There is still substantial room for improvement in levels of knowledge on several topics such as the fertile period, misconceptions about HIV/AIDS or ways of prevention of STIs. The less educated also still have lower levels of knowledge and are more at risk of sexual and reproductive health problems, and efforts should be continued to reduce the gap across socioeconomic groups. Furthermore, the project areas were more urban and educated than the rest of the countryâ&#x20AC;&#x2122;s population, and scaling up sexual and reproductive health interventions in rural areas is essential.

Conclusion

The various monitoring and evaluation tools also show that access to services and quality of services seem to be quite good in RHIYA project areas. Services are perceived to be accessible and available by young people. The client exit surveys also show high levels of satisfaction among clients. The qualitative survey also indicate the increasing role of the private sector in providing contraceptives and condoms. Although this facilitates access to contraceptives, the counselling role of the NGOs remains essential to complement the activities of the private sector.

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For further copies, please contact: UNFPA RHIYA Central Unit Rue Montoyer, 14 – 1000 Brussels – Belgium – info@rhiya.org – www.rhiya.org

Reproductive Health Initiative for Youth in Asia (Rhiya) This project is funded by the European Union

This publication has been produced with the assistance of the European Union. The contents of this publication are the sole responsibility of the publisher and can in no way be taken to reflect the views of the European Union.