POPULATION, BIRTH CONTROL, ABORTION AND THE PREFERENCE FOR BOYS IN VIETNAM

POPULATION OF VIETNAM

Vietnam is Southeast Asia’s most populous country after Indonesia and Southeast Asia’s most densely populated country after Singapore and the Philippines, It is one of the world's most densely populated places on earth (580 per square mile) compared 72 per square mile in the U.S. More than a fifth of Vietnam’s population lives in the Mekong Delta. An even larger chunk lives Red River Delta area around Hanoi.

Population: 92,477,857 (July 2013 est.), making Vietnam the 14th most populous country in the world. Age structure: 1) 0-14 years: 24.6 percent (male 11,931,623/female 10,807,661); 2) 15-24 years: 18.4 percent (male 8,796,395/female 8,215,536); 3) 25-54 years: 44.4 percent (male 20,554,252/female 20,551,460); 4) 55-64 years: 7 percent (male 2,936,340/female 3,517,538) 65 years and over: 5.6 percent (male 1,986,839/female 3,180,213) (2013 est.). Population pyramid: Median age: total: 28.7 years; male: 27.6 years; female: 29.7 years (2013 est.)[Source: CIA World Factbook]

Total fertility rate: 1.87 children born/woman (2013 est.), country comparison to the world: 143 Population growth rate: 1.03 percent (2013 est.), country comparison to the world: 112; Birth rate: 16.56 births/1,000 population (2013 est.), country comparison to the world: 121; Death rate: 5.94 deaths/1,000 population (2013 est.), country comparison to the world: 166 Net migration rate: -0.33 migrant(s)/1,000 population (2013 est.) country comparison to the world: 125.

In 2004 Vietnam’s population was 82.2 million, and it was growing at a rate of about 1.2 percent per year. The average population density was 246 people per square kilometer, one of the highest levels in the world. The highest concentration of people was in the Red River Delta, in the northeast where Hanoi is located, and the lowest concentration was in the northwest. The population, which traditionally has been primarily rural, has become increasingly urbanized since 1986, when the Doi Moi economic renewal program began to boost income and employment opportunities in the cities. In 2004 about 26 percent of Vietnam’s population was urban and 75 percent rural, down from 85 percent in the early 1980s. Vietnam’s net migration rate was estimated at –0.45 migrant(s) per 1,000 population in 2004. Consistent with the trend toward urbanization, urban areas, such as Ho Chi Minh City, Hanoi, Da Nang, and the Central Highlands, have attracted the most migrants. In addition, a steady stream of migrants continues to move from the North to the South. As of 2002, the two largest groups of refugees were Vietnamese and ethnic Chinese returning to Vietnam from Cambodia and the Montagnards from Vietnam’s Central Highlands seeking asylum in Cambodia. [Source: Library of Congress *]

The population is concentrated in the two main rice-growing deltas: the Red River in the north and the Mekong in the south. In 1999, the Red River Delta (excluding Hanoi), population density averages 1,170 per square kilometer, and in Thai Binh it rises to 1,230 per square kilometer, among the highest rural densities in the world. The Mekong Delta, which is over twice as large as the Red River Delta, has a far lower population density (400 per square kilometer) and is the source of the rice surpluses that Vietnam exports. *

Vietnam has the fastest growing population in Southeast Asia. In the year 2025 it is estimated that Vietnam will have a larger population than Japan. In 2004, the population growth rate stood at 1.44 percent, representing an increase of 1.25 million people from the previous year. In 2004 Vietnam’s age distribution was estimated as follows: 0 to 14 years of age, 29.4 percent; 15 to 64, 65 percent; and 65 and older, 5.6 percent. This age distribution signals slower population growth than in the past. According to 2005 estimates, Vietnam’s birthrate was 17.07 births per 1,000 people, and the fertility rate was 1.94 children born per woman. The infant mortality rate was 25.95 per 1,000 live births, and the death rate was 6.2 per 1,000. Also according to 2005 estimates, life expectancy was 70.61 years for the total population, consisting of 67.82 years for men and 73.6 years for women. *

Population Trends and Demography Since the Vietnam War

During the Vietnam War, about 10 percent of the population of Vietnam was either killed or wounded. During the war, about 2.5 million North and South Vietnamese died out of a total population of 32 million. In spite of intense fighting and heavy casualties sustained during the war, the population of Vietnam rose steadily a 3 percent through the 1960s. According to U.N. estimates the population of North and South Vietnam in 1965 around the time the war began was around 40 million. The population of a united Vietnam in 1975 around the time the war ended was around 50 million. The loss of large numbers of men in the war still influences demographic figures today. As of the mid 2000s, there were only 97.6 men for every 100 women, one of the lowest ratios in Southeast Asia. About 70 percent of the people living in Vietnam were born after the fall of Saigon.

In 1999, Vietnam had a population of more than 76 million, up from only 47 million in 1975. Almost 40 percent of the population are under 15 years of age, about 80 percent are under 40, and 5.3 percent are 65 or older. Life expectancy at birth in 1995 was 62.9 years for males and 67.3 years for females. According to Hanoi, the population of Vietnam was almost 60 million at the end of 1985 (Western sources estimated about a half million more than that in mid-1985). Vietnamese officials estimated that the population would be at least 66 million by 1990 and 80 million by the year 2000, unless the growth rate of 2 percent per year used for these estimates was lowered to 1.7 percent by 1990. With declining mortality rates achieved through improved health conditions, the population increased by 1.2 million or more per year between 1981 and 1986 (1.5 million in 1985 alone), worsening the country's chronic food shortage. In the 1980s, Vietnam needed to produce an additional 400,000 tons of food each year just to keep pace with its rapidly increasing population. [Source: Library of Congress]

Census results of October 1979 showed the total population of reunified Vietnam to be 52.7 million of which 52 percent lived in the North and 48 percent in the South. About 19 percent of the population was classified as urban and 81 percent as rural. Females outnumbered males by 3 percent, and the average life expectancy at birth was 66 for females and 63 for males. With 52 percent of the total under 20 years of age, the population was young. Ethnically, 87 percent were Vietnamese-speaking lowlanders known as Viet or Kinh, and the remainder were Hoa or members of highland minority groups. In December 1986, Hanoi estimated that more than 1 million Vietnamese lived overseas, 50 percent of them in the United States. A Vietnamese source in Paris claimed that about half of Ho Chi Minh City's population lived completely or partially on family aid packages sent by Vietnamese emigres abroad. *

In the 1980s, Vietnam was the world's third-largest communist country--ranking below China and the Soviet Union and above Poland--and the most densely populated. According to Vietnamese figures, the country's population in 1985 totaled more than 60 million, with an average density of 179 persons per square kilometer. In comparison, the German Democratic Republic (East Germany), ranking second in population density, averaged 154 persons per square kilometer. Vietnam's average annual population growth rate was reported to be 2.5 percent. *

Crowding and Efforts to Relocate Vietnam’s Population

Increases in agricultural productivity have been offset by population increases. Vietnam occupies about the same amount of land as New Mexico and has only 12 percent arable land. Crowding is such a problem in Vietnam that many demographers believe that the country faces a catastrophe. Crowding has become particularly worrisome in the Red River Delta in northern Vietnam, where large numbers of people have pulled up stakes and moved to the south, where there are more economic opportunities.

A population boom in the 1980s put pressure on food supplies and severely taxed the government's ability to create jobs. Harvest shortfalls were frequent, grain reserves remained low, and foreign exchange was extremely scarce. As a result, overcoming even a short-term food deficit was difficult for the government and costly for the people. [Source: Library of Congress *]

The average population density in 1985 was 179 persons per square kilometer. Population density varied widely, however, and was generally lower in the southern provinces than in the northern ones; in both North and South it was also lower in the highlands and mountainous regions than in the lowlands. The most densely settled region was the Red River Delta, accounting for roughly 75 percent of the population of the North. Also heavily settled was the Mekong River Delta, with nearly half of the southern population. *

After 1976, population redistribution became a pressing issue because of food shortages and unemployment in the urban areas. A plan unveiled at the Fourth National Party Congress in December 1976 called for the relocation of 44 million people by 1980 and an additional 10 million by the mid-1990s. The plan also called for opening up 1 million hectares of virgin land to cultivation and introduced a measure designed to divert some armed forces personnel to the building of new economic zones. The relocation was to involve an interregional transfer of northerners to the South as well as an intraregional movement of lowlanders to upland areas in both the North and the South. Between 1976 and 1980, most of the 4 million people who were relocated to rural areas and the new economic zones were from Ho Chi Minh City and other southern cities. In the 1981-85 period, a total of about 0.6 million workers and 1.3 million dependents were relocated, causing the country's urban population to decline from 19.3 percent of the total in 1979 to 18 percent in 1985. The country's long-range goal, established in 1976, called for the population to be distributed more or less evenly throughout Vietnam's 443 districts with an average for each district of 200,000 persons living on 20,000 hectares. *

Population Control and Vietnam's Two-Child Policy

North Vietnam was among the first countries in the developing world to adopt an official policy to reduce population growth. Following reunification, policies to reduce population growth received increasing political attention from the national government. In January 1993, the Communist Party Central Committee identified population growth as contributing to a wide range of social, economic, and ecological problems. A resolution endorsed the recommendation that each family should have only one or two children, so that fertility could be lowered and population stabilization achieved. In June 1993, the prime minister approved the "Population and Family Planning Strategy to the Year 2000," a comprehensive plan to guide the implementation of the resolution. [Source: Encyclopedia of Sexuality, 2.hu-berlin.de/sexology **]

To fight rapid population growth the government has threatened to fire workers who have more than two children. Billboards at main intersections in towns graphically depict the use of condoms, intrauterine devices and vasectomies. These measures have had limited effect as 70 percent of population lives in the countryside and are generally not exposed to such campaigns. "We'll never apply the draconian measures used in China to curb population growth," a government consultant told the New York Times. "But we've got to do something before it's too late."

Traditionally large families have been desired to perform farming chores, take care of elders in old age, and make up for high infant mortality. Many infertile women have visited the village of Hung Loc in Dong Nai and consumed the water there because an unusually high number of twins have been born there. Between 1980 and 2000, 60 sets of twins were born there.

In 2000, the BBC reported: "Seven years after introducing a two child per family policy, Vietnam's population control programme has become one the most effective in the world. In the late 1980s Vietnamese women had an average of 3.8 children - that compares with 2.3 children today. Officials say that reduction has been a crucial element of the economic and social development programmes introduced in the era of Doi Moi or renovation. "They have been very successful," said Omar Ertur the UN Population Fund's Representative in Hanoi. "They have achieved a tremendous reduction in a very short period of time." A degree of coercion is used to enforce the two-child policy. Communist Party members who have more than two face automatic expulsion and parents are often asked to pay the health and education costs of a third child. More serious sanctions include having land confiscated. [Source: Owen Bennett-Jones, BBC, November 8, 2000 <=> ]

"But while some local authorities and employers impose penalties, they are not enforced on a nationwide basis. Some families still go for three or more children. In many such cases they are couples who have had two daughters and want a son. There is also a tendency for poorer families to have larger families. Family planning officials argue that as their education programmes begin to hit home, there is less and less need for coercion. "We have focussed on information and education so people can persuade themselves that having a smaller family will bring benefits to them," said Tran Tien Duc, the Information Director of the National Committee for Population and Family Planning. "We have conducted surveys and have come to the conclusion that coercive measures do not play an important role in reducing population growth." <=>

"There is evidence that attitudes to family size are changing. Many young people - especially in cities - say they don't want too many children. "My friends want just one or two children so that they can enjoy their life," said Khanh, 38, who works for a western company in Hanoi. "Now we have a new concept of quality of life - if we have too many children we have to find the money to support the babies and we have to spend so much time looking after them." <=>

"Despite the steady drop in the population growth rate throughout the 1990s officials fear there are still too many people being born. The Vietnamese population, currently 79 million, increases by over one million every year. But there are no plans to emulate neighbouring China's one-child policy. "We consider two children is a very reasonable fertility level for our country," says Mr Duc. One reason why Vietnam is holding back from a one-child policy is a fear the population's gender balance would be affected. "In so called chopstick culture countries - like Vietnam, China, Korea, Japan and Taiwan - there is still a strong son preference." added Mr Duc. "If you have a one-child policy many couple will try to have only a boy." <=>

History of Birth Control and Family Planning in Vietnam

Contraceptives until a few decades ago were not widely used. Abortion has traditionally been the No. 1 method of birth control. The Vietnamese family planning program has its roots in the early 1960s, when some contraceptive methods became available in both the southern and northern regions on a limited basis. Beginning in 1962 in the northern province, the government planning policy was directed to reducing the rate of population growth, and the use of certain relatively permanent contraceptive methods, such as the IUD, was promoted. Until the 1970s, however, a governmental policy was not formally implemented. The family planning program in the southern province began in the late 1960s, largely in response to concern over maternal and infant mortality and the increasing number of illegal abortions. In the mid-1970s, the Government of the Republic of the South Vietnam stated that family planning had been adopted as an official policy, but inadequate medical facilities made it impossible to implement an effective family planning program. [Source: Encyclopedia of Sexuality, 2.hu-berlin.de/sexology **]

Beginning in the early 1960s, the socioeconomic implications of rapid population growth became an increasing concern of the government in Hanoi. A family planning drive, instituted in 1963, was claimed by the government to have accounted for a decline in the annual growth rate in the North from 3.4 percent in 1960 to 2.7 percent in 1975. In the South, however, family planning was actively encouraged only after 1976, and the results were mixed, consistently falling short of announced goals. In 1981 Hanoi set a national goal of 1.7 percent growth rate to be achieved by the end of 1985: a growth rate of 1.3 to 1.5 percent was established for the North, 1.5 to 1.7 percent for the South, and 1.7 to 2.0 percent for the sparsely settled highland provinces. In 1987, the growth rate, according to Vietnamese sources, was about 2.0 percent. [Source: Library of Congress]

Family planning was described as voluntary and dependent upon persuasion. The program's guidelines called for two children per couple, births spaced five years apart, and a minimum age of twenty-two for first-time mothers--a major challenge in a society where the customary age for women to marry, especially in the rural areas, was nineteen or twenty. Campaign workers were instructed to refrain tactfully from mentioning abortion and to focus instead on pregnancy prevention when dealing with people of strong religious conviction. Enlisting the support of Catholic priests for the campaign was strongly encouraged. In 1987 it was evident that the government was serious about family planning; a new law on marriage and the family adopted in December 1986 made family planning obligatory, and punitive measures, such as pay cuts and denial of bonuses and promotions, were introduced for non-compliance. *

A substantial portion of the population had mixed feelings about birth control and sex education, and the number of women marrying before age twenty remained high. Typically, a woman of child-bearing age had four or more children. The 1986 family law that raised the legal marriage age for women to twenty-two met with strenuous opposition. Critics argued that raising the legal age offered no solution to the widespread practice among Vietnamese youth of "falling in love early, having sexual relations early, and getting married early." Some critics even advanced the view that the population should be increased to further economic development; others insisted that those who could grow enough food for themselves need not practice birth control. A significant proportion of the population retained traditional attitudes which favored large families with many sons as a means of insuring the survival of a family's lineage and providing for its security. Although problems associated with urban living, such as inadequate housing and unemployment, created a need for change in traditional family-size standards, old ways nevertheless persisted. They were perpetuated in proverbs like "If Heaven procreates elephants, it will provide enough grass to feed them" or "To have one son is to have; to have ten daughters is not to have." *

The Committee for Population and Family Planning (CPFP) was established during the early 1980s, and a one- or two-child policy was formally initiated in late 1988. At about the same time, Vietnam introduced comprehensive free-market reforms, which increased the effectiveness of the population program. The program included an extensive media campaign, free provision of contraceptive services and devices, and the creation of incentives and disincentives to encourage compliance. With a government target to reduce the total fertility rate to 3.0 births per woman by the year 2000, the fertility rate had already fallen to 3.1 by 1994. The sharp drop in Vietnam’s fertility over the past several years, which has attracted global attention, can be linked to the general context of how family planning is delivered - including penalties for family planning violation, and to the widespread use of modern contraceptive methods and abortion. The intrauterine device (IUD) is by far the most popular contraceptive method, followed by traditional methods (withdrawal, "rhythm," and breastfeeding), increasing use of the condom, and the pill a distant last place. [Source: Encyclopedia of Sexuality, 2.hu-berlin.de/sexology **]

Contraceptive Methods Used in Vietnam

The predominant contraceptive method used in Vietnam has been the IUD: in 1988, 33 percent of the respondents relied on the IUD (with neither a decrease nor increase in 1994). But the IUD is nevertheless known and feared for its side effects: heavy bleeding, infection of the ovaries, and severe abdominal pains, as well as very likely infection of the cervix, ectopic pregnancies, and a low effectiveness rate in general (Goodkind & Anh 1997). As Gammeltoft (1999) was told by a woman: "You know, in the old days, heaven decided how many children one would have. Today we have the IUD, so heaven still decides." One reason for failure and health problems may be that for a long time, the only IUDs available were used IUDs from Communist East Block countries. Some health providers also complain that the IUDs, which today are imported from the U.S., are too large for the uteruses of Vietnamese women. Most improbable seems to be the opinion of Women’s Union cadres that "it is a disease of the mind," and that women simply blame all their troubles in life on the IUD. [Source: Encyclopedia of Sexuality, 2.hu-berlin.de/sexology **]

According to Goodkind (1997), primary reliance on the IUD and abortion is typical of former Marxist states, which have tended to discourage supply-based methods, thus reflecting an indifference to consumer choice and an inability to afford these methods, or to keep tight reins on their distribution and use. Within Asia, Vietnam is distinguished by having the highest levels of IUD and abortion use in the region, perhaps partly because policymakers see this strategy as the most effective way to meet current fertility targets. **

One reason for the rise in condom use is the increased availability of the product because of free-market reforms introduced in the mid-1980s. In combination with family planning promotion in the late 1980s, these reforms allowed for two channels of condom distribution: through the public health sector and sales through private pharmacies and familyowned roadside stalls. There are drawbacks, however, to obtaining condoms through public sector centers, namely, the necessity to travel some distance to reach a center, the need to register one’s name to receive supplies, and the necessity to use whatever brand of condom is being offered. But because condoms are offered free of charge, a growing number of condom users seems to prefer going through the private sector. In recent years, the growth of social marketing programs has increased the number of brands available and also competition, which has kept prices low. **

The condom is more popular than the pill, both for spacing births and for preventing them. One reason for the greater popularity of the condom may be its greater compatibility with traditional methods, such as withdrawal. Data from the 1994 national Vietnam Inter-Censal Demographic Survey (VICDS), being both an inter-census demographic survey and a family planning survey, indicated that 31 percent of married women of reproductive age who switched from the condom to another method did prefer one or both traditional methods, rhythm or withdrawal, compared with only 24 percent of those women who switched from the pill. Given the high prevalence of traditional-method use in Vietnam - 22 percent in 1994 - these attitudinal dynamics seem to favor use of the condom over the pill. As Goodkind (1997) pointed out, the preference for condoms cannot be fully accounted for only by conventional explanations like the lesser compatibility of the pill with traditional methods, monetary concerns, or problems in pill supplies. In addition to these reasons, one might speculate that the national family planning leaders discouraged pill use, because they were skeptical that rural women could use it effectively. **

Also, the IUD and sterilization, even abortion, are being looked at much more favorably, because they reflect the socialist legacy of de-emphasizing consumer choice and ensuring compliance with the one- or two-child policy. Goodkind argued that enduring cultural factors, including its Confucian heritage, may also contribute to a preference for condoms over the pill. Vietnam exhibits the same family-formation characteristics as many other Confucian societies in East Asia: patrilineal family organization, son preference, lunar birth timing, and high rates of abortion. Preference of the condom may stem from traditional Chinese medical beliefs, which are intertwined with Confucian, Buddhist, and Daoist religious philosophies. These beliefs often emphasize the importance of maintaining a balance of natural body rhythms. The pill may thus be perceived as interfering with the menstrual cycle and disturbing the proper balance between "hot and cold" food intake. **

The condom is the only method with a higher preference among urban users and among those with higher levels of educational and occupational status. In 1994, 10 percent of urban residents used condoms, compared with 4 percent of rural residents. However, women of all occupational statuses and educational levels overwhelmingly prefer the IUD and traditional methods, with the pill coming in a distant last place. **

Increasing Condom Use in Vietnam

The condom was rarely used in Vietnam until recently, but both knowledge and use of the condom have increased significantly over the past ten years. Among married women aged 15 to 49, knowledge of the condom rose from 45 percent in 1988 to 76 percent in 1994, and the use of the condom more than tripled from 1 percent in 1988 to 4 percent in 1994. Goodkind (1997) suggested that because Vietnam is currently developing very rapidly, its population is becoming better educated, more affluent, and more urbanized. Economic reforms have contributed to a rising standard of living as well as to a growing disparity between rich and poor. These conditions have also increased the numbers of commercial sex workers and their patrons. Because of these social and demographic developments, one can expect the use of condoms to increase both for pregnancy and STD prevention outside marriage. [Source: Encyclopedia of Sexuality, 2.hu-berlin.de/sexology **]

According to a recent but undated United Nations study, 40 percent of Vietnamese married men have had extramarital sex. Another survey conducted in 1993 showed that 69 percent of homosexual men and 38 percent of urban heterosexual men used condoms during their sexual encounters. Half of sex workers had not used a condom during their most recent sexual encounters (Goodkind 1997). **

The decision to use condoms is partly a question of government efforts to improve knowledge and awareness of HIV and other STDs and how to prevent them. There are influential political groups, however, who assume that condoms encourage people to engage in premarital or extramarital sex; these groups object to the discussion and distribution of condoms. Others, like the Vietnam Women’s Union, hold a more pragmatic view. They have recently prepared a publication about AIDS prevention that is targeted to young people. **

Condom use will very likely continue to increase because: 1) Family-size desires are still declining; 2) Economic reforms and increased personal income have made condoms more accessible; 3) Condoms are suitable to use with traditional methods; 4) Current social mobility and migratory patterns are redistributing more Vietnamese into better educated, wealthier social groups; and 5) Recent increases in adolescent and extramarital sexual activity, coupled with a growing concern over STD/AIDS prevention. **

Knowledge of Contraceptive Methods

Government authorities were concerned over the lack of coordination among agencies involved in family planning and the lack of necessary clinics and funding to provide convenient, safe, and efficient family planning services in rural areas. Even more disturbing was the knowledge that many local party committees and government agencies were only going through the motions of supporting the family planning drive. To remedy the situation, the government in 1984 created the National Committee on Family Planning (also known as the National Commission on Demography and Family Planning, or the National Population and Parenthood Commission). The commission was directed to increase the rate of contraceptive use among married couples from about 23 percent in 1983 to 70 percent by 1990 and to limit the population to between 75 and 80 million by the year 2000. The latter goal was to be based on an annual growth rate of 1.7 percent or less, a figure that in 1987 seemed unrealistically low. According to a National Committee on Family Planning report released in February 1987, the population grew by 2.2 percent in 1986 (Western analysts estimate the increase to have been between 2.5 and 2.8 percent). In light of the 1986 growth rate, the committee's target for 1987 was revised at the beginning of the year to 1.9 percent. Even if such a goal were met, Vietnam's population at the end of 1987 would stand in excess of 63 million inhabitants. [Source: Library of Congress]

By 1988, 94 percent of all married Vietnamese women were familiar with at least some methods of contraception, including at least one modern method; 90 percent of the married women were familiar with the IUD (Goodkind 1997). By 1994, a marked increase in familiarity with specific methods, both modern and traditional, was evident. About 75 percent of the women surveyed indicated awareness of the condom and both male and female sterilization, whereas 68 percent said they had heard about the pill. Reported contraceptive use was substantial and, according to the VICDS (1994), continued to increase between 1988 and 1994. About 73 percent of married women reported ever having practiced some form of contraception, compared with 60 percent in 1988. In 1997, according to the most recent Demographic and Health Survey of Vietnam (VN-DHS II), more than 84 percent of currently married women aged 15 to 49 have ever used a contraceptive method. [Source: Encyclopedia of Sexuality, 2.hu-berlin.de/sexology **]

Vietnam is one of two countries to receive an award from the United Nations in 1998 for its population control programs. The 1994 Vietnam Inter-Censal Demographic Survey (VICDS) was conducted from April through June 1994 in a nationwide effort to obtain information about fertility, investigate the prior trend of fertility decline, and determine whether the decline is likely to continue. [An intercensal survey is a national survey conducted to obtain information not gathered in the regular national censuses.] Results revealed a substantial change over recent years in reproductive attitudes and behavior. Fertility has continued to decline to a level not far above three children per woman. Compared with the late 1980s, contraceptive knowledge has broadened and contraceptive use has increased. Stated family-size preferences have shifted noticeably downward. The findings also confirmed that urban women are characterized by far lower fertility than rural women, that the Red River Delta (which includes Hanoi) followed by the Southeast (Ho Chi Minh City) show the lowest fertility levels, and that the Central Highlands show the highest fertility rates. Finally, the survey documented that there is an inverse association between fertility levels and educational attainment: The fertility rate for each successively higher educational grouping is lower than for the previous grouping. **

The contraceptive prevalence rate (CPR) is 75 percent, and 56 percent of ever-married women are currently using a modern method. The total CPR is up by 10 percent over the level of the 1994 survey, and the use of modern methods rose by 12 percent, with traditional-method use falling by about 2 percent owing to less frequent use of periodic abstinence. Compared with the 1988 DHS NCPFP, Vietnam Demographic and Halth Survey, 1988 (Hanoie, 1990) and 1994 VICDS, the contraceptive mix has not changed very much. About half of the reported increase was attributed to use of modern methods and half to increased use of traditional methods. As far as the "method mix" is concerned, two features stand out: the dominance of the IUD among modern methods, and the relatively high share of traditional methods. Current use of oral contraceptives is still very low, being used by 2 percent of married women. **

In 2004, Radio The Voice Of Vietnam reported, "The growth rate can only be kept stable in two or three years’ time. The Committee for Population, Family and Children has decided to allocate VND40 billion - the biggest sum so far - for the communication campaign for reproductive healthcare in remote and far-flung regions. [Source: Radio The Voice Of Vietnam - December 29, 2004]

ABORTION IN VIETNAM

In 1999, the Alan Guttmacher Institute, the research arm of Planned Parenthood, reported that Vietnam had the highest abortion rate of any nation. In Vietnam, abortion is legal and available as part of overall family planning services provided at various provincial, district and communal health facilities. While experts say the communist government does not espouse abortion as a birth control method, the procedure is "heavily subsidized by the government," and "many published family planning campaigns still list abortion as a method of birth control" according to the Deutsche Presse-Agentur news agency. [Source: Steven Ertelt, LifeNews.com, July 11, 2006]

Abortion has traditionally been the No. 1 method of birth control. In the late 1990s there were 900,000 officially registered abortions in Vietnam each year. Vietnam has long had one of the highest abortion rates in both Asia and the world and the number of abortions has been on the rise. According to national health statistics, 760,000 abortions were carried out in 1989, 1.3 million in 1994 and 1.4 million in 1995. In many cases people have used abortion as a form of contraception. As ultrasound has it easier to identify the sex of a foetus, abortions have been used to ensure the birth of a son rather than a daughter. In November 2001, the government banned test that can determine the sex of unborn children to prevent women from aborting girls.

In 2006, Xinhua reported: "One woman died of unsafe abortion every five days in Vietnam, and there are 83 abortion cases for every 1,000 Vietnamese women of the childbearing age, local newspaper Pioneer reported Monday. That compares with a birth rate of only 17 babies born per 1,000 women. The report added that each local woman undergoes 2.5 times of abortion in her life on average, and about one-thirds to half of the abortion cases are conducted in small private health establishments. To reduce the abortion rate, Vietnam is encouraging local people to use modern contraceptive methods and improving sex education among people, especially the youth. Vietnam now has a population of over 83.1 million, 50.8 percent of whom are women. [Source: Xinhua, April 3, 2006]

History of Abortion in Vietnam

In North Vietnam, since 1962, abortion on request (with the husband’s consent) was available during the first trimester of pregnancy and was usually performed by vacuum curettage. Because of the 1933 decree enforcing a French law prohibiting abortion and the use of contraception in the Republic of South Vietnam, abortions could be performed only for narrowly interpreted indications. Between the late 1960s and the early 1970s, family planning clinics offered services only to women with at least five living children. Even when family planning clinics were later expanded to include women with one living child, a marriage or cohabitation certificate was required to obtain an abortion. [Source: Encyclopedia of Sexuality, 2.hu-berlin.de/sexology **]

Abortion on request has been available in North Vietnam since at least 1971, and in the entire country since its unification in 1975. The Law on the Protection of Public Health (30 June 1989) states that "women shall be entitled to have an abortion if they so desire." According to Decision No. 162 of the Council of Ministers in January 1989, the State will supply, free of charge, birth control devices and public-health services, including induced abortion, to eligible persons that register to practice family planning. As mentioned earlier, it is typical of former Marxist states to primarily rely on abortion, together with the IUD, for population control. Henceforth, all possible grounds for abortion are permitted as long as the abortion is performed by a physician. **

The proportion of single women among all women seeking abortion has increased to 20-to-30 percent in 1995 (compared with 7 percent in 1991), suggesting an increase in premarital sexual activity. Attitudes toward informal dating have become more tolerant, especially in urban areas. The availability of Western videos, TV programs, and other media have brought specific images of sex and romance to young people, and these are slowly changing the norms of acceptable behavior in Vietnamese culture. **

According to the United Nations, Vietnam had 59 abortions per 1,000 women in 1987, 71 per 1,000 in 1988, and 70 per 1,000 in 1989. The Alan Guttmacher Institute reported in 1998 reported that Vietnam had the highest abortion rate of any nation in 1996, with 83 abortions per 1,000 women between the ages of 15 to 44. This number covers only abortions performed at state clinics; and when private clinics are included, the abortion rate was 111 per 1,000 women, or a total of roughly two million abortions. In 1999, the state-run media reported that the abortion rate in Hanoi continues to rise. In the first six months of 1999, 33,215 abortions were performed at Hanoi city hospitals, a 3-percent increase over the previous year, and nearly double the number of reported births. Although the government does not espouse abortion as a preferred family planning method, the procedure is heavily subsidized by the government, and many published family planning campaigns still list abortion as a method of birth control after IUDs, condoms, and the pill, according to the Deutsche Presse-Agentur (7/1999). **

In April 2001, Associated Press reported: "Vietnam's abortion rate is declining, but remained very high in 2000 year at 679,000, an official newspaper reported, The figure equaled 50.3 percent of the number of babies born last year, the trade union newspaper Lao Dong said. It called the level alarming, although it was lower than the 63.8 percent recorded in 1999. It was a considerable decline from 1991-1992, when 1.3 million to 1.5 million abortions were reported each year, it said. Vietnam has set a target of bringing its abortion rate down to 25 percent of live births by 2010, the newspaper said. But it said this would be very difficult. Abortions are legal in Vietnam. The newspaper quoted Nguyen Dinh Loan, director of the Ministry of Public Health's Mother and Child Department, as saying people should be educated and persuaded to use family planning measures to bring down the abortion rate. [Source: Associated Press, April 17, 2001]

Twenty Percent of Abortions in Vietnam on Teenage Girls

Steven Ertelt of LifeNews.com wrote: "The number of abortions in Vietnam has been staggeringly high for some time, but a new report from the Asian nation shows 20 percent of all abortions are done on younger teenage girls, and they are using abortion as a method of birth control. By comparison, abortion figures in the United States show that most abortions are done on women of college age, between 20 and 25.[Source: Steven Ertelt, LifeNews.com, July 11, 2006 ><]

About 300,000 abortions are done in Vietnam annually and the local newspaper Labor reports that the nation's Health Ministry said most of them are on unmarried and younger women. The Obstetrics Hospital in Hanoi does about 20-30 abortions every day and the number of abortions on teens is on the rise. The paper said that teenagers are increasingly relying on abortion as a method of birth control and not using, or not knowing about, methods of contraception. The paper says about 20 percent of teenagers are actively having sexual relations with using any method of birth control. The nation plans to launch contraception educational campaigns in an attempt to lower the abortion rates. ><

Vietnamese Preference for Boys over Girls

According to the U.S. Department of State: According to a 2010 UN Population Fund report, the national average male-female sex ratio at birth was 111 to 100. The imbalanced ratio of newborn boys to girls continued to increase, particularly in some wealthier areas of Hanoi and Ho Chi Minh City. The government acknowledged the issue and was taking steps to address it. [Source: 2011 Human Rights Reports: Vietnam, Bureau of Democracy, Human Rights, and Labor,U.S. Department of State; 2011 Country Reports on Human Rights Practices Report, May 24, 2012 ***]

"Before I had my baby my mother-in-law was never polite to me; now she's friendly," Huong, a 26-year-old worker at a graphic design company in Hanoi, with a two-year-old son, told The Guardian in 2013.

Margie Mason of Associated Press wrote: "Vietnam's preference for boys over girls is further tipping the balance between the sexes in Asia, already skewed by a strong bias for boys among Chinese and Indians. The trend could lead to increased trafficking of women and social unrest, a U.N. report says. Vietnam is now positioned where China was a decade ago, logging about 110 boys born to every 100 girls in a country where technology is readily available to determine the sex of a fetus and where abortion is legal, according to research released this week by the U.N. Population Fund. The sex ratio at birth generally should equal about 105 boys to 100 girls, according to the report. [Source: Margie Mason, Associated Press, October 31, 2007]

"The consequences are already happening in neighboring countries like China, South Korea and Taiwan. They have to import brides," said Tran Thi Van, assistant country representative of the Population Fund in Hanoi, adding that many brides are coming from Vietnam. "I don't know where Vietnam could import brides from if that situation happened here in the next 10 or 15 years." The report, which looked at China, India, Vietnam and Nepal, warned that tinkering with nature's probabilities could cause increased violence against women, trafficking and social tensions. It predicted a "marriage squeeze," with the poorest men being forced to live as bachelors. Gender imbalance among births has been rising in parts of Asia since the 1980s, after ultrasound and amniocentesis provided a way to determine a fetus' sex early in pregnancy. Despite laws in several countries banning doctors from revealing the baby's sex, many women still find out and choose to abort girls.

Vietnam’s two children per family limit has led many women to abort girls and keep trying for sons who can carry on the family lineage. "I have noticed that there have been more and more boys than girls," said Truong Thi My Ha, a nurse at Hanoi's Maternity Hospital. "Most women are very happy when they have boys, while many are upset if they have girls."

The report calls for increased public awareness, more government intervention and steps to elevate women's place in society by promoting gender equality."My husband took me to a private clinic to be checked. I broke down in tears when I saw the result because I knew this is not what my husband wanted," said Nguyen Thi Hai Yen, 33, recalling when she discovered her second baby was a girl. "But he was good. He told me it was OK."

Sex ratio: at birth: 1.12 male(s)/female; 0-14 years: 1.1 male(s)/female; 15-24 years: 1.07 male(s)/female; 25-54 years: 1 male(s)/female; 55-64 years: 0.83 male(s)/female; 65 years and over: 0.62 male(s)/female; total population: 1 male(s)/female (2013 est.)

Vietnam to Ban Abortion of Unwanted Female Foetuses

In 2002, Dinh Pham Tran of Reuters wrote: "Vietnam plans new legislation aimed at stamping out abortion of unwanted female foetuses. An official at the Committee for Population and Family Planning said an ordinance to be submitted to the National Assembly's Standing Committee for approval would make clear it was illegal to abort foetuses because of their sex. An existing ordinance makes diagnosis to determine the sex of unborn babies illegal, but this had not prevented the practice and abortion of unwanted female foetuses, said Dinh Cong Thoan, head of the drafting team. "The new version of the ordinance bans the selection of the sex of unborn babies by any means, which covers a wider range of activities to determine sex," he said. [Source: Dinh Pham Tran. Reuters, July 4, 2002]

Another population official said that despite the existing rule, parents were able to find out the sex of foetuses through routine pre-natal scans. "Pregnant women are encouraged to check their future child, even to have tests regularly to protect their health. So they are able to find out whether they will have a boy or a girl," he said. "But the new ordinance clearly states the parents cannot carry out such scans just to abort a foetus if they find out it's a girl."

Vietnam has one of the highest rates of abortion in the world, one of the reasons for which is a preference for male offspring stemming from the country's Confucian traditions. Government figures show that in 2000, Vietnam recorded 217,691 voluntary abortions, 30,865 natural abortions and 470,338 pregnancy terminations through "menstrual regulation" a process of induced abortion in the early weeks of pregnancy. Females still outnumber males in Vietnam, but the size of the male population is growing fast. In 2001 males made up 49.16 percent of the population, compared with 48.80 percent in 1991. Vietnam had a population of 78.69 million people in 2001.

Sex-Select Abortion and the Missing Girl Trend in Vietnam

In their report "Missing Girls in Vietnam: Is High Tech Sexism an Emerging Reality?" Gita Sabharwal and Than Thi Thien Huong wrote: "Over the past years there is a noticeable and worrying change in the demography as the number of women to men (sex ratios) has declined particularly across urban Vietnam and for some provinces. In 1999 the sex ratio at birth in urban Vietnam was 93 girls to every 100 boys given the normal ratio of 95. This dipped to 86 in 2001 and seems to stabilise at 93 in 2004. The sex ratio in 2002 dramatically changes and swings up to 102 much within the standard sex ratio. For the country as a whole the sex ratio declined from 95 in 1999 to 93 in 2004 slightly below the normal standard. For rural Vietnam, data suggests slight variations over the years and a drop to 94 in 2004, which is slightly below the normal standard. This is a reflection of some degree of gender instability and imbalance in Vietnam’s population as a whole and particularly so in urban areas. [Source: "Missing Girls in Vietnam: Is High Tech Sexism an Emerging Reality?" by Gita Sabharwal and Than Thi Thien Huong \^/]

"There is wide variation in sex ratio across cities and provinces. This could give rise to distorted demographic pockets and high levels of gender imbalance. Analysis of the 1999 census shows that 6 out of the 61 provinces reported much lower than standard sex ratios at birth (78-83). For example, An Giang reported the lowest sex ratios in Vietnam with 78 girls to every 100 boys followed by Kon Tum at 81 and Thai Binh province in the north at 83. Analysis based on the annual population change and labor survey suggests dramatic drops in girls to boys ranging from the lowest recorded ratio of 68 in Thanh Hoa in 2001 to 71 in 2004. Kon Tum is another interesting case in point. In 1999 it records a sex ratio of 81, which drops to 54 in 2001 and goes up to 75 in 2004. The annual figures show a very high degree of fluctuation. Their accuracy may be questionable as they are based on records of commune and district health clinics which may not necessarily be a complete record of all births. Research also shown that sex ratio at birth in urban areas or provincial centers is higher than for the province as a whole. For example, Ha Dong town has a sex ratio of 83 while Ha Tay the province in which it is located has a sex ration of 91. It’s a similar picture in Thu Dau Mot (88) in Binh Duong province (92)." \^/

Reasons for the Missing Girl Trend in Vietnam

In their report "Missing Girls in Vietnam: Is High Tech Sexism an Emerging Reality?" Gita Sabharwal and Than Thi Thien Huong wrote: The decline in the female birth ration "seems to stem from the preference for son’s which is embedded within the patriarchal Confucian tradition. This preference combined with the availability of modern techniques to simply and cheaply determine the gender of the foetus seems to be resulting in sex-selective abortion. [Source: "Missing Girls in Vietnam: Is High Tech Sexism an Emerging Reality?" by Gita Sabharwal and Than Thi Thien Huong \^/]

"Some analysis suggests that the availability of modern techniques to simply and cheaply determine the gender of the foetus is resulting in sex-selective abortions becoming common in cities of Vietnam. This factor is corroborated with the high abortion rates for urban areas. Although it is difficult to obtain consistent data on abortion, the rate is widely accepted as being high. Studies indicate that 46 percent of all pregnancies were terminated in 2002. The abortion rate among married women averages to 1.47 and goes up to 1.66 for women in urban areas for 2003. These figures could be an underestimate as they do not cover the abortions performed privately. \^/

"These could be "early days," and as the ultrasound technology spreads more widely across the country, Vietnam’s sex ratio could decline further. This is quite possible despite the fact that the National Assembly has outlawed sex determination of the foetus (except when it is medically required) precisely to prevent its abuse for sex selective abortion. \^/

"From the data presented above we can draw some early conclusions. Firstly, declining sex ratio at birth appears to be more of an urban phenomenon largely due to easy availability of ultrasound technology in the cities and economic well being with increased disposable incomes. Secondly, as the technology spreads to the peripheries of the country, there is a possibility that families in rural Vietnam could also start to exercise the choice of sex determination. This could result in further decline in the sex ratio for the country as a whole. Thirdly, declining sex ratio is not an inevitable result of the two child policy. Economic well being and access to technology combined with families wanting sons will inevitably result in sex selective abortions. \^/

"There are also appears to be a close link between women’s economic prospects and preference for boys. For this long term solutions should include affirmative actions for women and girls including women being given preference for public sector jobs and education and training opportunities to enter "male" occupations." \^/

Image Sources:

Text Sources: New York Times, Washington Post, Los Angeles Times, Times of London, Lonely Planet Guides, Library of Congress, Vietnamtourism. com, Vietnam National Administration of Tourism, CIA World Factbook, Compton’s Encyclopedia, The Guardian, National Geographic, Smithsonian magazine, The New Yorker, Time, Newsweek, Reuters, AP, AFP, Wall Street Journal, The Atlantic Monthly, The Economist, Global Viewpoint (Christian Science Monitor), Foreign Policy, Wikipedia, BBC, CNN, Fox News and various websites, books and other publications identified in the text.

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© 2008 Jeffrey Hays

Last updated May 2014

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