The birth rate in rapidly developing Vietnam has dropped in recent years while maternal health and antenatal standards have risen – albeit only for the dominant ethnic groups. Ethnic minorities mostly still give birth at home, without a healthcare worker or midwife, specialists say.
Vietnam has 54 ethnic groups, with the Kinh comprising more than 80 percent of the population of 85.8 million, according to government figures. They are the dominant ethnic group. A few others, such as the Tay and Hoa (ethnic Chinese), have similar standards of living and education.
But most other ethnic minorities - more than eight million people - live mostly in the mountainous and remote areas, and are economically disadvantaged. The poverty rate is 69.3 percent, compared with 23.11 percent for the majority Kinh and Chinese ethnic groups, according to the UN Children’s Fund (UNICEF).
Maternal mortality rates vary widely across the country. In Cao Bang province, with a 98 percent ethnic minority population, there are 411 maternal deaths for every 100,000 live births, according to UNICEF. In Binh Duong province, near Ho Chi Minh City, the rate is less than one-tenth of that.
Minorities such as the H’Mong mostly still give birth at home, and are far less likely to access healthcare, especially antenatal care, health specialists say.
The H’Mong, who make up less than 1 percent of the population, have much lower standards of living, and are often confined to remote areas, in the mountains.
Women “don’t know how to recognize problems and this may lead to obstetric emergencies”, said Nguyen Van Hai, manager of the Save Newborn Lives project at Save the Children.
Barriers to care cited by experts include a lack of confidence when it comes to accessing and dealing with the healthcare system and health workers, and poor fluency in Vietnamese.
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In addition, H’Mong women traditionally give birth at home with their husbands or with traditional birth assistants (TBAs), who lack formal training.
The cost of healthcare is also prohibitive, including the US$10 to give birth at a health centre. “For ethnic minority groups, it's too much,” said Hai.
Hoa Binh leads the way
Since 2001, the UN Population Fund (UNFPA) has been working with local government in Hoa Binh province, 80km south of Hanoi, to improve the use of antenatal services among H’Mong communities.
UNFPA officials say visits by H’Mong women to two commune-level health centres have increased since 2001, and there has not been a maternal death since 2003.
Tran Thi Tuyet Minh, a government doctor who works with UNFPA, said 65 percent of her patients now are H’Mong or another minority, against 8-10 percent in 2001.
“Hoa Binh province achieved some results. However, we must try more,” she told IRIN.
The rise in attendance of H’Mong women at one commune-level health centre is partly thanks to one of the midwives being ethnic H’Mong. Patients are more apt to trust her as they share a culture and, more importantly, language. Many H’Mong girls do not complete middle school, or even attend primary school for more than a year or two. Poor education and lack of fluency in Vietnamese keep them confined to the house and fields.
“If it [the commune-level health centre] is run in a city way, rural people won’t go,” said Duong Van Dat, national programme officer with UNFPA’s reproductive health unit in Hanoi. “It must be culturally adapted to needs.”
The Hoa Binh programme is still something of a pilot project, but Dat said there were hopes the lessons learned could be replicated and applied to other areas, even though it is near the capital and far northern mountainous areas, such as Ha Giang and Cao Bang province, might provide different challenges.