2011 International Conference on Family Planning
29 November–2 December 2011
"Contraception use and abortion in Vietnam: An exploration of the determinants of high usage of both methods in a rural setting in northern Vietnam"
Ashish Bajracharya, Tung Mai, and Liem Nguyen
Vietnam’s rapid fertility decline in the last three decades to replacement levels has been well documented and has been widely attributed to high rates of contraceptive use resulting from aggressive family planning policies enacted by the government (see Goodkind, 1995; Haughton, 1997; Teerawichitchainan & Amin, 2010). According to the 2002 Vietnam Demographic Health Survey (DHS), virtually all women in Vietnam had heard of at least one form of contraception and current use rates were as high as 80%. The other key factor that has contributed to rapid fertility decline in Vietnam is the high rates of induced abortion. Abortion was widely promoted in the Vietnam’s early family planning campaigns and continues to be heavily subsidized by the government (Goodkind, 1994; Teerawichitchainan & Amin, 2010). Thus, Vietnam presents an anomalous situation in which both contraceptive use and induced abortion rates co-exist at unusually high rates. But as studies such as Marston and Cleland (2003) suggest, such a circumstance however may co-exist in settings that have not yet begun their fertility transition to below replacement fertility. Given that there is ample evidence that Vietnam has completed the transition to replacement fertility (TFR=1.8, 2009 USAID figures) however, this situation has baffled researchers and family planning program planners. There is some evidence that ethnic minorities, who make up approximately 16% of the population, continue have high fertility levels, leading to the speculation that these groups may be driving these patterns. While use of traditional forms of contraception is more common among these groups, rates of abortion however are seen to be lower (Teerawichitchainan & Amin, 2010).
We address why abortion rates and contraceptive rates co-exist in Vietnam at such high levels by exploring the potential determinants of the demand for abortion in relation to the use of contraception. Following a review of the literature on fertility limitation in various settings, we hypothesize that such a situation may exist as a result of the following circumstances:
1) Ineffective current use of contraceptives, particularly due to the continued high rates of use of traditional forms of contraception.
2) High reported use of contraception but lower actual use, as has been speculated in the case of Vietnam by various studies, which might increase the demand in abortion to reached desired family size.
3) Lack of adequate family planning counseling on proper contraceptive use and inadequate post-abortion counseling on effective methods to avoid unwanted pregnancy.
4) Son preference in the face of a two-child policy that sanctions higher parity births.
5) Lack of adequate choice in contraceptive methods and continued subsidization and marketing of abortion by the government as a means of contraception.
The Population Council in partnership with the Institute for Population Health and Development in Vietnam is conducting a population-based survey that focuses on the access, utilization, quality and equity of primary and reproductive health (RH) care services in the Thai Nguyen Province in northern Vietnam. This survey administers detailed RH and abortion modules that enable us to address issues outlined above in the hypotheses. The survey samples 2,880 men and women of reproductive age using a multistage stratified cluster sampling method, oversampling ethnic minorities and P135 designated (poor) populations. Logistic regressions that estimate the demand for abortion will be estimated using independent variables that address the use of traditional vs. modern methods, perceptions about abortion as a means of contraception, regarding ease of access and use of abortion to limit fertility.
We hope to shed light on these questions using a targeted questionnaire based on our hypotheses. With a high proportion of ethnic minorities and P135 designated populations residing in Thai Nguyen, this survey allows for a specific focus on contraceptive use and demand for abortion among these groups. As the survey is currently being conducted, results are not available at this time. Data collection is currently underway and data entry is slated to be completed by July 2011. We expect to have preliminary numbers by August 2011.
This study will provide important insights in delineating circumstances under which high rates of both contraception and induced abortion may co-exist even in settings where fertility has dropped below replacement levels. If assertions about ethnic minority and poor populations are confirmed, the study could advocate for different population policy emphasis for these groups. If our hypotheses about the potential causes outlined above are true, results from this study will be instrumental in developing and planning more effective and better-targeted family planning policies that emphasize greater choice in modern contraceptive method options. Results from this study could also illuminate the need for stronger family planning or post-abortion counseling that promotes more effective means of contraception to avoid unintended pregnancy. It could also advocate for the provision of safer means of abortion under such high demand.
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