Dreams and dilemmas : women and family planning in rural Vietnam

University dissertation from Stockholm : Karolinska Institutet, Department of Public Health Sciences

Abstract: The general aim of this thesis is to investigate women's experiences in family planning. It is seen in the broad context of their reproductive lives and in view of their 'reproductive dilemma', that is having to satisfy the family's need for sons on the one hand, and the requirements from the state to limit child bearing to two children only, on the other. A special focus is on women's use of contraceptives and on child bearing patterns, viewed in relation to the government's policy. Field studies were carried out in rural communes and some urban quarters in two provinces in North Vietnam between 1992 and 1996. Reproductive life lines of 58 purposively selected women of different generations showed the impact of the wars on reproductive patterns and the dramatic decline in fertility. Contraceptive use and experiences in family planning were investigated among 206 randomly selected women in reproductive age. The IUD, almost the only contraceptive method available, was used by over half of the women, most of whom had experienced side-effects from use, such as increased menstrual bleeding, abdominal pain, headache and backache. Women related the use of IUDs to feelings of weakness and fatigue. The need for a son was a source of concern and distress among women without sons. A study of IUD discontinuation patterns among 1432 randomly selected women showed that women without sons had significantly higher rates of discontinuation due to IUD expulsion and failure. We interpret the findings as an indication that women without sons had privately removed the IUD in the hope of getting a son, to satisfy the family's demand, while avoiding criticism from the authorities for deliberately breaking the policy. We investigated the reproductive patterns of 1123 randomly selected women 15-49 years of age. Over half of them had had a third child during the last five years, thus breaking the two-child norm. Women without sons, Catholic women and those who had lost a previous child, were more prone to have a third child. Another study of 1432 randomly selected women showed that marriage age and age at first child birth had declined from the older to the younger women, while birth intervals had become longer. Abortion rates have increased rapidly in Vietnam during the 1990s, to reach an average of 2.5 lifetime abortions per woman. Abortion patterns and experiences were explored among 226 purposively selected women. A common reason for the abortion was a wish to avoid paying economic fines for having a third child. Husbands usually shared in the abortion decision, while the older generation were often against. Large difference in abortion ratios between two adjacent communes are seen as a sign of the stronger political pressure in one of the communes to limit births. The involvement of 20 purposively selected husbands in their wives' abortion was explored. All the men had shared in the abortion decision and took great care about their wives' health post- abortion. Many of them had ethical concerns about abortion as such, but the negative consequences and strains of an additional child for the family's welfare was felt to be stronger. Conclusions: Fertility had declined but the younger women had their first child earlier. Delayed child bearing is associated with higher education and status for women, and with reduced population growth. Policies to improve conditions for rural girls and women are important in their own right, and for voluntary and sustained reduction of population growth rates. Removal of targets and quotas in the family planning programme, together with improvement of quality of contraceptive services, will reduce IUD failure and abortion, leading to improved reproductive health among women. Male involvement in reproduction should be encouraged.

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