http://www.iaeme.com/IJM/index.asp 1698 [email protected]
International Journal of Management (IJM) Volume 11, Issue 6, June 2020, pp. 1698-1709, Article ID: IJM_11_06_156
Available online at http://www.iaeme.com/IJM/issues.asp?JType=IJM&VType=11&IType=6
ISSN Print: 0976-6502 and ISSN Online: 0976-6510
DOI: 10.34218/IJM.11.6.2020.156
© IAEME Publication Scopus Indexed
FACTORS AFFECTING ACCESS TO
REPRODUCTIVE HEALTHCARE SERVICES OF
ETHNIC MINORITY WOMEN: EVIDENCE IN
VIETNAM
Pham Thi Phuong Thai
Associate Professor Ph.D, Thai Nguyen University of Science, Vietnam
Ta Thi Thao
Ph.D, Thai Nguyen University of Science, Vietnam
Nguyen Phu Truong
Ph.D, Central Propaganda Committee, Vietnam
Le Thu Hien
Ph.D, Vietnam Youth Academy, Vietnam
Doan Van Truong
Ph.D, Thanh Hoa University of Culture, Sports and Tourism, Vietnam
ABSTRACT
Research has identified factors affecting access to reproductive health care
services for ethnic minority women in the Northern mountainous region of Vietnam.
To achieve the goal, in this study we surveyed 450 ethnic minority women. The results
of the correlation analysis have identified three factors that have a significant
influence on the access to reproductive health care services of ethnic minority women
in Vietnam, including: (i) Family economic conditions, (ii) Culture - customs, (iii)
individual characteristics. In which, factors of family economic condition and
geographical distance have the greatest influence on reproductive health care access
behavior. On this basis, the study proposes several positive solutions to raise the
awareness of ethnic minority women in accessing reproductive health care services.
Key words: Women, ethnic minorities, health care, access to health services, Vietnam
Cite this Article: Pham Thi Phuong Thai, Ta Thi Thao, Nguyen Phu Truong, Le Thu
Hien and Doan Van Truong, Factors Affecting Access to Reproductive Healthcare
Services of Ethnic Minority Women: Evidence in Vietnam, International Journal of
Management, 11(6), 2020, pp. 1698-1709.
http://www.iaeme.com/IJM/issues.asp?JType=IJM&VType=11&IType=6
Pham Thi Phuong Thai, Ta Thi Thao, Nguyen Phu Truong, Le Thu Hien and Doan Van Truong
http://www.iaeme.com/IJM/index.asp 1699 [email protected]
1. INTRODUCTION
Human development is an expansion of human choices, not only limited to economic
prosperity but also focused on improving the quality of human life, in which health choice is
also one of the important choices. The Northern Uplands is home to the majority of ethnic
minority groups in Vietnam, where the economy is underdeveloped. These are areas with high
slopes, the main form of cultivation is shifting cultivation and forest exploitation; Food
production capacity is very limited, mainly self-sufficient at a minimum. Each ethnic minority
woman surveyed gave an average of 4-5 children, with a high crude birth rate and a high
crude death rate (IrishAid, 2017). Reproductive health care is an important part of health
policy for ethnic minorities because it is closely related to child health and poverty reduction
effectiveness, which are two of the 17 development goals in the period 2015 - 2030 of the
United Nations. Many previous studies show that the rate of antenatal care visits at health
facilities of ethnic minority women is not high, the form of giving birth at home accounts for
a large proportion, the rate of using contraception is low,... So what are the factors leading to
the above situation? This paper will focus on analysing how factors including: family
economy condition, individual characteristics of ethnic minority women, and culture –
customs, tradition-folk knowledge affect to reproductive health care services of ethnic
minority women.
2. LITERATURE REVIEW AND HYPOTHESIS DEVELOPMENT
A number of studies in the world point out the factors affecting the reproductive health care of
women with specific conditions. Research by Zelalem Birhanu Mengesha, Tinashe Dune and
Janette Perz (2016) conducted a systematic review of scientific articles and grey literature
published in English from 1990 to 2015 to identify barriers and facilitators in accessing sexual
and reproductive health care with a group of women of cultural and linguistic diversity in
Australia. The results show that the main barriers and facilitators are identified in three major
themes, including: personal level experiences of accessing health care, women’s interaction
with the healthcare system and women’s experience with healthcare providers (Zelalem
Birhanu Mengesha, 2016).
Amanda Harris, Yun Zhou, Hua Liao, Lesley Barclay, Weiyue Zeng, Yu Gao, (2010)
conducted a descriptive study on maternal health care use among ethnic minority women in a
remote region of China. Research has identified factors that influence women obtaining care
and their decision-making. The results show that the utilization of maternal health care is
related to a range of social, economic, cultural and geographical factors, as well as the
policies of the state. Only a small number of women in this area receive prenatal and postnatal
care (Amanda Harris, 2010). Women give birth at home because the cost of giving birth at a
hospital is beyond their ability to pay, the quality of commune hospital is poor and there is a
lack of supportive services such as pain relief (Binh, 2004); (Dien, 1996).
In Vietnam, women make up over 50% of the country's population. They participate in
economy, politics, culture, society, security and national defense and increasingly prove their
role in society. In the cause of national renewal, women always uphold and promote the spirit
of patriotism, solidarity, dynamism and creativity (Doan Van Truong, 2020). Vietnam's health
system is divided into central, provincial and communal levels, including public and private
health. The commune health station is the first unit to reach out to people in the state health
system. The use of health care services by the people depends on their needs and affordability.
Some studies have shown that factors such as economic characteristics, geographical distance,
quality of health services, and socio-cultural characteristics are factors that influence the
behavior of access to health services citizen.
Factors Affecting Access to Reproductive Healthcare Services of Ethnic Minority Women:
Evidence in Vietnam
http://www.iaeme.com/IJM/index.asp 1700 [email protected]
McKinn, S., Duong, TL, Foster, K. et al. (2017) also point out that ethnic minority women
face challenges including differences in language and gender with health experts, time
constraints and reluctance to ask questions (McKinn, 2017). Hoang Van Minh, Bui Thi Thu
Ha, Nguyen Canh Chuong and Nguyen Duy Anh (2018) using data from the MICS Survey in
Vietnam between 2000, 2006, 2011 and 2014 show that: the percentage of women received
Reproductive and health care services by skilled medical staff are mostly from highly
educated people, Kinh ethnicity, have good economy and live in urban areas (Hoang Van
Minh, 2018). Goland, E., Hoa, D.T.P. & Malqvist, M (2012), analyzing data from the MICS
survey conducted in Vietnam in 2006, showed that ethnicity, household wealth and education
were all significantly associated with antenatal care coverage and skilled birth attendance,
individually and in synergy. Within the group of mothers from poor households ethnic
minority mothers were at a three-fold risk of not attending any antenatal care and six times
more likely not to deliver with skilled birth attendance (Goland, 2012).
In the indigenous knowledge system of ethnic minorities in general, traditional knowledge
and experience on women's and children's health care play an important role. The author Vu
Truong Giang's research provides social perceptions about the practices of reproductive health
care for women and children. The author lists the abstinence practices during pregnancy,
childbirth, some traditional remedies, the practices of postnatal care, offerings to newborn
babies, the duration of stay, medical treatment by rituals.
Most of the studies mentioned above consider the practices as a key point for ethnic
minorities' access to health services. Each project has its own approach and view. From a
medical perspective, the authors pay attention to cross-sectional investigations, analyzing
quantitative data to make general figures related to medical indicators. From an ethnological
perspective, considering ethnic factors, residence areas, ethnic traditions to consider health
care behaviors of ethnic minorities ... However, these are all considered scientific bases. value
for later research.
3. RESEARCH METHODS
3.1. Model Research
Figure 1 Research model
(Source: Synthesis of author)
- Characteristics of ethnic
minority women (Age,
literacy, occupation)
- Cultural characteristics
+ Spiritual culture
+ Folk knowledge
- Socio-economic
conditions of the locality:
Facilities; Health
resources
Behavioral access to reproductive health services of
ethnic minority women
Prenatal
care Postpartum
care
Family
planning
Pham Thi Phuong Thai, Ta Thi Thao, Nguyen Phu Truong, Le Thu Hien and Doan Van Truong
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3.2. Sampling Method
3.2.1. For in-Depth Interviews and Focused Discussions
We used qualitative research, interviewed local health workers (n = 10), in-depth interviews
and focused discussions with ethnic minority women (n = 40), in-depth interviews with local
officials (n = 5). In addition, we use secondary data from a national study on the current status
of socio-economic development of 53 ethnic minorities in Vietnam (2017).
20 health workers interviewed were selected from 10 commune health stations in 4
districts of 2 provinces. 40 ethnic minority women participating in the survey were also
deliberately selected including: pregnant women, women raising children under 5 years old.
This group of women was also deliberately selected according to the criteria: ethnicity, level
of access to health services (using family planning methods, giving birth at health stations,
periodic antenatal care). Table 1 Structure of survey sample
Grassroots health workers n = 20 Ethnic women n = 40
Gender Age
Male 6 < 20 8
Female 14 20 – 24 20
Age (22 – 60) 25 – 30 7
< 25 2 31 – 35 5
25 – 34 4 Folk
35 – 44 11 Cong 10
> 45 3 Si La 10
Qualification La Hu 10
Doctor 4 Mang 10
Nurses / Doctors 3 Academic level
Midwives 13 Unlettered 14
Local officials Primary school (1-5) 19
Male 3 Junior high school (6-9) 6
Female 2 10 + 1
(Source: The survey data of the study)
3.2.2. For Semi Structured Interview
The sample structure is as follows: Table 2 Sample structure
Folk The scale Ratio (%)
La Hu 33.3
Cong 22.2
Mang 22.2
Si La 22.2
Academic level Unlettered 42.7
Primary school 44.4
Junior high school 11.1
High school 1.5
Intermediate or higher 0.02
Job Agriculture 90.7
Self-employed/Employed 8.0
Business 0.8
Other 0.5
Standard of living Poor 83.5
Medium 11.5
Wealthier 5.0
Wealthy 0.0
(Source: The survey data of the study)
Factors Affecting Access to Reproductive Healthcare Services of Ethnic Minority Women:
Evidence in Vietnam
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Samples were selected in Dien Bien and Lai Chau; in Lai Chau, a survey of La Hu and
Mang groups was conducted; in Dien Bien, a survey of ethnic groups of Cong and Si La was
conducted.
3.3. Data Collection Methods
We focus on understanding the ethnic cultural characteristics in relation to local socio-
economic conditions, which helps us ensure an objective view in the research when
acknowledging. cultural diversity of ethnic minorities in the context of integration.
As follows:
(i) In-depth interviews: 20 health workers, 40 ethnic minority women (Cong, Mang, La Hu, Si
La)
(ii) Semi-structured interview: 450 ethnic women
(iii) Group discussion: 04 meetings with 4 groups of women: Cong, Mang, La Hu and Si La.
Interviews were conducted with the assistance of an interpreter (from Vietnamese to local
languages and vice versa). Because they are not fluent in Vietnamese, they must go through
the interpretation of the local government representatives and village midwives. Interviews
are recorded and recorded in writing.
4. RESULTS AND DISCUSSION
In order to generalize the influencing factors, we interviewed grassroots health workers and
EM women groups about information related to why women use/not use reproductive health
services. Reproductive health care for women is an important part of health policies in
particular and policies for ethnic minorities in general. Because this issue is closely related to
children's health and poverty reduction effectiveness. The results of secondary data analysis
and group interviews show that the three situations of accessing reproductive health care
services in ethnic minority areas are as follows:
(1) The proportion of women attending antenatal care at health centers is not high. Among the
surveyed women, the percentage of pregnant women who had ANC at least once during
pregnancy was very low, respectively La Hu (8.99%), Si La (23.08%), Cong (36.94%). And
the percentage of women having 3 or more antenatal care visits during pregnancy accounts for
less than 10%. This also partly explains why these ethnic groups have the highest mortality
rate among children under 1 year of age (Chart 2).
Pham Thi Phuong Thai, Ta Thi Thao, Nguyen Phu Truong, Le Thu Hien and Doan Van Truong
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Chart 1 Use health insurance Chart 2 Access to health care
Although recommended by health professionals for routine visits during pregnancy, many
women are unaware of the importance of preventing illness, they only seek medical attention
when encountering a really important problem.
We will go to the clinic if we have a stomach ache or if we are seriously ill, we will not go
there if we are normal (La Hu, group discussion of pregnant women).
(2) Home births are common among ethnic minorities. Only about 64% of births have been
performed at health centers out of the total ethnic minority. For the surveyed women, the rate
of giving birth at a health station is less than 30%, especially for La Hu ethnic group, Only
12.95% of pregnant women gave birth at a health station or have health workers giving birth
at home (Table 3).
I just want to check if there is a problem with my child. The doctor told me my baby was
healthy, so I gave birth at home because I thought he was okay (Cong ethnic group, in-depth
interview with women raising children).
This difference may be partly explained by the distance from home to the clinic/hospital.
Ethnic groups with a high rate of giving birth at a health facility are often closer to health
centers/hospitals than other ethnic groups. While the average distance to medical stations of
ethnic minorities is 3.8 km; Mang people is 15.5 km from the nearest medical station and 33.6
km from the hospital. Similarly, La Hu people are 9.1 km and 39.2 km.
(3) The contraceptive prevalence rate among ethnic minorities is still high, especially among
the Mang (51%) and the La Hu (37%), the Cong (35) %) and the Si La (27%). More than 50%
of Mang women do not use contraception, which is one of the reasons why the fertility rate of
Mang women is the highest among 53 ethnic minorities in Vietnam.
We women must find our own contraceptive method. Men do not accept condoms because
they do not like them (Si La ethnic group, group discussion of women having children, over
35 years old).
4.1. Several Factors Affecting Ethnic Minority Women's Access to Health
Services
4.1.1. Family Economy
The current work of ethnic minority groups is mainly in agriculture and forestry. The rate of
employment in industry, construction and services is limited, not exploiting the potential of
tourism and local services. The average income per capita is about 1.1 million
VND/person/month, less than half of the national average. Secondary data analysis showed
that the ethnic minorities in the survey group have very low income, averaging less than
632,000 VND/month/person, including ethnic groups such as Mang, La Hu. Accordingly, the
two ethnic groups of Mang and La Hu have poverty rate up to over 70%.
Table 3 Correlation between household economic conditions and level of interest in reproductive
health status of ethnic minority women (%)
Economic conditions The level of interest in reproductive health care
Very interested Care Do not care
Poor 0.4 22.5 77.1
Medium 9.2 22.4 68.4
Wealthier 43.5 7.6 49.4
Wealthy 50.0 0.0 50.0
* Statistical significance level p = 0.000
(Source: The survey data of the study)
Factors Affecting Access to Reproductive Healthcare Services of Ethnic Minority Women:
Evidence in Vietnam
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Examining the relation by 2 tau-b quantities of Kendall, gamma of Goodman and Kruskal,
we found a relationship between the level of concern about reproductive health status and
family economic conditions (p = 0,000).
Basically, the ethnic minorities in the area get their income from shifting cultivation,
hunting, gathering as their main source of income. With the characteristics of self-sufficiency,
closed-up, very low exchange rate, outdated farming techniques, crude production tools, so
labor productivity is low. People practice shifting cultivation often lack of food. Women do
the same jobs as men, but more gently, so the income is not worth much, sometimes it is not
enough to eat daily (Male, Ethnic Minority Leader, Lai Chau)
Gender discrimination, early marriage among girls, obsolete perceptions about the role of
women in the family (doing housework, taking care of the family, etc.) have led to the main
work of women. These activities do not require skills, bring very little income (gathering,
farming, forestry, catching small animals,...).
Table 4 Correlation between economic conditions and ethnic minority women's access to reproductive
healthcare services (%)
Condition
economy
Ultrasound
during
pregnancy
Vaccination
during pregnancy
Place of birth and postpartum care
District Hospital Clinics At home
Poor 6.2 4.6 2.3 92.3 5.4
Medium 10.5 7.9 4.3 60.5 34.2
Wealthier 15.2 17.4 5.3 72.8 21.7
Wealthy 50.0 50.0 50.0 50.0 0.0
Statistical
significance level p = 0.042 p = 0.003 p = 0.000
(Source: The survey data of the study)
With a statistical significance level of p <0.05, family economic characteristics are the
most influential factor in ethnic minority women's decision to use reproductive health
services. A group of women with moderate and poor economic conditions mainly use
available health services locally (commune health stations, home births).
The majority of households are in the poor group. Motorbikes are considered as a means
of transportation, supporting people in goods exchange, medical examination and treatment
but still the households in the survey group do not have this type of vehicle. The statistics
show that the Cong ethnic group has the highest percentage of households having a
motorbike, accounting for 71.9%, the remaining ethnic groups account for 34.5 - 64%, of
which the La Hu enic group accounts for a low percentage (34.5%). The absence of transport
leads to limited access to health services, due to the great distance.
I had to walk down the mountain and it was very cold and it hurt when I walked back
home after birth. If I had another baby, I would give birth at home because I didn't have
enough money to rent a motorbike (Mang woman, 34 years old, has 1 child).
Research results show that the costs (both direct and indirect) of health services are a
barrier to full access to services. Although health insurance has paid for, many ethnic minority
women do not fully understand the conditions for health insurance and how it works. Health
services also include indirect costs not covered by health insurance, such as transportation
costs such as taxi, medicine, meals, accompanying expenses and unofficial expenses ( or
envelopes) for health care workers to get good service and care. These indirect costs are
beyond the affordability of many ethnic minority families.
Pham Thi Phuong Thai, Ta Thi Thao, Nguyen Phu Truong, Le Thu Hien and Doan Van Truong
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Going to the hospital we would have to buy many things because we could not bring
things at home, had to rent a motorbike taxi, we had no money, we were afraid of being
cheated (La Hu ethnic women)
The women interviewed said they were 'too busy' and 'did not have time' to go to the
commune health station because they had to work in the field to make sure their daily meals.
In some communes, women work in the field until delivery and they feel the need to return to
work immediately after birth due to both financial pressure and family desires. For many
women, the distance from home to health facilities is too far, meaning that if they go for
antenatal care, they lose 1 day of labor. This explains why some women go to the health
center only once or twice for antenatal care. In addition, some women are also concerned that
if they give birth in a health facility, they may have a caesarean section and that it will take
them time to recover.
Even when we had the money, we didn't go to the hospital. When we were born at home,
we could do normal housework, except for very hard work, but if we went to the hospital we
would be cut, it would be very painful, the cut would heal and be very painful (Cong ethnic
women, in group discussion, have children under 5 years old).
Table 5 Correlation between family economic conditions and the use of family planning measures (%)
Economic conditions Measures
contraception
Pregnancy check
Pediatric recurring Total
Poor 70.6 29.4 100.0
Medium 95.0 5.0 100.0
Wealthier 78.6 21.4 100.0
Statistical significance level p = 0.138
(Source: The survey data of the study)
Statistics show that there is no relationship between family economic conditions and the
use of family planning measures. Because family planning in ethnic minority areas is carried
out on the basis of state policies and communal health policies (Decision No. 75/2009/QĐ-
TTg and Circular No. 07/2013/TT-BYT) is considered as an appropriate approach, but the
effectiveness is not high due to low remuneration; personnel changes; inadequate
qualifications and training, but also difficulties in terms of policy scope.
4.1.2. Some factors belong to individual characteristics of ethnic minority women
Literacy
The rate of Vietnamese language proficiency is still very low. Especially, there are ethnic
groups with more than half of illiterate population. On average only 79.2% of ethnic minority
people can read and write Vietnamese. The survey group has the lowest literacy rate such as
Mang, La Hu. The survey area has a very high rate of illiterate people of working age. This
leads to underemployment for people of working age; poverty status; limited access to social
services, including health services. Table 6 Correlation between educational attainment and reproductive health care access by ethnic minority
women (%)
Academic level
Ultrasound
during
pregnancy
Vaccination
during
pregnancy
Place of birth and postpartum care
District Hospital Clinics At home
Unlettered 18.2 3.9 0.0 83.3 16.7
Primary school 7.9 27.3 7.1 89.3 3.6
Junior high school 2.8 4.2 11.1 85.2 3.7
High school 9.3 8.0 18.4 78.4 0.5
Intermediate or
higher 31.2 14.7 77.3
19.0 0.0
Factors Affecting Access to Reproductive Healthcare Services of Ethnic Minority Women:
Evidence in Vietnam
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Statistical
significance level p = 0.002 p = 0.001 p = 0.022
(Source: The survey data of the study)
Education is a factor influencing ethnic minority women's access to reproductive health
services. Well-educated women often restrict their birth choices at home. Basically, they
choose to give birth at a health station because of geographical distance. In addition,
restrictions on Vietnamese communication make women afraid to go to public administrative
places where communication is needed.
The facilities are fine but health workers have difficulty communicating with ethnic
women if they do not speak Vietnamese. Therefore, ethnic minority women do not want to go
to the clinic because the health workers say they do not understand and vice versa (In-depth
interview, local leader, Ha Giang).
Age
The selected group of women is mainly of reproductive age. Age group from 21-40 years old
accounts for 57.6%, age group from 41-50 years accounts for 20.7%. Survey results show that
the level of access to reproductive health care varies by age group, but this does not confirm
that age is related to ethnic minority women's access to this service.
Table 7 Correlation between age and ethnic minority women's access to health care (%)
Age
Ultrasound
during
pregnancy
Vaccination
during
pregnancy
Place of birth and postpartum care
District Hospital Clinics At home
< 20 years old 90.5 95.2 83.3 16.7 0.0
21 – 40 years old 90.5 83.5 14.3 85.7 0.0
41 – 60 years old 87.2 15.4 20.0 20% 60.0
Statistical
significance level p = 0.631 p = 0.241 p = 0.659
(Source: The survey data of the study)
The survey showed no correlation between age and ethnic minority women's access to
health care. The majority of women surveyed chose the health clinic as the first place to visit,
during and after delivery. Because they think that giving birth is a natural thing for women, as
long as the clinic has a midwife. There is still the phenomenon of giving birth at home, but
this rate is not much, mainly among women who live far away from health centers, have
difficult transportation or because their families have no money.
Ethnic
The La Hu ethnic group has the lowest rate of antenatal care and giving birth at health centers
among surveyed groups. This is related to language and social barriers. Among the four ethnic
groups surveyed, the percentage of La Hu people speaking and writing in Vietnamese is only
34.4%, while the percentage of the Cong, Si La and Mang ethnic groups are 67.2%, 63.7%,
respectively 43.8%.
Table 8 Correlation between ethnicity and proportion of women accessing reproductive health care
services (%)
Folk More than one antenatal examination
at health facilities
Women to health facilities
give birth
La Hu 9.1 4.5
Mang 34.9 13.7
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Si La 25.5 11.2
Cong 38.3 19.9
Statistical significance level p = 0.034
(Source: The survey data of the study)
In addition, because La Hu ethnic people reside on high mountains, the distance from home to
remote health stations, their lives depend mainly on hunting, gathering and small-scale animal
husbandry, creating barriers in access to reproductive health care.
Geographical Distance
The survey results also show that the distance from home to health facilities is generally quite
far. Ethnic minorities are often distributed in mountainous areas, highlands, lack of
infrastructure, difficult transportation, and distance from hospitals. Being far from medical
centers is one of the reasons leading to the limitation in access to medical examination and
treatment services.
Going from home to the clinic too far, we were afraid to give birth on the way (Si La
ethnic women, group discussion)
Ethnic groups near health clinics have a higher rate of giving birth at health centers than
other ethnic groups. For example, while the average distance to EM clinics is 3.8 km; Mang
people are 15.5 km from the nearest health center and 33.6 km from the hospital. Similarly,
La Hu people are 9.1 km and 39.2 km.
If I get pregnant again, I want to give birth at home. My house is about 2 trees from the
commune health station but the road is very difficult. My parents-in-law allowed me to go to
the medical station, but I didn't want to go, especially when the weather was cold (Cong
ethnic woman, 28 years old).
4.1.3. Culture - Customs, Traditions - Folk Knowledge
For ethnic minority women, they prefer midwives from village birth attendants or family
members if the birth is not unusual and does not require the care of professional health
workers.
At prenatal check-ups, all women know whether they will give birth easily or have a
difficult pregnancy. If the birth is easy, we will give birth at home (Group discussion, La Hu
ethnic women).
In terms of psychology, giving birth and taking care of at home also help mothers feel
more secure when they and their children are supervised and protected by family members. In
addition, in remote areas, with difficult economic and geographic conditions, giving birth at
home is a reasonable choice.
Table 9 Reasons why ethnic minority women do not go to health care services (%)
Reason La Hu Cong Mang
Can be cured by folk methods 50.0 46.9 24.4
The cost of examination is high 12.4 27.1 6.7
Medical facilities far from residence 22.9 9.1 46.3
Attitudes of medical staff 14.7 4.4 15.9
The condition is not serious 0,0 12.5 6.7
Total 100.0 100.0 100.0
Statistical significance level p=0.000
(Source: The survey data of the study)
Some of their preferences are not implemented or allowed at health facilities. Some
women report that they prefer to squat on a low chair during labor or kneel on the floor while
holding a towel hung on the rafters; Meanwhile, if giving birth at a health station, the supine
Factors Affecting Access to Reproductive Healthcare Services of Ethnic Minority Women:
Evidence in Vietnam
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position at birth is required. Following the customs of some ethnic minorities, families will
bury the placenta around the house especially if the child is a boy. However, if they give birth
at a health facility they will not be able to bring home pregnant vegetables.
Contraceptive prevalence rates among ethnic minorities are still high, especially among
Mang and La Hu ethnic groups. Survey results have shown that up to 23% of married women
do not use any contraception. The main reasons for not using contraceptives are given as:
unnecessary (73.9%); fear of side effects (9.5%); lack of information on contraception and
family planning (4.5%); fear of infertility (3.6%); There are no contraceptive methods
available (2.3%); reasons for religion and belief (2.1%); Costs and distance to clinics (1.0%).
Health workers may not be familiar with the cultural characteristics, beliefs, and traditions
of ethnic minority women. Moreover, rules such as women being forced to lie on their backs
during childbirth, or family members not allowed to be in the maternity room during labor
may also affect access and access to ethnic minority women's health services.
5. CONCLUSIONS AND RECOMMENDATIONS
Based on the results of the analysis, we conclude the following conclusions: The low rate
of access to and use of health services by ethnic minority women is often due to a range of
socio-economic factors and culture from service users, including: family economy;
academic level; facilities and cultural elements. In which, family economic factors and
facilities are the factors that have the most impact on the decision to use medical services
in reproductive health care of ethnic minority women. Health services that are not
appropriate for the local context or do not meet the specific needs of local people often do
not attract users.
From the results of the research and the reality in the mountainous areas of Northern
Vietnam, we propose some recommendations to improve the access to reproductive health
care services of ethnic minority women as follows: (i) need to provide higher quality medical
services than is available. Health services need to be safe, effective, reasonable and equitable
based on the customs, cultural values and diverse desires of different ethnic minority
communities. Local health services need to be improved and implemented in a humane,
respectful and supportive environment; (ii) The Government needs to ensure that ethnic
minority women have access to health insurance and understand how to use health insurance;
(iii) Guidance on the use of insurance is needed to facilitate health insurance access. Many
ethnic minority women are concerned about the ability to pay for services (including direct
and indirect costs) so increasing access to affordable services is essential.
ACKNOWLEDGMENTS
The article is the product of a state-level scientific project: “Basic and urgent solutions to
improve the effectiveness of the policy of conservation and developing of ethnic minorities in
our country today”, code CTDT 42.18/16-20.
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