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Lancet. 1996 Jun 1;347(9014):1529-32.

Population policies and reproductive patterns in Vietnam.

Author information

1
Department of International Health and Social Medicine, Karolinska Institutet, Stockholm, Sweden.

Abstract

BACKGROUND:

Vietnam's population policy since the 1980s had stipulated a limit on family size to two children, born 3-5 years apart, and recommends a minimum age of 19 for the mother of a first child. We analysed trends in the timing of marriages and births, and in fertility and abortion rates, among women born between 1945 and 1970, to assess the impact of these policies on reproductive patterns.

METHODS:

Reproductive histories were recorded in a random sample of 1432 married women aged 15-49 in a rural province in northern Vietnam. Mean age at marriage and at birth of the first child, birth intervals, fertility, and abortion rates were examined in relation to the woman's year of birth.

FINDINGS:

Later-born women married and had their first child at a younger age than women born earlier. Birth intervals had increased among later-born women but 25% still had only a 1-year interval between first and second child. Fertility had gradually decreased while abortion ratios had increased rapidly. Childbearing patterns had become "earlier, longer, and fewer" rather than "later, longer, and fewer" as stipulated by the policies. The results also show that women with more schooling married and had their first child later. Women involved in farming had shorter spacing between children.

INTERPRETATION:

There are signs that Vietnam's population policy has focused too strongly on contraception and abortion while ignoring the connection between fertility and women's opportunities for education and employment. In these respects, rural women are at particular risk.

PIP:

This study aims to examine the impact of government population policies and the impact of the timing of marriage and births on the fertility and abortion rates among women born during 1945 and 1970. The analyzed sample population includes 1189 married women aged 15-49 years from 40 communes in rural Thai Binh province in northern Vietnam. The region is known for having one of the lowest fertility and one of the highest abortion rates in the country. Reproductive histories were collected during two weeks in March 1994. Fertility was lowest among the women born in the two lowest 5-year groups. 85% reported a farming occupation. 80% had a lower secondary school education. Only 11 women were illiterate. Marriage age decreased over time from 23.2 years for women born during 1945-49 to 20.8 years for women born during 1965-69. The mean age at first birth for women born during 1945-49 was 26.1 years or 3 years after marriage and 21.8 years or an average of 1 year after marriage for women born during 1965-69. Median interval between first and second births increased over time. Farmers had a 6 month shorter birth interval. Fertility increased over time from 0.6 children by the age of 25 years among women born in 1945-49 to 1.4 children among women born in 1965-69. At the age of 35 years, later-born women had fewer children. Among the total sample of 1432 women, there were pregnancies among 1377 women (3945 pregnancies). 81% of pregnancies ended in a live birth, 6% experienced a miscarriage or stillbirth, and 13% had an induced abortion. About 66% of women currently used a contraceptive. Abortions were more common among the third and fourth pregnancies. Abortion ratios increased from about 6/100 births in 1983 to 58/100 births in 1993. It is concluded that the initial postwar decline in marriage age and age at first birth was a return to normal after the loss of men during the war years. Women born after 1960 appeared to be following the earlier, longer interval, and few births pattern rather than the government policy. It is suggested that policy should shift to a focus on girls' and women's equal access to education and employment opportunities from a policy focused on family planning.

PMID:
8684107
[Indexed for MEDLINE]
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