Pregnant Adolescents in Vietnam : Social context and health care needs

Background: The number of childbearing adolescents in Vietnam is relatively low but they are more prone to experience adverse outcome than adult women. Reports of increasing rates of abortion and prevalence of STIs including HIV among youth indicate a need to improve services and counselling for these groups. Midwives are key persons in the promotion of young people’s sexual and reproductive health in Vietnam. Aim: The overall aim of this thesis is to describe the prevalence and outcome of adolescent pregnancies in Vietnam (I), to explore the social context and health care seeking behavior of pregnant adolescents (II), as well as to explore the perspectives of health care providers and midwifery students regarding adolescent sexuality and reproductive health service needs (III, IV). Methods: The studies were conducted from 2002 to 2005, combining qualitative and quantitative research methods. A population based prospective survey was used to estimate rates and outcomes of adolescent pregnancies (I). Pregnant and newly delivered adolescents’ experiences of childbearing and their encounters with health care providers were studied using qualitative interviews (II). Health care providers’ perspective on adolescent sexual and reproductive health (ASRH) and views on how to improve the quality of abortion care was explored in focus group discussions (FGD). The values and attitudes of midwifery students about ASRH were investigated using questionnaires and interviews (IV). Descriptive statistics was used to analyse quantitative data (I, IV) and content analysis were applied for qualitative data (II, III, and IV). Findings: Adolescent birth rate was similar to previously reported in Vietnam but lower when compared to other Asian countries. The incidence of stillborn among adolescents was higher than for women in higher reproductive ages. The proportion of preterm deliveries was 20 % of all births, higher than previous findings from Vietnam. About 2 % of the deliveries were home deliveries, more common among women with low education, belonging to ethnic minority and/or living in mountainous areas (I). Ambivalence facing motherhood, pride and happiness but also worries and lack of self-confidence emerged as themes from the interviews; and experience of ‘being in the hands of others’ in a positive, caring sense but also in a sense of subordination in relation to husband, family and health care providers (II). Health care providers at abortion clinics and midwifery students generally disapproved of pre-marital sex, but had a pragmatic view on the need for contraceptive services and counselling to reduce the burden of unwanted pregnancies and abortions for young women. Providers and midwifery students expressed a need for training on ASRH issues (III, IV). Conclusion: Cultural norms and gender inequity make pregnant adolescent women in Vietnam vulnerable to sexual and reproductive health risks. Health care providers experience ethical dilemmas while counselling unmarried adolescents who come for abortion and this has a negative impact on the quality of care. Integrated ASRH in education and training programmes for health care providers, including midwives, as well as continued in-service training on these issues are suggested to improve reproductive health care services in Vietnam.

Internet- den nya barnmorskan? : En enkätstudie om hur gravida kvinnor söker information om graviditet och förlossning via Internet

Bakgrund: Internet används globalt inom många områden och aktuell forskning visar att gravida kvinnor använder Internet till att söka information om graviditet och förlossning. En graviditet innebär många frågor hos kvinnan och kvinnor söker efter information för att få en trygghet och försäkran om att allt är normalt med deras hälsa och barnet i magen. Syfte: Syftet är att undersöka gravida kvinnors informationssökning via Internet avseende graviditet och förlossning. Metod: Beskrivande tvärsnittstudie. Datainsamling skedde via en enkätundersökning och data analyserades med deskriptiv och jämförande ansats. Resultat: Nästan alla kvinnor i undersökningen använde Internet för att söka information om graviditet och förlossning. Kvinnorna söker information om barnets utveckling, kost/näring och graviditetslängd i hög utsträckning. Högutbildade kvinnor har andra kriterier för trovärdighet på hemsidor än kvinnor med lägre utbildning. Slutsats: Barnmorskor bör vara medvetna om gravida kvinnors användning av Internet samt själva skapa sig en uppfattning om informationen som de gravida kvinnorna läser på Internet. Vår studie visar att barnmorskors rekommendation av hemsidor på Internet har stor betydelse för gravida kvinnor.