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.

Patriarchal values : girls are more apt to change

Patriarchal values: girls are more apt to change How has the family value system changed between generations, especially when taking into account the gender dimension? This article presents some results from a study carried outin 2007 in one village of the Gourani tribe where the people are followers of Ahle Hagh in Islamabad Gharb (west of Iran). The differences between generations (those born and raised before and after the Islamic Revolution) in patriarchal values in the family are statistically significant. The older generation opts for the man of the family to make most of the decisions; on children’s education, marriage, naming, the families expenditure, the place for residence, the social network of the family and even the number of children. The younger generation has a different value system and it has moved towards a more egalitarian type of family. With the gender variable included in the findings we see that although the values of the younger male population have evolved toward a less patriarchal decision making structure inthe family, the degree of changes among the young women is much higher. Looking into the preferences for male sex for the first child as well as a larger number of boys in the family, the difference between generations is significant. However data on the differences analyzed with the gender variable proves that the changes concerning the equality of sexes are mainly due to drastic changes in the young women’s value system. That is, the male population, young or old, still prefer to have a boy as their first born and to have more sons in the family. But the young female generation in the rural area sees less difference in having boys or girls in the family. It is concluded that reforms in the old value system is an evolving process of everyday life and that the girls are the main social force for change.