Fertility and family planning in Vietnam.

This report provides the first reliable statistical data on fertility patterns and the family planning program in the Socialist Republic of Vietnam. Findings are from the 1988 Demographic and Health Survey of Vietnam and the 1989 census survey. The data show that the total fertility rate has declined from over 6 children per woman in the early 1970s to under 4 in the later 1980s. Contraceptive prevalence for modern methods is estimated at 37 percent among married women of reproductive age in 1988. The average duration of breastfeeding is over 14 months; marriage is relatively late. The IUD is the most common contraceptive method and abortion is widespread. The major factors likely to influence fertility and family planning in the future are the government's population policy, improved access to modern methods of contraception, and the institution of new economic policies that are currently under way in Vietnam.

PIP: An analysis of data gathered in the 1988 Vietnam Demographic and health Survey (VNDHS) and the 1989 Census Population Five Percent Sample suggests that the country has been undergoing a process of demographic transition since the reunification of North and South Vietnam in 1975. The total fertility rate has declined from 6.1 in 1969-1974 to slightly under 4.0 in 1988-89. Factors apparently promoting this decline include changes in nuptiality patterns (in 1988, the mean age at marriage was 23.5 years and only 60% of women of reproductive age were married), a low infant mortality rate (50/1000 live births in 1988-89), growing acceptance of the government's 2-child family size norm (desired family size stands at 2.7 children among rural women and 2.3 children among urban women), and a well-organized national family planning program (54% of currently married Vietnamese women 15-44 years of age were contraceptive users in 1988). 63% of contraceptive acceptors use the IUD--the method promoted by the government's family planning effort--but there appear to be problems with the quality of IUDs provided. 45% of ever-users of clinic methods and 19% of users of supply methods utilize the commune health center and another 37% and 24%, respectively, are supplied through district hospitals. The ability of the national family planning program to offer a range of contraceptive choices has been hindered by a severe fiscal crisis in the health sector, and privatization and decentralization are receiving consideration as possible solutions. Local demographers are currently assessing whether further economic renovation is likely to support further demographic transitions or undermine policy enforcement by weakening the influence of rural cadres.

Factors influencing infant mortality in Vietnam.

Selected determinants of overall infant mortality in Vietnam were examined using data from the 1988 Vietnam Demographic and Health Survey, and factors underlying neonatal and post-neonatal mortality were also compared. Effects of community development characteristics, including health care, were studied by logistic regression analysis in a subsample of rural children from the 1990 Vietnam Accessibility of Contraceptives Survey. Infant neonatal and post-neonatal mortality rates showed comparable distributions by birth order, maternal age, pregnancy intervals, mother's education and urban-rural residence. Rates were highest among first order births, births after an interval of less than 12 months, births to illiterate mothers and to those aged under 21 or over 35 years of age. Logistic regression analysis showed that the most significant predictor of infant mortality was residence in a province where overall infant mortality was over 40 per 1000 live births. In the rural subsample, availability of public transport was the most persistent community development predictor of infant mortality. Reasons for the low infant mortality rates in Vietnam compared to countries with similar levels of economic development are discussed.

PIP: The purposes of this study of infant mortality in Viet Nam were to determine the contribution of select variables to infant mortality and to compare these determinants with determinants of neonatal and postneonatal mortality. Data were obtained from the 1988 Vietnam Demographic and Health Survey (DHS) and the Vietnam Accessibility of Contraceptives Study in 1990. The DHS Sample included 4172 women aged 15-49 years and reports on 4884 children born between 1983 and 1988 and a subsample of 3382 children born in rural areas between 1983 and 1988. Explanatory variables were mother's age at time of birth, mother's education, birth order, sex, previous birth interval, the infant mortality risk status of the province, residence, and regional location. The accessibility survey provided data on availability of health care services, characteristics of the village, and geography of the area. Logistic regression showed that none of the explanatory variables significantly affected the infant mortality rate (IMR) for first births. For second and higher order births, provincial infant mortality risk was the only significant explanatory variable for IMR, and for postneonatal mortality for first births total, and for second and higher order births in the rural population. Risk was higher in areas with a higher than 40/1000 IMR. For second and higher order births, none of the explanatory variables was a significant predictor of neonatal, postneonatal, or infant mortality for all areas. Birth orders of 2-4 had a significantly lower risk of infant mortality than birth order of 5 or greater. In the rural subsample, high and low risk provinces were equally likely to live among the mountains and highlands; high risk provinces were more likely to be in coastal and delta areas. Children from intermediate sized villages were more likely to live in high risk provinces from those living in villages of under 2000 population or larger villages with 10,000 population. Lower infant mortality rates were associated with living in areas with public transport, a secondary school, a telephone, and electricity. Low risk infant mortality provinces also had higher proportions of children living 10 km from a polyclinic which was open over 24 hour/weeks and having a nurse or midwife available. More children with a village midwife lived in high risk provinces. The presence of public transport was associated with a significantly lower IMR.