Viet Nam - Demographic and Health Survey - 1999

Publication date: 1998

Demographic and Health Survey 1997 National Committee for Population and Family Planning The Population and Family Health Project Ha Noi 3 - 1999 Viet Nam Demographic and Health Survey 1997 NATIONAL COMMITTEE FOR POPULATION AND FAMILY PLANNING THE POPULATION AND FAMILY HEALTH PROJECT HANOI 3-1999 33-335 197-35-99 TK-99 CONTENTS TAB L ES . v F IGURES . ix PREFACE . xi ACKNOWLEDGMENTS . xii i SUMMARY OF F INDINGS . xv MAP OF V IETNAM . xvi i i CHAPTER 1 INTRODUCTION . 1 1.1 1.2 1.3 1.4 1.5 1.6 Country Setting . I Population . ~. I Socioeconomic Condit ions . 2 Population Pol icy and Programs . 2 Survey Object ives . i . 3 Survey Implementation . 3 CHAPTER 2 CHARACTERIST ICS OF HOUSEHOLDS AND RESPONDENTS . 7 2.1 2.2 2.3 2.4 Characterist ics o f the Household Population . 7 Housing Characteristics . 12 Household Durable Goods . 14 Background Characteristics o f Women Respondents . 15 CHAPTER 3 FERT IL ITY . 27 3.1 3.2 3,.3 3.4 3.5 Ferti l ity Levels and Trends . 27 Chi ldren Ever Born . 31 Birth Intervals . . . 33 Age at First Birth . 34 Adolescent Fertil ity . 36 CHAPTER 4 FERT IL ITY REGULAT ION . 39 4.1 Knowledge o f Family Planning Methods . 39 4.2 Ever Use of Family Planning Methods . 41 4.3 Current Use o f Family Planning . 42 4.4 Number of Chi ldren at First Use o f Contraception . 45 4.5 Knowledge o f the Fertile Period . 45 4.6 Age at Steri l ization . 46 4.7 Source o f Supply . .'. . 47 4.8 Contraceptive Discontinuation . 48 4.9 Future Use o f Contraception . 51 4.10 Family Planning Messages . 54 4. I l Family Planning Outreach Activities . 57 4.12 Att itudes toward Family Planning among Couples . 59 4.13 Abort ion and Menstrual Regulation . 60 CHAPTER 5 PROXIMATE DETERMINANTS OF FERT IL ITY . 65 5.1 Marital Status . 65 5.2 Age at Marr iage . 66 5.3 Postpartum Amenorrhea, Abstinence and Insusceptibil ity . 68 5.4 Terminat ion o f Exposure to Pregnancy . ; . : . 69 iii CHAPTER 6 FERT IL ITY PREFERENCES . , . 71 6.1 6,2 6.3 6,4 CHAPTER 7 7.1 7.2 7.3 7.4 7.5 Desire for More Children . 71 Need for Family Planning Services . 74 Ideal Family Size . 76 Fertil ity Planning . 78 . INFANT AND CHILD MORTAL ITY . i . 8 I Assessment o f Data Qual ity . 8 I Levels and Trends in Infant and Chi ld Mortal i ty . 84 Socioeconomic Differentials in Infant and Chi ld Mortal ity . 86 Demographic Differentials in Infant and Child Mortal ity . 87 High-r isk Fertility Behavior . 88 CHAPTER 8 MATERNAL AND CHILD HEALTH . : . 91 8.1 8.2 8.3 8.4 CHAPTER 9 Antenatal Care . 91 Del ivery Care . 94 Vaccieat ion o f Chi ldren . 98 Chi ldhood ll lness and Treatment . I 0 t % INFANT FEEDING 9.1 9.2 9.3 Prevalence o f Breastfeeding . 107 Supplementation . 108 Duration and Frequency o f Breastfeeding . 110 CHAPTER 10 KNOWLEDGE OF AIDS 10.1 AIDS Knowledge . 113 10.2 Source o f Information . 113 10.3 AIDS Prevention . I 15 10.4 AIDS-related Perceptions . 116 10.5 Knowledge of Where to Obtain Condoms . I 18 CHAPTER 11 AVAILABIL ITY OF HEALTH SERVICES . I21 11.1 Avai labi l i ty o f Family Planning Services . 121 I 1.2 Avai labi l i ty o f Other Health Services . 126 REFERENCES . . 131 APPENDIX A SAMPLE DESIGN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133 APPENDIX B ESTIMATES OF SAMPLING ERRORS . 145 APPENDIXC QUESTIONNAIRES . 163 APPENDIX D PERSONS INVOLVED IN THE 1997 VIETNAM DEMOGRAPHIC AND HEALTIt SURVEY . 251 i'4 TABLES Table I.I Table 2.1 Table 2.2 Table 2.3 Table 2A Table 2.5 Table 2.6 Table 2.7 Table 2.8 Table 2.9 Table 2.10 Table 2.11 Table 2.12 Table 2.13 Table 2.14 Table 2.15 Table 2.16 Table 3.1 Table 3.2 Table 3.3 Table 3.4 Table 3.5 Table 3.6 Table 3.7 Table 3.8 Table 3.9 Table 4. I Table 4.2 Table 4.3 Table 4.4 Table 4.5 Table 4.6 Table 4.7 Table 4.8 Table 4.9 Table 4. I 0 Table 4. I 1 Table 4.12 Table 4.13 Table 4.14 Table 4.15 Table 4.16 Table 4.17 Table 4.18 Table 4.19 Table 4.20 Table 4.21 Table 4.22 Table 4.23 Sample results . 6 Household population by age, residence and sex . 7 Population by broad age groups from selected sources . 8 Household composition . 9 Educational level of the male household population . : . l0 Educational level of the female household population . 1 I School enrollment . 12 Housing characteristics . 13 Household durable goods . 14 Background characteristics of respondents . 16 Level of education . 17 School attendance and reason for leaving school . 18 Employment status . 19 Place of work . 20 Decision on use of earnings. . 21 Child care while working . 23 Access to mass media . 24 C'urrent fertility rates . 28 Trends in fertility rates . 30 Fertility by background characteristics . 31 Children ever born and.living . 32 Trends in the number o f children ever born . 32 Birth intervals . 34 Age at first birth . 35 Age at first birth by background characteristics . 36 Adolescent pregnancy and motherhood . L . 37 Trends in knowledge of contraceptive methods . 39 Knowledge of contraceptive methods by background characteristics . 40 Ever use of contraception . - . 41 Current use o f contraception . : . 42 Current use of contraception by background characteristics . 44 Number of children at first use of contraception . . . . . . . . . . . . i. . 45 Knowledge of the fertile period . 46 T iming of sterilization . 46 Source of supply for modern contraceptive methods . 47 Contraceptive discontinuation rates . 49 Reasons for discontinuation . 50 Future use of contraception . : . : . 5 I Reasons for not using contraception . 52 Preferred method of contraception for future use . 53 Exposure to family planning messages on radio and television . 5 ~1 Acceptability of media messages on family planning . 5~ Exposure to family planning messages in print media . 57 Contact of nonusers with family planning providers . 58 Discussion o f family planning with husband . 59 Attitudes of couples toward family planning . 60 Lifetime experience with pregnancy termination . 61 Abortion rates by background characteristics . 62 Use of contraception prior to pregnancy termination . 63 Table 4.24 Table 5.1 Table 5.2 Table 5.3 Table 5.4 Table 5.5 Table 5.6 Table 5.7 Table 6.1 Table 6.2 Table 6.3 Table 6.4 Table 6.5 Table 6.6 Table 6.7 Table 7. I Table 7.2 Table 7.3 Table 7.4 Table 7.5 Table 7.6 Table 7.7 Table 8.1 Table g.2 Table 8.3 Table 8.4 Table 8.5 Table 8.6 Table 8.7 Table 8.g Table 8.9 Table 8. I 0 Table 8. I 1 Table 8.12 Table 9. I Table 9.2 Table 9.3 Table 10.1 Table I0.2 Table 10.3 Table 10.4 Table 1 I. I Table II .2 Table I 1.3 Table I 1.4 Table 11.5 Table I 1.6 Table I 1.7 Table 11.8 Table 11.9 Table A.I Table A.2 Health problems and treatment following pregnancy termination . 64 Current marital status . : . 65 Never-married women . 66 Age at first marriage . 66 Median age at first marriage . 67 Postpartum amenorrhea, abstinence, and insusceptibility . 68 Median duration of postpartum insusceptibility by background characteristics . 69 Termination of exposure to the risk of pregnancy . 70 Fertility preferences by number of living children . 71 Fertility preferences and age . 72 Want no more children by background cbaracteristics . 73 Need for family planning services . 75 Ideal and actual number of children . 76 Ideal number of children by background characteristics . 77 Fertility planning . 79 • Births by calendar years . 82 Reporting of age at death in days . 83 Reporting of age at death in months . 84 Infant and child mortality . 84 Infant and child mortality by socioeconomic characteristics . 86 Infant and child mortality by demographic characteristics . 87 High-risk fertility behavior . 89 Antenatal care . 92 Number of antenatal care visits and stage o f pregnancy . 93 Tetanus toxoid vaccination . 94 Place of delivery . 95 Assistance during delivery . 96 Delivery characteristics: Caesarean section, birth weight and birth size . 97 Vaccinations by source of information . 99 Vaccinations by background characteristics . 100 Prevalence and treatment o f acute respiratory infection and prevalence o f fever . 102 Prevalence of diarrhea . 103 Knowledge of diarrhea care . 105 Treatment of diarrhea . 106 Time at initiation of breastfeeding . 108 Breastfeeding status . 109 Median duration and frequency of breastfeeding . I I I Knowledge of AIDS . 114 AIDS prevention . 116 AIDS perceptions . 117 Knowledge of where to obtain condoms . 118 Availability of family planning services in the community . 122 Family planning and health campaigns in the year preceding the survey . 123 Distance to nearest family planning services . 124 Distance to nearest provider of specific contraceptive methods . 124 Use of contraception and distance to nearest facility providing family planning services . 125 Availability of health services in the community . 126 Distance to nearest facility providing materrtal artd child health services . 127 Distance to nearest health facility providing antenatal and delivery care . 128 Distance to nearest health facility providing health services for children . 129 Vietnam population 1996 . 137 Projected population to I c)97 . 139 vi Table A.3 Table A.4 Table A.5 Table A.6 Table B.I Table B.2 Table B.3 Table B.4 Table B.5 Table B.6 Table 13.7 Table B.8 Table B.9 Table B.10 Table B.I1 Table B.12 Table B.13 Proportional sample allocation . 139 Proposed non-proportional sample allocation . 139 Number of households to yield the target number o f respondents . : . 140 Number of clusters to be selected . 140 List of selected variables for sampling errors, Vietnam 1997 . 150 Sampling errors - National sample . 151 Sampling errors - Urban sample . t 52 Sampling errors- Rural sample . 153 Sampling errors - Northern Uplands sample . 154 Sampling errors - Red River Delta sample . 155 Sampling errors - North Central sample . ] 56 Sampling errors - Central Coast sample . 157 Sampling errors - Central Highlands sample . 158 Sampling errors - Southeast sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159 Sampling errors - Mekong River Delta sample . 160 Sampling errors - Non-project provinces sample . 161 Sampling errors - Project provinces sample . 162 vii FIGURES Figure2.1 Figure 2.2 Figure 2.3 Figure 3.1 Figure 3.2 Figure 3.3 Figure 4.1 Figure 4.2 Figure 4.3 Figure 4.4 Figure 6. I Figure 6.2 Figure 6.3 Figure 7. I Figure 7.2 Figure 7.3 Figure 8.1 Figure 9. I Figure 10.1 Population pyramid . $ School enrollment among children age 6-15 by age, sex, and urban-rural residence . 12 Percentage of ever-married women who completed at least lower secondary education by region . 18 Total fertility rates by residence . . . 29 Median age at first birth, by current age . 35 Percentage of teenage women who have begun childbearing by education . 38 Sources of family planning among current users of modern contraceptive methods . 48 Reasons for discontinuing use of family planning methods . 50 Preferred method among nonusers who intend to use in the future . 53 Exposure to family planning messages on radio and television by region . 55 Fertility preference, currently married women 15-49 . 72 Proportion of current ly married women with two children who want no more children by level of education . 74 Mean ideal number of children for ever-married women by level of education . 78 Trends in infant mortality . 85 Under-five mortality by residence and education . 86 Under-five mortality by selected demographic characteristics . 88 Vaccination coverage among children age 12-23 months . 99 Distribution of children by breastfeeding status according to age . I09 Percentage of ever-married womenf'who know of AIDS according to background characteristics . . . 115 ix PREFACE The 1997 Vietnam Demographic and Health Survey (VNDHS-II) was carried out according to a subcontract between the National Committee for Population and Family Planning (NCPFP) and the Futures Group International Inc. in USA within the frame of the Population and Family Health Project. The Macro International Inc. in USA provided technical assistance to the survey. The execution of the survey and the preparation of this report have gone through several phases, starting March 1997 and ending with the publication of this report in March 1999. These phases included the preparation for the survey, field operations, data processing and tabulation, publication of the preliminary report in January 1998, analysis of the survey data, preparation and editing of the chapters for this report, and publication and dissemination of the report. It gives us great pleasure to present this report to all planners, policymakers, scholars, researchers and concerned users. The report is a detailed presentation of many aspects of the data collected in the survey. I wish to thank all the institutions and individuals who participated in the execution of this survey and the preparation of this report. Although this report cannot be free from limitations, I believe that it meets the stated objectives of the survey and will be useful for all planners, policymakers and researchers, both within and outside Vietnam. Dr. Nguyen Thien Truong Vice Chairman, NCPFP XI ACKNOW~LEDGMENTS The Population and Family Health Project would like to sincerely thank leaders of the National Committee for Population and Family Planning, and technical advising agencies: the Futures Group International Inc., the Macro International Inc. and the General Statistical Office for their supports to the conduct of the 1997 Vietnam Demographic and Health Survey. The Project would like to thank national and international consultants who have participated in the survey data collection, data analysis, preparation of analysis reports and comment to finalise the report of survey results. This report was written by Messrs Nguyen Van Phai, Mai Van Cam and Hoang Xuyen (General Statistical Office) and Drs. Jeremiah M. Sullivan and Pavalavalli Govindasamy (Macro International Inc.). Dr. John Ross (Futures Group International Inc.), Mr. Han Raggers, Ms. Thanh Le, and Drs. Fred Arnold and Marilyn Wilkinson (Macro International Inc.), Ms. Chu Thi Loan (GSO), Dr. Dang Nguyen Anh (Institute of Sociology), Dr. Nguyen Dinh Loan (Ministry of Health), Dr. Nguyen The Hue (Institute of Ethnicity), Dr. Nguyen Minh Thang, Dr. Tran Van Chien, Dr. Pham Ba Nhat, and Messrs. Nguyen Quoc Anh and Khong Van Man (National Committee for Population and Family Planning) provided technical advising and comments to the report preparation. Dr. Sidney Moore contributed edition and Ms. Kaye Mitchell contributed word processing assistance to the English version of the report. The Project would like to express sincere gratitude to Dr. Althea Hill and Dr. Rama Lakshiminarayanan advisors of the World Bank for their contribution of valuable experience in survey implementation, management and analysis results. Hanoi, 26 February 1999 Project Director Dr. Ngo Khang Cuong xiii SUMMARY OF FINDINGS The 1997 Viemam Demographic and Health Survey (VNDHS-II) is a nationally representative survey of 5,664 ever-married women age 15-49 selected from 205 sampling clusters throughout Vietnam. The VNDHS-II was designed to provide information on levels of fertility, family planning knowledge and use, infant and child mortality, and indicators of maternal and child health. The survey included a Community/Health Facility Questionnaire that was implemented in each of the sample clusters included in the women's survey. Fieldwork for the survey took place from July to October 1997. All provinces were separated into "project" and "non-project" groups to permit separate estimates for about one-third of provinces where the health infrastructure is being upgraded. VNDHS-II data confirm the patterns of declining fertility and increasing use of contraception that were observed between the 1988 VNDHS-I and the 1994 lntercensal Demographic Survey (ICDS-94). FERTILITY Fertility Levels and Trends. The total fertility rate (TFR), which was estimated for the period 1992-96, is 2.7 children per woman. This represents a continuation of the rapid fertility decline indicated by the findings of earlier surveys: 4.0 children per women for 1987 (VNDHS-I) and 3.3 for the period 1989-93 (ICDS-94). The decline in the TFR from 3.3 (ICDS-94) to 2.7 (VNDHS-II) is consistent with the amount of decline that is predicted by the observed increase in the contraceptive prevalence rate (I 0 percentage points) between the two surveys. Fertility Differentials. There are substantial differences in fertility levels in Vietnam. The TFR is a full child higher in rural areas than in urban areas (2.9 children per woman compared with 1.8 children per woman). Regional differences are also marked; the highest fertility is in the Central Highlands (4.3 children per woman) while the lowest is in the Southeast region (1.9 children per woman), which includes Ho Chi Minh City. Differences between project and non-project provinces are minimal. As in most countries, fertility levels are closely linked to women's education. Women with no formal education give birth to an average of 4.0 children during their reproductive years compared with 2.g children for women with primary school education and 1.9 children for women with higher secondary school education. Unplanned Fertility. Despite the high level of contraceptive use in Vietnam. the VNDHS-It data indicate that unplanned pregnancies are common. Overall, more than one-fourth of births in the three years preceding the survey were reported as unplanned: 15 percent were mistimed (wanted later) and 12 percent were unwanted. Although many women are not receiving the services they need in order to achieve their reproductive goals, the rate of unplanned pregnancies has decreased since the ICDS-94 survey (33 percent). FERTILITY REGULATION Knowledge of Contraception. Knowledge of the IUD among married women has been above 90 percent in Vietnam since the late 1980s. The VNDHS-II found that 98 percent of women know of this method while about 90 percent know about the pill, the condom, and male and female sterilization: 80 percent know about the traditional methods of periodic abstinence and withdrawal. Knowledge of modern methods other than the IUD and of traditional methods has increased substantially since first being measured in 1988 by the VNDHS-I. Use of Contraception. The decline in fertility in Vietnam over the past decade has been accompanied by a steady increase in the use of contraception. Between 1988 and 1997 the contraceptive prevalence rate among married women increased from 53 to 75 percent. The rise was driven primarily by XV increased use of modem methods (up 48 percent) and, secondarily', by increased use of traditional methods (up 25 percent). In the three-year period between the ICDS-94 and the VNDHS-II, the contraceptive prevalence rate increased 10 percentage points among married woinen, from 65 to 75 percent. Contraceptive Method Mix. Over the last two decades the IUD has been the most popular method of contraception in Vietnam. The VNDHS-II found that 39 percent of married women are currently using the IUD. Othe, r modern methods used are female sterilization (6 percent), the condom (6 percent), and oral contraception (4 percent). Although less popular than the IUD, these latter methods are the fastest growing segment of method use, increasing fourfold since 1988. The increased use of methods other than the IUD may have implications for service delivery by the family planning program in future years. Two traditional methods account for a significant amount of current use: these are periodic abstinence (7 percent) and withdrawal (12 percent). Source of Modern Methods. In Vietnam, provision of modern methods is dominated by the public sector. Eighty-eight percent of current users obtained their last method from the public sector By far the most important source of contraception is the commune health center (43 percent), followed by government hospitals (27 percent) and mobile clinics (11 percent). Together these three sources supply 80 percent of current users of modern methods. Differential Contraceptive Use. Given the overall high rate of contraceptive use in Vietnam, there is little room for variation between population subgroups. Nevertheless, the Central Highlands stands out from other regions as having a particularly low level of contraceptive use (64 percent). There are also substantial differences by education, with contraception rates being higher among more educated women. Differentials in contraceptive use by urban-rural residence are small, as are differentials between project and non-project provinces. Unmet Need for Family Planning. Unmet need for family planning services was low in the IDCS-94 (11 percent) and has continued to decline. The VNDHS-I1 data indicate that 7 percent of married women have an unmet need for family planning services. Half of this unmet need is comprised of women who want to wait two or more years before their next child (spacers) and half is comprised of women who Want no more children (limiters). If all women who say they want to space or limit their births were to use contraception, the contraceptive prevalence rate would increase from 75 to 82 percent among married women. Discontinuation Rates. The rate of discontinuation of contraceptive useis quite low in Vietnam. Overall, less than one in five women (18 percent) discontinues use within 12 months of adopting a method. The 12-month discontinuation rate for the IUD is particularly low (10 percent) but rates are several times higher for the pill (33 percent), the condom (23 percent), periodic abstinence (29 percent), and withdrawal (19 percent). Availability of Services. Family planning services are widely available in Vietnam. The VNDHS-II data indicate that over 95 percent of married women live in communities served by both community-based distribution (CBD) workers and family planning fieldworkers. Moreover, virtually all CBD workers and family planning fieldworkers provide pills and condoms. In addition, 70 percent of women live within one kilometer of a health facility that offers family planning services (commune health center, intercommune health center, or hospital) and over 95 percent live within five kilometers of such a facility. Outreach Activities. Despite the wide availability of family planning services, during the 12 months preceding the survey, two out of three married women who were not using contraception (67 percent) did not receive a visit from a family planning fieldworker and did not visit a health facility where family planning was discussed. This may indicate lost opportunities to provide family planning services. xvi MATERNAL HEALTH Maternal Health Care. Tile VNDHS-II data indicate that substantial increases have occurred in the number of women receiving maternal care. In tile three years before VNDHS-II, mothers received antenatal care from a doctor, nurse, or midwife for 71 percent of births compared with only 55 percent of births in the ICDS-94. Mothers reported receiving no antenatal care for 28 percent of births in VNDHS-II compared with 43 percent of births in ICDS-94. Proper medical attention and hygienic conditions during delivery can reduce tile risk of serious illness among mothers and their babies. The VNDHS-II found that three out of five deliveries (62 percent) occurred in health facilities. This is an increase from 56 percent reported in tile ICDS-94. Awareness of AIDS. Knowledge of acquired imrnunodeficiency syndrome (AIDS) is high among ever-married women in Vietnam: 91 percent reported having heard of AIDS. Radio and television are tile primary sources of knowledge about AIDS. More than two-thirds of women have been exposed to a message about AIDS in these two media. Among women who know about AIDS, a large proportion (75 percent) were able to name a valid behavior that would rednce the risk of becoming infected with the virus. Availability of Services. Maternal and child health services are wi0cly available in Vietnam. Tile VNDHS-I[ data indicate that over 55 percent of married women live in comnlunities served by trained midwives and over 80 percent live in communities visited by health Iieldworkers. In addition. over 90 percent live within five kilometers of a health facility that offers maternal and child health services (private doctor, commune health center, intercomnlune health center, or hospital). CHILD HEALTH Infant and Child Mortality. Infant and under-five mortality rates estimated fi-orn tile VNDHS-II data were 27 and 38 deaths per 1,000 live births, respectively, for the period 1992-96. Higher mortality rates were estimated for earlier time periods from tile VNDHS-II data as well as from data of other surveys. This indicates that there has been a declining trend in mortality over the past 15 years in Vietnam. The VNDHS-[I data also show that births occurring after a short birth interval (less than 24 months), births to very young wonlen (under age 20), and births to women nearing the end of their childbearing years (age 35 and over) are at an elevated risk of dying. Breastfeeding Practices. Breastfeeding is uearly universal in Vietnam: 98 percent of children are breasffed. The median duration of breastfeeding is 16 to 17 months. The VNDHS-II data indicate that supplementary feeding of children begins early. For example, among newborns less than two months of age, 46 percent are receiving supplementary foods or liquids. Childhood Vaccination Coverage. In tile VNDHS-II, mothers were able to show a health card with immunization data for only 13 percent of children. Accordingly, estimates of coverage are based on both data from health cards and mothers" recall. Estimated vaccination rates among children 12-23 months of age for BCG and the first doses of DPT and polio are 90 percent or higher while tile estimate for measles is 77 percent. The estirnated rate for full vaccination coverage is 57 percent. This may be an underestimate if, as suspected, mothers' recall of whether their children received the second and third doses of DPT and polio was faulty. Child Illness and Treatment. Among children tinder three years of age, 21 percent were reported to have had a fever and 14 percent were reported to have had acute respiratory infection ill tile two weeks preceding the survey. Of the children with respiratory illness, approximately two out of three (68 percent) were taken to a health facility or provider for treatrnent. All estimated l0 percent of children had diarrhea in the two weeks preceding the survey. Three out of four childr,:n with diarrhea (72 percent) received some type of oral rehydration therapy. xvii MAP OF V IETNAM PROVINCES/C IT IES ¢, I. Northern Uplands ) t--,_c ( ~aGmng ~N . / a .~,xj ~- , , " , S ; v ~ 2 ', - -' 2. ruyen Quang ~ s ,;,. :~.,~f.< "~.\ , ,v-,~.) , 3. C o ang 3 ;,." , .a , ,, , , < 4. l,ang Son ~ ~g; -- ' - " " , . ; ~ , , '~" "'~u 5. Lai Chau k J ,o " " ;*'r~'(,~.-~-n-- ,x. 7. Yen Bai 8. Bac Can 9. "~ai Nguyen 10. Son La 11. Hoa Birth 12. Phu Tho 13. Vinh Phuc 14. Bac Gieng 15. Bac Ninh 16. Quang NitaJa IL Red R iver De l ta 17. Ha Noi 18. Hai Phong 19. 1 la "ray 20. Hai Duong 21 Hung Yen 22. Thai Birth 23. lta Nam 24. Nam Dinh 25. Ninh Birth I l l . Nor th Cent ra l 26. Thanh Hoa 27. Nghe An 28. Ha Tinh 29. Quang Binh 30. Quang Tri 31. Thua Thien - Hue IV. Cent ra l Coast 32. Da Nang 33. Quang Nam 34. Quang Ngai 35 Binh Dinh 36. Phu Yen 37. Khanh Hoa 38. Ninh Thuan 39. Birth Thuan V. Cent ra l H igh lands 40 Gia Lai 41 Kon Ttma 42 l)ac l.ac 43 I,am Dong VI. Southeast 44. l lo Chi Mirth 45. Birth Duong 46 Binh Phuoc 47 "ray Ninh 4g Dong Nai 49. Pm. Ria-Vung Tau VI I . Me Kong R iver De l ta 50. Long An 51. Dong Thap 52. An Giang 53. Tien Giang 54. Ben "Ire 55. Vinh Long 56. Tra Vinh 57. Can Tho 58. Soc Trang 59. Kien Giang 60 Bac Lieu 61. Ca Mau • 26 ~flONG 33 ~ t!. L ,~P~J i 35 \ 40 47 ,~'~'~ / k z . v , "¢, I U [ Q. ;'2 t O ke ,5 Ox ~G t j~ xviii CHAPTER 1 INTRODUCTION 1.1 Country Setting The Socialist Republic of Vietnam is located in southeastern Asia between 8°35 ' and 23°24 ' north latitude and 102°00 ' and 109000 ' east longitude. The total area is 330,000 square kilometers. Vietnam has a sea territory of about one million square kilometers which includes thousands of islands of various sizes. Some islands exist separately while others are gathered into archipelagos such as Hoang Sa and Truong Sa in the East Sea. Vietnam is bordered by tile Peoples Republic of China in tile north and tile Peoples Democratic Republic of Laos, and Cambodia in the west. The Pacific Ocean ties to the east. The sea coast from the north to the south is shaped like an elongated ~'S." Vietnam includes tropical rain forests, rich agricultural plains, and forested Ilills and mountains. About 80 percent of Vietnam consists of mountains, high plateaus, and jungles. These areas have low agricultural productivity. The rice producing deltas provide the bulk of food for the population. The climate is tropical in the south with a rainy season and a dry season, and sub-tropical in tile north where the winters are cool and dry, and the summers are hot and humid. 1.2 Population Population Size and Distribution The latest population census in tile Socialist Republic of Vietnam was conducted in 1989. In that year, the resident population of Vietnam was 64,4 million, The estimated population in 1996 was around 75.4 million (GSO, 1998). At tile national level, tile population density is about 228 persons per sqt:are kilometer (1996), distributed among 60 provinces/cities and tile capital, Ha Noi. The provincial level units are divided into 600 districts and these are subdivided into 10,331 communes. The populatio~ is distributed between rural and urban areas. In 1996, 21 percem ::f"he population lived in urban areas, qne most densely populated cities are Ha Noi, Ho Chi Minh Cit-,, H:,i Phong. and Da Nang. Population Growth In 1995, the estimated crude birth rate in Viemam was 23.9 per thousand, while tile crude death rate was 6.8 per thousand. The total fertility rate, which is the estin',a'~ed number of iive births a woman will have by the end of her reproductive years, is 2.69 births per woman. According to the 1994 lntercensal Demographic Survey, the infant mortality rate for the latest cohort (1989-1993) was only 44.2 per thousand (GSO, 1995). Life expectancy at birth in 1989 was estimated at 63 years for men and 67 years for women. In the last decade there was a clear irnprovement in the standard of living and health conditions, which was reflected in the continuing increase in life expectancy. 1.3 Socioeconomic Conditions Education Education is one of the most important measures of social and economic development. Because the government has paid a great deal of attention to education, educational levels are high in Vietnam. According to the I989 census, 88 percent of the population age 10 years and above were literate. Among the population at least I 0 years of age, 93 percent of males and 84 percent of females were literate. The urban literacy rate is 94 percent and the rural rate is 87 percent (GSO, 1994). The avera,,e= number of years of schooling in Vietnam is relatively high. At the time of the 1989 census, the average number of years of schooling for the population age 10 years and above was 9.5, 9.8 years for males and 9.3 years for females. The urban-rural differential was wide. In urban areas, the average number of years of schooling was 1.6 years, whereas in rural areas it was only 9.2 years. Health Health conditions in any commumty are the result of various social, economic, cultural, and environmental factors. Despite the poor national economy, Vietnam's health situation is favorable relative to other developing conntries. Infant mortality and child mortality rates have decreased considerably in the last few decades due to the emphasis on education and basic health care for all. The Ministry of Health has developed a basic health care system covering the whole country. Most commtmes have their own commune health center staffed by trained health workers. Problems that cannot be handled at the local level are referred to district, provincial or specialized hospitals. The efficiency of health services has increased. Even in the rural areas, 93 percent of communes have their own health centers (GSO, 1995:7). Population Activities In 1989, 28.7 million workers were employed, an increase of 8 million compared with the 1979 census (GSO. 1994). This translates into an increase of 3.4 percent per year, which is much higher than the rate of population growth. Economic activity rates in 1989 were 78 percent for males and 71 percent for females aged 13 years and over. Workers were mainly employed in agriculture (71 percent) and industry (12 percent). Following these two industries was trade (7 percent). Government policies relating to the development of industrial production - especially consumer goods manufacture - and the encouragement of trade, have increased the share of industry, trade, and transport in the economy since 1979. Unemployment rates were high in 1989 - 5.8 percent for the total labor force and 13.2 percent for the urban labor force. Unemployment was an especially severe problem among persons under 20 years of age. 1.4 Population Policy and Programs Vietnam (The Democratic Republic of Vietnam in the North) was among the earliest countries in the developing ~+orld to adopt an official policy to reduce rapid population growth. As early as 1961, spurred by the results of the 1960 census, the government of tl~e Democratic Republic of Vietnam (North Vietnam) issucd a statement recommending that couples limit their family size and space their births to reduce the excessive rate of population growth. The policy appears to have been motivated by long- standing concerns about pressures on the land and associated chronic food shortages in the North as well as by the related desire to improve women's welfare, part of the strategy to enhance production to meet the needs of the struggle for independence and reunification. In South Vietnam, prior to unification, the government did not promote family planning until the United States Agency for Internatiollal Development encouraged it to do so in 1971. Nevertheless, the program in the South remaiued incomplete through the end of the war. Following reunification, policies to reduce population growth received increasing political attention from the national government, and efforts to extend coverage of birth control services throughout the country gained greater priority. A series of government decisions and decrees led to the formal adoption at the national level of a policy advocating a family norm of one to two children in late 1988. The 30 June 1989 National Health Law passed by the National Assembly legalized the principle of freedom of choice for couples in their use of family planning practices. It stressed that individuals must be free to choose the family planning method they wished, and "All acts of preventing or forcing the implementation of family planning are prohibited." In January 1993, the Communist Party Central Committee for the first time approved a resolution on population and family planning. In a strong statement, they identified excessive population growth as contributing to a wide range of social, economic, and ecological problems. The resolution endorsed the recommendation that "each family should have one or two children" so that fertility could be lowered and population stabilization achieved. A comprehensive, official plan - Population and Family Planning Strategy to the Year 2000 - was approved by the Prime Minister in Jnne 1993 to guide efforts to implement the resolution. 1.5 Survey Objectives The primary objectives of the second Vietnam National Demographic and Health Survey (VNDHS-II) in 1997 were to provide up-to-date information on fertility levels, fertility preferences, awareness and use of family planning methods, breastfeeding practices, early childhood mortality, child health and knowledge of AIDS. 1.6 Survey Implementation Sample Design ~ The sample for the VNDHS-II is a subsample of the 1996 Multi-Round Demographic Survey (1996 MRS). The latter is a semi-annual survey of about 243,000 households that'the General Statistical Office (GSO) regularly undertakes to collect information on population changes in households. The sample households are located in 1,590 sample areas, or enumeration areas (EAs), spread throughou t the 53 provinces of Viemam, with 30 EAs in each province. On average, an EA comprises about 150 households. For tile VNDHS-II, a subsample of 205 EAs was selected and 26 households from each urban EA and 39 households from each rural EA were selected. The sample households were selected from a listing of households that was conducted as part of the 1996 MRS. A total of7,150 households were selected. i A full description of the sample design, including an evaluation of the coverage of the 1996 MRS, is given in Appendix A. This section contains only a summary of the design. 3 The VNDHS-II was designed to provide separate estimates for the whole cotmtry, for urban and rural areas, for 18 project provinces, and for the remaining non-project provinces. 2 Questionnaire Content Three types of questionnaires were used in the VNDHS-II: the Household Questionnaire, the Individual Questionnaire, and the Comrnunity/Health Facility Questionnaire. A draft of the first two questionnaires was prepared using the DHS Model A Questionnaire. A user workshop was organized to discuss the contents of the questionnaires. Additions and modifications to the draft of the questionnaires were made after the user workshop and in consultation with staff from Macro International Inc., and with members of the Technical Working Group, who were convened for the purpose of providing technical assistance to the GSO in planning and conducting the survey. The questiolmaires were developed in English and translated into and printed in Vietnamese. The draft questiounaires were pretested in two clusters in Ha Noi City (one urban and one rural cluster). The Household Questionnaire was used to enumerate all usual members and visitors in selected households and to collect information on age, sex, education, marital status, and relationship to the head of h0usehold. The main purpose of the Household Questionnaire was to identify women eligible for the individual interview (ever-married women age 15-49). In addition, the Household Questionnaire collected information on characteristics of the household such as the source of water, type of toilet facilities, material used for the floor and roof, and ownership of various durable goods. The Individual Questiomlaire was used to collect information on ever-married women age 15-49 in the surveyed households. These women were asked questions on the following topics: Respondent's background characteristics (age, education, residential history, etc.); Reproductive history; Contraceptive knowledge and use; Antenatal and delivery care: Infant feeding practices; Child immunization and health; Fertility preferences and attitudes about family planning; Husband's background characteristics; Women's work information; and Knowledge of AIDS. The Community/Health Facility Questionnaire was used to collect information on all communes in which the interviewed women lived and on services offered at the nearest health facilities. The questionnaire consisted of four sections. The first two sections collected information from community informants on characteristics such as the major economic activity of residents, distance to civic services, and the location of the nearest sources of health care. The last two sections collected information from the nearest commune health center and the nearest "other" health facility (bealth center, intercommune health center or hospital), if such facilities were located within 30 kilometers of a sample cluster. For each facility visited information was collected on factors such as the type of services offered and the number of : Project provinces refer to 18 focus provinces targeted for the strengthening of their primary health care systems by the Government's Population and Family Health Project, to be implemented over a period of seven years, from 1996 to 2002. (At the outset of this project there were 15 focus provinces, which became |8 by the creation of 3 new provinces from the initial set of 15.) These provinces were selected according to criteria based on relatively low health and family planning status, no substantial family planning donor presence, and regional spread. These criteria resulted, by and large, in the selection of the country's poorer provinces. Nine of these provinces have significant proportions of ethnic minorities among their population (World Bank, 1995). 4 days services were offered per week, the type and.number of staff assigned and their training, and the equipment and medicines available at the time of the facility visit. Training and Fieldwork Data collection for the VNDHS-II was carried out by eight teams, each consisting of four female interviewers for Household and Individual Questionnaires, an interviewer for Community/Health Facility Questionnaire, a field editor, a supervisor, and a driver. The field staff was provided with a Interviewers Instruction and Procedures Manual and were trained by GSO staff in two training courses. Each training course lasted three weeks. The first started on 23 June 1997 in My Tho City, Tien Giang Province and the second started on 14 July 1997 in Ha Noi. Fieldwork began in mid-July 1997 and lasted until October 1997. Field supervision was conducted by tbe senior staff of GSO, members of the Technical Working Group, and staff from Macro International Inc. Data Processing The first stage of data editing was done by the field editors, who checked the questionnaires for completeness and consistency. Supervisors also reviewed the questionnaires in the field. The completed questionnaires were then sent to the GSO by post for data processing. The office editing staff first checked that questionnaires for all households and eligible respondents had been received from the field. The data were then entered and edited using microcomputers and a software program developed for DHS surveys, the Integrated System for Survey Analysis (ISSA). Data entry was 100 percent verified. During the first three weeks of fieldwork, office editors and data processing staff were trained and supervised by a data processing specialist from Macro International Inc. Office editing and data processing activities were initiated immediately after the beginning of the fieldwork and were completed in mid-October t997. Survey Response Rates Table 1.1 presents information on the results of the housebold and individual interviews. The table shows high response rates. From a total 7,150 households selected in the sample, 7,031 households were occupied at the time of the interview, and 7,001 were successftdly interviewed, giving a household response rate of 99.6 percent. The household response rate was high in both urban (99.2 percent) and rural (99.7 percent) areas. A total of 5,704 eligible women were identified in the interviewed households~ and 5,664 (99.3 percent) were successfully interviewed. Non-response was mainly due to the fact that respondents were not at home at the time of interview and during callbacks. Only one woman refused to be interviewed. The individual response rate was high in both urban (99.5 percent) and rural (99.2 percent) areas. The overall response rate for the VNDHS-II was 98.9 percent. Table I I Sample results Number of households by urban-rural residence and ntm~ber of interviews and response rates. Vietnam 1997 Residence Tolal Result Urban Rural Number Percent Household interviews Ilouseholds selected 1,690 I Iouseholds occupied 1.644 I Iouseho[ds absent (br extended period 23 [),,veiling vacant/destroyed 14 I |ouscholds intervic~ cd 1.63 I I Ic, uscholds not intervic,.,.cd 13 5.460 7.150 100.0 5.387 7.031 100.0 45 68 1,0 19 33 0.4 5.37(} 7.001 99.6 [7 30 0.4 Individual interviews IZligibl¢ "~'. on1 en 1.323 4.381 5.704 100.0 Women intcr',ic',~-cd 1.316 4.348 5.664 99.3 Women not interviewed 7 33 40 (1.7 99.2 99.5 I Iouschold response rate Iv, divktua! respor, sc rat,: Overall response rate 99.7 99.6 99.2 99.3 98.9 6 CHAPTER 2 CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS The purpose of this chapter is to provide a descriptive summary of some socioeconomic characteristics of the households and the individual respondents of the second Vietnam Demographic and Health Survey (VNDHS-II), such as age, sex, residence and education. It also examines some environmental conditions, such as water sources, toilet facilities, and possession of consumer goods. This information is very important for interpreting the survey findings and can provide an approximate indication of the representativeness of the survey. 2.1 Characteristics of the Household Population In the VNDHS-II, information was collected for usual residents of the selected households and visitors who had spent the previous night in the households. A household was defined as a person living alone or a group of persons who live and eat together. Age and Sex Composition The percent distribution of the de facto population by five-year age groups, according to urban- rural residence and sex is presented in Table 2.1. By residence, the distribution of the surveyed population was 18 percent urban and 82 percent rural. The age distribution is typical of high fertility societies in which a larger proportion of the population is found in the younger age groups than in the older age groups (see Figure 2.1). However, the number of children under five is less than the number age 5-9 and the number of children age 5-9 is slightly tess than the number age 10-14, which is evidence of a rapid decline in fertility during the last 10 years. Table 2.1 110uschold population by age. residence and sex Percent distribution of the dc facto household population Vietnam 1997 by five-year age groups, according to urban-rural residence and sex, Age Urban Rural Total group Male Female Total Male Female Total Male Female Total 0-4 8.8 7.2 8.0 I I.I 9.9 10.5 10.7 9.4 10.0 5-9 9.6 8.8 9.2 13.9 12.3 13.1 13.1 I 1.6 12.3 0-14 I 1.0 9.1 10.1 14.8 12.7 13.7 14.1 12.1 13.1 15-19 10.2 9.2 9.7 10.6 I O. I 10.3 10.5 9.9 10.2 20-24 9.(1 9.8 9.4 7.9 7.9 7.9 8. I 8.3 8.2 25-29 8,7 9.2 8.9 6.9 7.4 7.2 7.3 7.7 7.5 30-34 8.9 8.2 8.5 7.6 8.0 7.8 7.8 8. I 7.9 35-39 8.3 9. I 8.7 6.4 %0 6.7 6.7 7.4 7.1 40-44 7.2 7.4 7.3 5.4 5.3 5.3 5.7 5.7 5.7 45-49 4.7 4.9 4.8 3.4 3.6 3.5 3,6 3.9 3.8 50-54 2.8 3.4 3. I 2.2 2.5 2.4 2.3 2.7 2.5 55-59 2.9 3.5 3.3 2.2 2.8 2.5 2.3 2.9 2,6 60-64 2.1 2.8 2.5 2.4 2.9 2,7 2.4 2.9 2.6 65-69 2.3 2.7 2.5 2,2 2.4 2.3 2.2 2.4 2.3 70-74 1.6 1.6 1.6 1.5 2.1 1.8 1.5 2.0 1.8 75-79 I.U 1.7 1.4 0.8 1.5 1.2 0.9 1.5 1.2 80+ Og 1.3 I. 1 O.7 1.6 1.2 0.7 1.5 I. I Total I00,0 I00.0 100.0 100,0 I00.0 100.0 10n.0 100.0 100.0 Number 2.894 3.080 5.974 12.882 13.669 26.551 15,775 16.750 32.525 There appears to be an excess of males over females at ages under 20. For ages over 20 there are more females than males. The population pyramid shows no excess of women in the age group 50-54. which suggests that there has been no shifting of eligible women out of age group 45-49 by interviewers seeking to reduce their workload (as has occurred in some countries where similar surveys have been conducted). Table 2.2 compares the broad age structure of the population from the 1989 Population Census, the 1994 Intercensal Demographic Survey (ICDS-94), and the 1997 VNDHS-II. The proportion of the population less than 15 years has declined over the last decade or so and the proportion age 15-64 has risen. The most likely explanation for this change is the recent decline in fertility. Figure 2.1 Population Pyramid, Vietnam 1997 75-79 70-74 65-6~ 6O-6= 55"59 50-6¢ 45-49 40-44 35-39 30-3~ 25-29 2024 ~5-19 ~0-14 5-9 0~ 6 5 3 2 0 2 3 5 ;3 7 e Table 2.2 Population by broad aae arouos f, rgm selected sources Percent distribution of the population by broad age group, selected sources. Victnarn Age group 1989 Census ICDS-94 VNDI IS-! Less than 15 39.8 36.8 35.0 15-64 55.4 57.5 58.6 65+ 4.8 5.7 6.3 Total 100.0 100.0 100.0 Median age 19.8 22. I 22.8 Note: Pore.~ntages may not add to 100 duo to rounding. i Sources: Viotrmm Population Census-19g9 (GSO, [1991]); Vietnam Intcreensa[ Demographic Survey 1994 (GSO. [1996]) Household Composition Table 2.3 shows that three-quarters (75 percent) of the households in Vietnam are headed by men, with only one-quarter (25 percent) headed by women. Female-headed households are more common in urbal areas than in rural areas (41 percent versus 21 percent). The average household size has decreased from 4.8 persons in the ICDS-94 to 4.7 persons in the VNDHS-II. possibly due to a decline in fertility. The average household size in urban areas is slightly less than that in rural areas (4.6 versus 4.8). More than half of households (59 percent) consist of 3 to 5 persons. As in the ICDS-94, four-person households are most common (24 percent in 1997 compared with 21 percent in 1994). Just half of the population resides in households with 5 or more persons. However, the proportion of these households has decreased from 69 percent in the ICDS-94 to 50 percent in the VNDHS-II. This may be due to improved socioeconomic conditions that have resulted in more yotmg couples moviug out to live on their own. Tahl¢ 2.3 Ilousehold composition Percent distribution of households b'. ~cx t)f household head and household size, according lo urban-rtmd residence. Vietnam 1997 Residence Background characteristic l.lrban Rural Total Head of household Male 59,0 79.3 75.4 Female 41 .U 21).7 24.6 Number of usual members I 3.5 4.0 3.9 2 7.0 7.6 7.5 3 17.5 14.11 14.6 4 28.2 22.6 23.6 5 19.5 2(I.7 20.4 6 10.7 13.9 13.3 7 5.8 9.1) 8.4 8 4.1 4.5 4.4 9 3.6 3.9 3,8 Total 100.0 100.0 100.0 Mean size 4.6 4.8 4.7 Note: Table is based on de.jure househt~ld members, i,c. usual residents. Education Formal education in Vietnam is based on a three-tier system known as the 5-4-3 system. It consists of 5 years of primary school education, 4 years of lower secondary education, and 3 years of higher secondary education. Graduates of higher secondary school may then further their education by enrolling at any of the various national universities or colleges or technical schools throughout the country to acquire more specific skills. VNDHS-II results show that there is a clear differential in education between males and females in Vietnam (Table 2.4 and Table 2.5). The data indicate that 7 percent of men and 12 percent of women age six and above have not received any formal education. While there is a male-female gap at all levels of education, this gap has narrowed substantially in recent years, which is especially evident in the age group 6-14. Above age 40 the gap widens substantially. Table 2.4 Educational level o!'tbc male household population Percent distribution of the de facto male household population age six and over by highest level o1" education attended, and median number of years of schooling, according to selected background dmracteristics, Vietnam 1997 Education Completed Completed N~lmbcr Median Background No Some Completed lower higher of vents of characteristic education primary prima~ secondary secondary+ Total men schooling Age' 6-9 20.2 78.9 0,8 0.0 0.0 100.0 1.664 0.9 10-14 2.9 36.5 57.6 3.1 0.0 100.0 2.223 4.6 15-19 3.1 13.2 38.0 37.0 8.7 100.0 1.661 7.6 20-24 5.7 14.0 33.6 29.9 16.8 ] 00.0 1.280 7.5 25°29 4.8 I 1.4 29.6 31.6 22.6 100.0 I, 146 8.2 30-34 2.8 I 1.9 28.2 36.7 20.4 100.0 1.236 8.2 35-39 1.7 12.1 23.7 40.8 21.6 100.0 1.062 8.4 40-44 2.0 " 14.1 26.9 35,0 21.9 100.0 899 8.2 45-49 3.5 12.2 24.6 35.9 23.8 100.0 576 8.3 50-54 3.2 14.8 26.9 35.5 19.6 100.0 369 8.2 55-59 5.6 18.2 32.7 23.6 [ 9.9 100.0 364 6.3 60-64 8.5 28.9 34.3 16.4 11.8 100.0 372 47 65+ 17.6 34.9 29.2 10.8 7.5 100.0 833 3.8 Residence Urban 3.2 16.3 28.4 25.1 27.1 100.0 2.572 g.I Rural 7.3 29.0 31.8 23.0 8.9 100.0 11.116 5.4 Project province No 6.0 27.3 31.8 22.4 12.4 100.0 9.629 5.7 Yes 7.5 25.0 29.8 25.7 12.1 100.0 4.059 6 1 Region Northern Uplands 8.4 31.2 30.4 21.9 8. I 100.0 2.716 5.0 Red River Delta 3. I 16.1 24.5 37.6 18.6 100.0 2.837 8 2 North Central 4.8 26.7 32.2 27.6 8.7 101).0 1.769 6.0 Central Coast ' 7.5 25.4 32.8 19.8 14.6 100.0 1.459 5.7 Central Highlands 12.2 34,6 26.4 13.8 13.0 100.0 420 4 4 Southeast 4.0 24.4 34.5 I g.9 t 8.2 100.0 ~ ,705 6.4 Mekong River Delta 9.3 33.6 35.9 13.8 7.4 100.0 2.783 4.5 Total 6.5 26.6 31.2 23,4 12.3 100.0 13.688 5.8 Excludes 4 men for whom age was not reported. The level of educational attainment in Vietnam is relatively high compared with other developing countries and the high level of education was achieved many years ago. Thus, the data on education do not show a clear trend of improvement in education, except above age 45 compared with younger women and above age 60 compared with younger men. The last columns of Tables 2.4 and 2.5 show the median number of years of schooling attained by males and females. Overall, males have a median duration of schooling of 5.8 years, a full year longer than females. The gap in the median number of years of schooling between males and females is negligible up to age 40 as noted; then the gap becomes more significant. The propor t ion o f the popu la t ion w i th no educat ion is tw ice as h igh in rural areas as in urban areas. As expected , the med ian number o f years o f schoo l ing for the male popu la t ion as wel l as the female popu la t ion is h igher in u rban than in rura l areas. 10 Table 2.5 Educational le,~el of the female household population Percent distribution of the de facto female household population age 6 and over by highest level of education attended, and median number of years of schooling, according to selected background characteristics. Viemam 1997 Education Completed Completed Number Median Background No Some Completed lower higher of years of characteristic education primer'z, p r ima~ secondary secondary+ Tota l women schooling Age' 6-9 19.3 811.0 0.8 0.0 0.0 100.0 1.580 1.0 10-14 3.2 32.8 60.8 3.2 0.0 100.0 2.021 4.7 15-19 4.3 14.9 38.8 32.6 9.4 100.0 1.660 6.9 20-24 5.6 13.1 36.2 28.5 16.6 100.0 1.385 7.3 25-29 4.0 15.3 28.6 29.7 22.4 100.0 1.290 8.1 30-34 3.3 17.6 28.6 33.7 16.8 100.0 1.349 8.0 35-39 4.1 19.2 26.1 35.6 15.0 I110.0 1.243 8.ll 40-44 6.5 20.0 26.3 34.1 13.1 I00,0 954 6.9 45-49 8.11 24.3 29,8 25.2 12.8 100,0 649 5.7 50-54 147 33.7 28.4 14.1 9.2 100.0 452 4,1 55-59 22.2 41.4 22.8 10.3 3.2 100,0 493 2.9 60-64 28.4 49.7 17.4 3.7 11.8 100.0 479 1.9 65+ 55.5 34.3 8.0 1,6 0.5 100.0 1.255 0.0 Residence Urban 6.4 I9.0 26.1 24.6 23.9 100.0 2.796 7.7 Rural 13.4 32.2 30.0 18.6 5.8 100.0 12.015 4.4 Project province I No I I.I 31,0 30.8 18.8 9.1 100.0 10.461 4.7 Yes 14.3 26.8 27.5 22.0 9.4 100.0 4.349 5.0 Region Northern Uplands 15.2 34.0 26.3 18.3 6.1 100.0 2.903 4.1 Red River Delta 8.7 20.4 23.5 33.7 13,6 100,0 3,117 7,3 North Central 11.6 28.6 30.5 22.6 6,7 100.0 1.900 5.0 Central Coast 13.7 31.5 30.1 I5.8 8.9 100.0 1.609 4.4 Central 11ighlands 19.3 31.2 24.4 14.1 I 1.0 100.0 432 3.9 Southeast 7.9 26.3 32.0 17.0 16.8 100.0 1.911 5.4 Mekong River Delta 13.5 37.1 36.0 9.1 4.2 100.0 2.9,38 3.9 Total 12.1 29.7 29.3 19.7 9.2 100.0 1i.811 4.8 i Fxclndcs I woman lbr whom age and place or" residence by project province was not reported. The median number of years of schooling is highest in the Red River Delta region (8.2 for males and 7.3 for females), followed by the Southeast region (6.4 for males and 5.4 for females) and the North Central region (6.0 for males and 5.0 for females). The median number of years of schooling is lowest in the Central Highlands region (4.4 for males and 3.9 for females) and the Mekong River Delta region. Table 2.6 presents the school enrolh'nent rate for the population age 6-24 by age, sex and urban- rural residence. Four in five children age 6 to 15 years (83 percent) are attending school. School enrollment drops substantially after age 15 to only 28 percent among those age 16-20 years, and to 4 percent among those age 21-24 years. This sudden drop may be partially due to a lack of financial resources to continue schooling and partially due to the need to work to support the family. 11 Table 2.6 School enrollment Percentage distribution of the de-facto household populalion age 6-24 years enrolled in school, by age.~x, and urban-roral residence, Vicmarn 1997 Male Fgmalc Total Age Urban Rural Total Urban Rural Total Urban Rural Total 6-10 87.4 83.6 84.1 90,6 85.3 86,0 89,0 84.4 85.0 1-15 88.6 85.5 85.9 89.9 75.3 77.5 89.2 80.6 81.9 t-15 88.1 84.6 85.0 90.2 80.3 81.7 89.1 82.5 83.4 16-20 46.1 28.4 31.5 48.7 19,3 24.5 47.4 23.8 28.0 21-24 9.6 3.6 4.9 I 1.9 1.6 3.9 I 0.8 2.6 4,4 • Figure 2.2 School Enrollment among Children Age 6-15 by Age, Sex, and Urban-Rural Residence, Vietnam 1997 90 80 70 60 5O 40 3O 2o 10 0 S', 39 90 f."t =_ i 76 Mate Femate Male Ferna)~ Ir'~Urban I~Ruralj Aged 6-10 Aged I 1-15 2.2 Hous ing Character ist ics Socioeconomic conditions of the household~ were assessed by asking respondents questions about their household environment. This information is summarized in Table 2.7. Electricity is available to 78 percent of households in Vietnam with nearly all households in urban areas being electrified compared with 3 in g households in rural areas. Sources of" drinking water differ widely by area of" residence. In urban areas, piped water is a major source; 66 percent of households have water piped into their residence and another 4 percent obtain water from a public tap. However. one-fifth of urban households still use well water. In rural areas, only 3 percent of" households have piped water. Well water is the main source for rural households (62 percent). Seventeen percent of rural households use rainwater. Nevertheless, for most households (94 percent) the 12 Table 2.7 Housin~ characteristics Percent distribution of households by housing characteristics, according to urban- rural residence. Vietnam 1997 Residence "haracteristic Urban Rural Total Electricity Yes 98.6 73.7 78.4 No 1.4 26.3 21.6 Total 100.0 100.0 100.0 Source of drinking water Piped water Piped into residence 66.2 2.6 14.7 Public tap 4.0 0.6 1.3 Well water Well in residence 17,7 53.3 46.5 Public well 2.3 8.5 7.3 Spring 0.4 6. I 5. I River. stream 4.4 10.2 9. I Pond. lake 0. I 1.1 0.9 Dam 0.0 0, I 0. I Rain water 4.8 17.4 15.0 Tanker truck 0.2 0.2 (1.2 Total 100.0 100.0 100.0 Time to water source l.ess than 15 minutes 98.8 .93.4 94.4 ,% Sanitation facility Flush toilet Own flush toilet 64,5 5.6 16.8 Shared flush toilet 2.9 0.4 0.9 Pit toilet Traditional pit toilet 16.9 58.4 50.5 Vent. imp. pit toilet 7.3 9.4 9.0 No l~cility, bush 8.3 26.2 22.8 Tolal 100.0 100.0 100.0 Flooring Earth, sand 7.4 43.8 36.9 Rough wood/bamboo 1.9 10.8 9. I Finished floor 90.7 45.3 54.0 Total 100.0 100,0 100.0 Persons per sleeping room 1-2 52.3 44.6 46.0 3-4 31.6 31.9 31.8 5-6 11.7 14.7 14.1 7+ 37 6.9 6.3 Dont know/missing 0.7 2.0 1.7 Total 100.0 100.0 I00,0 Mean persons per room 3.0 3.3 3.3 N umber of households 1.330 5.671 7,001 13 average time taken to go to a water source to collect water and return, including wa~tlng time, is less than 15 minutes. In Vietnam, morethan half of all households have either a traditional pit toilet or a pit latrine (60 percent). In urban areas, 65 percent of bouseholds have their own flush toilet while 3 percent share a flush toilet. In contrast, a traditional pit toilet or pit latrine is the major type of toilet facility (68 percent) in rural areas. It should he noted that more than one in four households in rural areas has no toilet facility compared with less than one in ten households in urban areas. Fifty-four percent of households have a finished floor made of ceramic tiles, cement, etc. A finished floor is more common in urban areas (91 percent) than in rural areas (45 percent). More than half of rural households reside in houses with earth, sand. or rough wood flooring (55 percent). As a way of estimating the extent of crowding, information was gathered on the number of rooms used for sleeping in each household. Forty-six perc~at of households have I-2 persons per sleeping room, About one-third (32 percent) of households have 3-4 persons per sleeping room. The mean number of persons per sleeping room is 3.3. This figure differs little between urban and rural areas. 2.3 Household Durable Goods Respondents were asked about ownership of particular household durable goods such as radios, televisions and telephones (to assess their access to mass media)~ refrigerators (to assess their access to food storage), bicycles, motorcycles and cars (to assess their access to modes of transportation). The results are presented in Table 2.8. Table 2.8 shows that more than half of households (54 percent) have a radio, 50 percent have a television, and 7 percent have a telephone. One-third of urban households have a refrigerator (33 percent), The urban-rural difference is marked, especially in terms of possession of a television set, a telephone, and a refrigerator. One in three urban households has a refrigerator compared with 3 percent of rural households. Table 2.8 ttousehold durable eoods Percentage of households possessing various durable consumer goods, by urban-rural residence, Vietnam 1997 Residence Consumer goods Urban Rural Total Radio 68.6 50.2 53.7 Television 82.6 42.0 49.7 Telephone 27.3 2. I 6.9 Reli'igerator 32.8 2.5 8.3 Bicycle 84.0 72.2 74.4 Motoreyclc 53.3 16.5 23.5 Private car 2.2 0.5 08 None of the above 4.0 14.6 126 Number of households 1,330 5.671 7,001 14 As expected, urban hottseholds bave greater access to modes of transport than rural households: 4 in 5 urban households have a bicycle compared witll 3 in 4 rural bouseholds, and I in 2 urban households have a motorcycle compared with less than 1 in 5 of rural households. Overall, very few households bare a car. Thirteen percent of households do not own any of these consumer goods: 4 percent of urban households and 15 percent of rural households. 2.4 Background Characteristics of Women Respondents General Characteristics Women were asked two questions in tile individual interview to assess their age: "In what month and year were you born?" and "How old are you?" Interviewers were trained to probe in situations where a respondent did ftot know her age or date of birth, at-td they were instructed as a last resort to record a best estimate of the respondent's age. Table 2.9 shows the distribution of respondents by selected background characteristics including age, marital status, urban-rural residence, education, religiou and etlmic group. Respondents were ever- married women age 15-49 who slept in the selected households the night befbre the interview. As indicated in Chapter I, interviews were completed for a total of 5,664 eligible women. Tbe age distribution of women reveals that one in three women is under age 30 and one in four is 40 or above. Women are mostly concentrated in the age group 20-34. This is because the survey interviewed ever-married women only, and there are fewer ever-married women in the youngest group. The majority of women are currently married with a very small minority widowed, divorced or separated (6 percent). Eighty-one percent of women reside in rural areas. The distribntion of women by region shows that almost two-thirds (62 percent) are from the Northern Uplands, Red River Delta, and Mekong River Delta regions; and 38 percent are from the other four regions of the cotmtry. The majority of ever-married women (95 percent) have been to school. About one-third of wornen have completed lower secondary (33 percent): 14 percent of women have completed higher secondary, which is about tile same proportion as reported in the ICDS-94 (13 percent). 15 "fable 2.9 Badkground characteristics of respondents Percent distribution of ever-married women by selected background characteristics. Vietnam 1997 Number O f WOIllen Weighted Number NL/mber Background characteristic percent weighted unweightcd Age 15-19 2.3 129 113 20-24 12.9 732 744 25-29 17.9 1.016 1.023 30-34 21.1 1.197 1,174 35-39 20.0 1.134 1.11)3 40-44 15.5 876 893 45-49 10.3 581 614 Currott marital status Married 94.3 5.340 5.331 Widowed 2.8 157 152 Divorced 1.9 [10 120 Not riving togefler 1.0 57 6 I Ilesidenee- Urban 18.9 1.069 1.316 Rural 8 I. I 4.595 4.348 Project province No 70.2 3.976 3.757 Yes 29.8 1.688 1.907 Region Northern Uplatads 20.6 i. 168 1,092 Red River Delta 22.0 1,247 I.I 19 North Central 12.0 681 773 Central Coast 10.6 599 554 Central l lighlands 3.2 182 219 Southeast 12.2 691 650 Mekorlg River Delta 19.4 1.097 1257 Education No education 4.8 271 305 Some primary 19.0 1.078 1.002 Completed primary 29.4 1,665 1.662 Completed lower secondary 32.9 1,865 1.866 Compteted higi~er secondary + 13.9 785 869 Currently attending school Yes 0.1 7 8 No 99.9 5.657 5,656 Religion No religion 75.5 4.278 4.268 Buddhist 15.8 893 944 Catholic 4.6 261 271 Protcstasu 0.3 19 20 Cao Dai 1.8 [ 02 77 I Ioa I lao 0.7 39 48 Other 1.3 73 36 Ethnic Group Kinh 83.2 4.715 4.932 Toy 2.9 166 102 I'hai 5.3 279 206 I toa 0.7 42 42 Khmer 1.2 71 69 Dao 0.3 19 28 Sa Pho 0.4 22 35 Ca Tu 0.4 21 24 Muong I. I 61 62 E Dc 05 31 32 Nung 1.5 8~ 37 Iio Re (1.7 37 37 Chain t.3 73 36 Other 0.4 23 22 Total 100.0 5.664 5,664 16 Differentials in Education The level of female education is high among ever-married women in Vietnam. As noted in Table 2.9, less than 5 percent of women have no education, one in five women has some primary education, and nearly one in three has completed primary school or lower secondary schook and an impressive 14 percent have completed higher secondary school. Table 2,10 shows the relationship belween respondent's level of education and other background characteristics. Rural women are more disadvantaged in education than urban women; 6 percent of rural women have no education compared with 2 percent of urban women. However, the urban-rural gap becomes smaller at higher levels of education, up to lower secondary, where there is little difference between urban and rural women, Nevertheless, three times as many urban women have completed higher secondary school as rural women. This may be due to a lack of institutes of higher learning in rural areas. There are also wide differentials in level of education between regions, with women in the Central Highlands being least educated and women in the Red River Delta being most educated (based on the percentage with no education). By another measure, Figure 2.3 shows the distribution of women who have completed at least lower secondary education by region. The percentage of women who have completed primary school is higfiest in the Red River Delta (80 percent) and lowest in the Mekong River Delta (I 7 percent). Table 2.1(I l,cvcl o f education Percent distribution of ever-married women by the highest level of education attended, according to selected background characteristics. Vietnam 1997 Education Completed. Completed Number Background No Some Coinpleted lower higher of characteristic education primary priraary secondary secondary + Total women Age 15-19 7.3 30.0 40.9 21.9 (7.0 100.0 129 2(7-24 6.5 15.0 38.5 32.3 7.8 100.0 732 25-29 3.7 17.6 28.6 31.0 19.2 100.0 1.016 30-34 3.2 17.7 28.4 34.7 16.1 100.0 1.197 35-39 3.8 19.4 26.1 36.0 14.7 100.0 1,134 40-44 6.2 20.2 26.3 35.4 I 1.9 100.0 ,867 45-49 7 1 24.8 30,(7 26.3 I 1.9 100.0 581 Residence Urban 1.8 9.2 22.5 33.9 32.6 100.0 1.069 II.tn'al 5.5 21.3 31.0 32.7 9.5 100.0 4,595 Project province No 4.1 21.0 31.0 3 I.(I 12.9 100.0 3.976 Yes 6.5 14.3 25,6 37.5 16.1 100.0 1,688 Region Northern Uplands 6. I 21.4 27.3 34.2 11.0 100,0 I. 168 Red River Delta 0.4 3.g 16.3 58,0 21.5 100.0 1.247 North Central 2.2 12.4 33. I 40.5 I 1.9 100.0 68 I Central Coast 9. I 22.7 32.9 23.1 12.1 100.0 599 Central Highlands 13.6 19,0 28.4 21.6 17.3 100.0 182 Southeast 3 .(7 19.9 32.9 23.4 20.7 100.0 691 Mekong River Delta 7.3 35.4 40.2 11.6 5.4 I00.0 1.097 Total 4.8 19.0 29.4 32.9 13.9 100.0 5.664 17 J~ Figure 2.3 Percentage of Ever-married Women Who Completed at Least Lower Secondary Education by Region, Vietnam 1997 '+I+ + I sO eo BO 40 =0 10 0 P,~ ~ NO~ ~ ~ SouhMt Me,=nO Ud, am~ D~a Centn¢ Cout ~ n~ 0~ l IB Female respondents age 15-24 were asked whether they were attending school at the time of the survey, and if they were not, the reason for leaving school. Table 2.11 presents the distribution of women age 15-24 who have ever attended school by reason for leaving school. Less than I percent of ever-married women age 15-24 were in school at the time of survey. The most common reason for dropping out of school was to help in the family (42 percent). Twenty-two percent stopped school because they did not like it, and another 21 percent dropped out to get married; 7 percent left school because they did not pass their exams. Table 2. l I Schoo~ attendance and reason tbr leavin~ ~hool Percent distribution ot'ever-married women 15-24 by whether or not currently attending school and mason for leaving school. according to highest level of education attended, Vietnam 1997 Educational attainment Cnmplatcd Completed Attendance/Reason Some Completed lower higher for |caving school primal, prima~ secondary secondary + '1"oral Currently attending 2.4 0.2 0.7 ].g 0.9 Reason for leaving school Got pregnant 0,0 0.0 0.0 2.5 0.2 Got married 20.g 25.5 15.0 18.6 20.7 Care lbr younger children 0.0 0.5 0.0 1.3 0.3 Family needed help 54.0 44.2 37.4 22.3 42.2 Could not pay P, chooI fccs 0.0 0.5 0.1) 0.0 0.2 Needed to earn money 2.4 1.8 2.2 1.4 2.0 Graduated/had enough schooling 0.0 0,7 1.5 22.0 2.4 Did not pass exams (1.9 2.0 12.0 22.7 6.5 Did not like school 17. I 21.7 28.6 7,4 22. I S¢hoo1 not vce~:ssiblc 2.5 t .3 2.4 (L0 I .g Other 0.0 I. I 0.0 0.0 0.5 Don't know/Missing 0.0 0.5 1).3 0,0 (1.3 Total 100.0 100.0 100.0 I 1)0.0 [ 0(I.O Number 148 334 264 57 8(14 18 Employment Status Table 2.12 presents the distribution of ever-married women by employment status according to background characteristics. The data indicate that a large majority of women are currently working (92 percent). One percent of women worked in the last 12 months, but are currently tmernployed, and 7 percent of women did not work in the last 12 months. Rural women are more likely to be employed (94 percent) than urban women (82 percent). There is little difference in terms of current employment between women living in project provinces (95 percent) and women living in non-project provinces (90 percent). Work status differs by region. Employment is highest in the North Central and Northern Uplands regions (99 percent each) and lowest in the Southeast region where Ho Chi Minh City is located (76 percent). Surprisingly, work status differs little by education, ranging from a high of 94 percent anaong those who have completed lower secondary education to a low of 89 percent among those who have completed primary school. Table 2.12 Employment status Percent distribution of ever-married women by employment status, according to selected background characteristics. Vietnam 1997 Currently unemployed Did not work Worked in Number in the last 12 the last 12 Currently of Background characteristic months months employed Total women Age 15-19 9.4 2.6 88.0 100.0 129 20-24 9.6 2.5 g7.8 100.0 732 25-29 7.7 1.4 90.9 100.0 1.016 30-34 6.9 1.0 92.1 100.0 1,197 35-39 6.(I 0.7 93.4 100.0 l.134 40-44 6.4 0.5 93. I 100.0 876 45-49 6.5 0.7 92.8 ] 00.0 581 Residence Urban 16.4 1.7 81.9 100.0 1.069 Rural 5.0 1.0 94.0 100.0 4.595 Project province No 8.6 1.0 90.4 100.0 3.976 Yes 3.9 1.4 94.7 100.0 1.688 Region Northern Uplands 0.8 0.0 99.2 100.0 1,168 Red River Delta 2.9 0.6 96.4 100.0 1,247 North Central 0.1 0.6 99.3 100.0 68 I Central Coast 6.0 2.2 91.8 100.0 599 Central I l ighlands 10.3 7.3 82.5 100,0 182 Southeast 22.1 1.7 76.1 100.0 691 Mekorig River Delta 13.9 1.2 85.0 100.0 1,097 Education No education 7.4 2.3 90.4 100.0 27 I Some primary 7.8 1.4 90.9 100.0 1,078 Completed primary 9.5 1.4 89.1 100.0 1,665 Completed lower secondary 5. I 0.5 94.4 100.0 1.865 Completed higher secondary + 6. I 1.3 92.6 100.0 785 Total 7.2 1.1 91.7 100.0 5.664 19 Place of Work Table 2.13 shows that the majority of women (66 percent) work for a family member, 18 percent are self-employed, 7 percent work for the government, 5 percent work in a cooperative, and 3 percent work for someone else. Rural women are much more likely to work for a family member (69 percent) than urban women (51 percent). On the other hand, 26 percent of urban women work for the government compared with less than 4 percent of rural women. There is little variation in the type of employer between project and non- project provinces. Table 2.13 Place ofwork Percent distribution of currently employed ever-married women by type of employer at~d background characteristics. Vietnam 1997 Employer Background Family Coop- Govern- Somconc Sell'- Number characteristic member erativc ment e l se ernployed '['ota] of wonlen Age 15-19 74.3 7.1 1.2 0.8 16.6 100.0 113 20-24 69.7 6.2 2.5 5.6 16.1 100.0 643 25-29 19.1 4.6 6.7 2.9 19.7 100.0 923 30-34 66.4 5.9 6.6 2.4 18.8 100.0 1.102 35-39 65.5 3.7 9.8 2.7 18.3 100.0 1,059 40-44 65.6 5.9 9.4 2.4 16.7 100.0 815 45°49 62.4 6.2 8.5 2.7 20.2 100.0 539 Residence Urban 51.4 0.6 25.5 6.0 16.5 100.0 876 Rural 69.2 6.3 3.6 2.3 18.6 100.0 4.319 Project province No 65.2 4.8 7.4 3.3 19.3 100.0 3.595 Yes 68.4 6.5 7.0 2. I | 6.0 100.0 1.599 Region Northern Uplands 74.5 1.2 5.9 0.6 17.9 100.0 I. 158 Red River Delta 52.6 19.7 I 0. I 1.7 15.9 100.0 1.21)3 North Central 86.4 1.7 3.2 0.2 8.5 100.0 677 Central Coast 73.8 I.I 6.9 1.3 16.9 100.0 550 Central Highlands 51.0 0.6 I 1.5 0.0 36.9 100.0 150 Southeast 50.9 0.6 15.2 7.4 25.9 100.0 526 Mekong River Delta 65.4 0.5 3.3 8.3 22.5 100.0 932 Education No education 72.3 1.0 0.6 10.4 15.8 100.0 245 Some primar) 72.8 2.2 0.6 3.9 20.4 100.0 980 Completed primary 72.0 3.5 1.7 2.5 20.4 100.0 1,483 Completed lower secondary 66.6 9.7 5.2 1.3 17.4 100.0 1.761 Completed higher secondary + 42.5 4.3 34.7 4.0 14.4 100.0 726 Total 66.2 5.3 7.3 2.9 18.3 100.0 5,195 A high proportion of women who live in the Central Highlands are self-employed (37 percent), One in five women living in the Red River Delta region works in a cooperative. More than one in three women who have at least a higher secondary education work for the government, and one in IO who have completed lower secondary education work in a cooperative. Level of education is related to type of employer. In general, as the level of education rises, the percentage of 20 women working for a family member drops. Tiffs is especially evident among women who have completed at least lower secondary school. Cash Earnings Women earning cash for their work were asked who mainly decides how their earnings will be used. Table 2.14 indicates that 62 percent of respondents reported that they decide jointly with their partner how their earnings will be used, 24 percent of respondents decide by themselves, and 9 percent reported that their partner decides. Among women who are not currently married, most (95 percent) decide themselves how to use their earnings. Table 2.14 Decision on use ofearnines Percent distribution of employed women who receive cash earnings by person who'decides how earnings will be used. according to selected background characteristics. Viemam 1997 Background characteristic Person who decides how earninl~s will be used Jointly Jointly with Number with Someone someone of Respondent Panner panner else else Total women Age 15-19 7.5 8.2 36.9 43.6 3.8 100.0 113 20-24 14.8 9.6 58.9 13.7 2.9 1 I10.0 64 I 25-29 19.6 8.7 66.8 3.3 1.6 100.0 922 30-34 23.2 9.4 65.5 1.6 0.3 100.0 1,101 35-39 23.9 I 1.2 64.3 0.5 11.1 100,0 1.1156 40-44 32.6 8.8 58.4 0.3 0.0 1110.0 814 45-49 38.7 5.6 55.6 0,0 0.1 10o.0 538 Residence Urban Rural Project province No Yes 39,8 3.3 54.7 1.8 0.5 100.0 873 21.3 10,3 63.4 4.1 0.9 100.0 4.311 24.3 9.0 62.2 3.5 0,9 100.11 3,588 24.6 9.5 61,1 4.2 0.6 10(L0 1,596 Region Northern Uplands 17.0 16.9 58.0 %2 0,9 100.0 1,156 Red River Delta 25.0 10.8 59.2 4.2 0.8 100.0 1,201 North Central 18.0 3.3 76.4 2.3 0.0 100.0 676 Central Coast 273 9.6 59.5 2.8 0.8 100.0 547 Central Highlands 21.8 7.7 69.0 1.0 0.4 100,0 149 Southeast 34.8 2.9 60.8 1.0 0.6 1110.0 526 Mekong River Delta 30.3 5.2 60.6 2.2 1.6 I(111.0 929 Education No education 21.5 19.4 5 t .5 6,7 0.9 100.0 243 Sorne primary, 24.2 9.6 61.9 3.4 0.9 100.0 979 Completed primary 24,4 9.9 60.3 4.6 0.7 100.0 1.480 Completed lower secondary. 24.7 8. I 63. I 3. I 1.0 100.0 1.758 Completed higher secondary + 25.0 6.2 65.7 2.8 0.4 100.0 725 Current marital status Not married Currently married Total 94.8 0.0 0.0 3.3 1.8 100.0 304 20,0 9.7 65.8 3.7 0,8 100.0 4.880 24.4 9.2 61.9 3,7 0.8 100.0 5. I84 21 Urban women are more likely to decide themselves on tile use of thei? own cash earnings (40 percent) than rural women (21 percent). By region, tile proportion of women who decide themselves on how to use their cash earnings is highest in tile Southeast (35 percent), followed by tile Mekong River Delta (30 percent) and Central Coast (27 percent). Sole decisionmaking by women is lowest in the Northern Uplands (17 percent), and North Central ( 18 percent) regions. There is a strong relationship between decision making and level of education. The more educated a woman is. tile less likely her partner is the sole decisionmaker. While one in five women with no education reported that her partner made the decision how to use her earnings, the percentage drops to 6 percent among wolnen with completed higher secondary education. Child Care Table 2.15 presents the distribution of currently employed ever-married women who have a child under 6 years of age by the person who cares for the child while they are aLwork. The data indicate that half of currently employed women have a child under 6 years of age (51 percent}. These women report that, while they are at work, their cllildren are cared for primarily by relatives (44 percent), by other female children (17 percent), by the women themselves (13 percent) and by the staff of a school or institution that the children attend (13 percent). 22 Table 2.15 Child care while working Percent distribution of CtlItcntlx elnplo)cd x~on'~en b) :'.hcthcr or not the) have a child under six years, of age and the percent distributioll of cnlploved mothers x~ ith a child under six b) person who cares Ibr the child e, hile mother is at work. according to background characteristics. Vietnam 1997 Background characteristic P, cspon- l-mplo.~ ed wolnell Child's caretaker, among employed v~)lnell ~ho have a child <6 )'ears dent Olle has not Number No or more Neigh- Servant/ School. Othcr Otller ~ orked of d~ild ehidrcn Rcspon- Husband/ Other bor/ hired inst. female male since cmplo) ed < 6 <6 dent Parlner relative Friend help care child child birth Other Total women Residence Urban Rural 57.4 42.6 19.8 3.4 34.9 1.7 0.9 27.6 8.5 2.7 0.5 0.0 100.O 876 47.9 52.1 11.7 3.7 45.4 0.8 0.1 10.3 18.1 9.6 0.2 0.1 100.0 4.319 Project province No Yes 49.7 50.3 13.4 3.8 44.1 0.7 0.2 12.7 16.6 8.1 0.3 0.1 " 100.0 3.595 49.1 50.9 11.6 3.3 43.3 IA 0.2 12.9 16.9 9.8 0.2 0.2 100.0 1.599 Region Nollhem Uplands Red Rivcr Delta North Central Central Coast Central Ilighlands Southeast Mekong River Delta 47.6 52.4 7.7 4.9 51.9 0.8 O.I 6.4 19.8 7.9 0.1 0.3 100.0 1.158 54.4 45.6 5.4 3.2 44.5 I.O 0.2 34.1 6.6 5.0 0.1 O.O 100.0 1.203 39.9 60.1 5.5 1.7 50.2 0.2 0.0 9.6 20.7 11.6 0.4 0.0 I00.0 677 43.7 56.3 22.4 ,, 2.5 35.6 0.3 0.0 5.3 19.8 13.7 0.0 0.3 100.0 550 31.3 68.7 25.6 1.4 19.5 4.1 0.0 7.1 26.4 15.5 0.0 0.0 100.0 150 56.9 43.1 18.9 6.1 38.0 1.0 0.6 12.4 15.4 6.2 1.2 0.0 100.0 526 54.9 45.1 23.5 4.2 40.5 1.2 0.6 4.2 17.9 7.5 0.4 0.0 100.0 932 Educaiion No educalion Some primar) Completed primary Completed Iov, er secondar) Completed higher secondary + 40.8 59.2 13.5 0.7 44.1 0.0 0.0 0.0 23.7 16.8 0.0 1.3 100.0 245 52.7 47.3 11.6 3.8 40.5 0.2 0.5 3.3 28.4 I 1.6 0.2 0.0 100.0 980 48.3 51.7 14.0 3.0 46.6 1.4 0.0 6.0 18.1 10.5 0.3 0.1 I00.0 1.483 51.9 48.1 12.4 3.4 45.2 0.7 0.1 18.7 12.9 6.2 0.3 0.0 100.0 1.761 44.8 55.2 12.8 6.1 39.7 1.5 0.6 28.6 6.4 3.8 0.4 0.0 I00.O 726 Work for family, others, self For family lnelnber For SOlncone else Self-emplo3 cd 47.9 52.1 13.3 2.9 45.6 0.7 0.2 I0.0 17.9 9.0 0.2 0.2 I00.0 3.439 54.6 45.4 7.6 5.6 41.0 1.5 0.5 28.7 18.7 5.7 ' "-' 0.3 0.0 100.0 806 51.1 48.9 15.2 4.9 39.6 1.4 0.1 10.8 18.3 9.5 0.4 0.0 100.0 950 Total 49.5 50.5 12.8 3.6 43.9 0.9 0.2 12.8 '. 16.8 8.6 0.3 0.1 100.0 5.195 Rural children are more likely to be looked after by other relatives than urban children, whereas the latter are more likely to attend school or receive institutional care than the former. Urban children are cared for by respondents themselves more often than rural children. Educated women are more likely to have their children attend ,school or receive institutional care titan women with little or no education. Less educated women are more likely to have a child cared for by another female child, Access to Media In order to assess exposure to the mass media, women were asked if they usually read a newspaper, listen to the radio, or watch television at least once a week. This information is important for planning the dissemination of family plannin~ messages. Table 2.16 shows that 31 percent of women read a newspaper, 64 percent listen to the radio and 77 percent watch television at least once a week. Comparable rates from the ICDS-94 are Iox~cr. at 27 percent, 59 percent, and 64 percent, respectively. The indication is that exposure to the mass i~:edia has increased over the last 5 years, particularly in the case of television. "Fable 2.16 Access to mass media Percent of ever-married women who usually re~d a n: .'spaDer. listen to the radio, or watch television at least once i~ week by background characteristics, Vietnam 1997 Background characteristic Media exposure Reads All Number No media nears- [.istens to Watches three of exposure paper radio television media women AI5 .ge 19 23.3 19.9 60.4 62. I 13.9 129 20-24 19.4 25.0 58.4 71.6 18.7 732 25-29 14.0 30.0 59.5 77.2 21.9 1.016 30-34 15.0 32.8 63.5 76.7 24.6 1.197 35-39 ~ 2.6 35.2 66.4 78. | 29. I I. 134 40-44 12.7 34.3 68. I 80.7 29.4 876 45-49 15.0 27.0 68.0 77.9 23.6 58 I Residence Urban 5.5 62.0 69.4 92. I 49.2 1.069 Rural 16.9 23.9 62.5 73.3 18.9 4.595 Project province No 14.9 32.3 63.2 76.2 25.5 3.796 Yes 14.3 28.4 65.2 78.3 22.8 1.688 Region Northern Uplands 13.8 27.5 67.4 68.8 t9.4 1.168 Red River Della 1.8 39.7 79.1 95.2 33.5 1.247 North Centre! I 1.9 25.7 66.8 79.2 2(}.8 68 I Central Coast 22.2 29.9 57.7 68.6 23.3 599 Central I tiuhl~mds 32.7 25.8 39.0 59.6 16.4 182 Southeast " ] 6. I 45.2 59.0 80.0 37.3 69 I Mekong Ri',er I)clta 24.3 21.4 51.0 68.3 16.7 1.[)97 Education No cducati~)n 58.7 0.0 27.6 29.3 0.¢] 27 I Sol'he primar', 30.8 9:5 47.5 55.9 6.5 1.078 Completed primary 15.8 24.3 61.7 74.0 18.4 1,665 Con'lplctcd k~wer ~econdary 3.9 37.2 73.6 90.3 29.7 1,865 Completed higher secondary + 1.1 71.5 80.0 95.7 59.2 785 "fotal | 4.7 31.1 63.8 76.8 24.7 5.664 24 There is a strong association between media exposure and level of education. Fifty-nine percent of women with no education reported no media exposure compared with only 1 percent of women who had completed higher secondary school. Women ill rural areas are less exposed to rnass media than urban women. Seventeen percent of rural women [lave no exposure to rnass media compared with 6 percent of urban women. Another significant finding is that 33 percent of women in tile Central Highlands reported no media exposurc, which is about twice as high as tile national rate (15 percent). Tile other regions vary greatly in this respect, down to only 2 percent in the Red River Delta. 25 CHAPTER 3 FERTILITY An itpportant objective of VNDHS-II is to estimate fertility levels, trends, and differentials. Information on fertility will help to determine the impact of changes in the use of family planning and changes in the proximate determinants of fertility. In addition, fertility estimates will help in monitoring the achievements of the government's poptdation policies and programs. The fertility measures presented in this chapter are based on the reported reproductive histories of ever-married womeu age 15-49. Each woman was first asked to report the number of sons and daughters living with her, the number living elsewhere, the number that had died, and the number of pregnancies ending in fetal wastage (i.e., abortion, menstrual regulation, miscarriage or stillbirth). She was then asked to report an event-by-event history of her pregnancies. For each live birth, questions were asked about the sex of the child, date of birth, survivorship status, and current age (for surviving children) or age at death (for deceased children). 3.1 Fertility Levels and Trends Fertility Levels Measures of current fertility are presented in Table 3.1 for the five-year calendar period I992-96. This period was chosen (rather than a shorter or longer period) as a compromise between three criteria: to provide current in~brmation, to reduce sampling error, and to avoid problems associated with birth displacement.' Several measures of current fertility are shown. Age-specific fertility rates (ASFR) are calculated by dividing the number of births to women in a specific age group by the number of woman- years lived during a given period.: Age-specific fertility rates are useful in order to understand the age pattern of fertility. In an ever-married sample of women such as in the VNDHS-II, the calculation of all- women fertility, rates makes the implicit assumption that no births occurred among never-married women. The total fertility rate (TFR) is a useful summary measure of fertility levels. The TFR is calculated by summing the age-specific fertility rates. It is interpreted as the number of children a An examination of the distribution of births by calendar year of birth indicated a deficit of births in the years 1994, 1995. and 1996 relative to 1992 and 1993 (see Table 7.I). This pattern could be the result of transference of births by interviewers out of the period for which health data were collected (i.e., health data were collected for children born in 1994 and later). By estimating fertility rates for the five-year period 1992-96, the impact of birth transference on the estimated rates is minimized. z Numerators for the age-specific fertility rates were obtained by classifying births during the period 1992-96 into standard five-year age groups, according to the mother's age at the time of birth, and summing. Denominators for the rates were the number of person-years lived by all women in each five-year age group during the period. Since only ever-married women were interviewed in the VNDHS-H, it was necessary to inflate the number of person- years lived by ever-married women by factors representing the proportion of women who were ever-madtied in each age group. These Factors were calcu]ated from the data collected in the household schedule. Never-married women were presumed not to have given birth. In Vietnam. few births occur outside of marriage so that any underestimation of fertility from this source is negligible. 27 woman would bear during her lifetime if she were to experience the age-specific fertilit.v rates p.revailing during a given period. Two additional measures of fertility reported in this chapter are the general fertility rate (GFR) which represents the annual number of births per 1,000 women age 15-44, and the crude birth rate (CBR) which represents the annual number of births per 1,000 population. The CBR was estimated using the birth history data in conjunction with the population data collected in the household schedule. Fertility estimates for Vietnam are shown in Table 3.1 and Figure 3.1. At the national level the TFR is 2.7 children per woman which indicates that, on average, a Vietnamese woman will give birth to 2 to 3 children during her lifetime. In rural areas, the TFR is 2.9 children per woman, about one child higher than the rate for urban areas (1.8 children per woman). On the other hand, the difference in the TFR between project and non-project provinces is relatively minor (2.8 attd 2.6 children per woman, respectively). Tnble 3, I Current I~rtiliw rates Age-specific and cunlulativ¢ I~:rtility rates and crude birth rates Ibr the five-year calendar period I992-96. by urban-rural residence. Vietnam 1997 Residence Pr~jcct province A~e ~roup Urban Rural No Ycs Total 15-19 17 44 37 39 39 20-24 105 199 175 187 I78 25-29 117 155 145 153 148 30-34 84 97 94 96 95 35-39 34 58 49 59 52 40-44 10 23 20 2(1 20 45-49 2 4 2 7 4 TFR 15-49 1.84 2.90 2.62 2.81 2.67 TFR 15-44 1.83 2.88 2.60 2.77 2.65 GFR 15-44 64.0 101.0 92.0 95.0 93.0 CI3R 17.2 23.0 21.9 21.9 21.9 Note: Rates lbr age group 45-49 nnay be slightly biased due to truncation. TFR: Total fertility rate. expressed per ,.,.omart GFR; (}¢r~¢ral |~rliliu,' rate (births divided by flumber of %~o111cn 15-44). expressed per 1,000 ;vomen ('BR: Crude birth rate, expressed per 1.000 population 28 Figure 3.1 Total Fertility Rates by Residence, Vietnam 1997 TFR 2.9 3.5 3 2.5 2 1.5 1 0.5 0 2.8 Vietnam Urban RurB¢ Pr(~ject Non-pro)eel Province Province Fertility Trends A series of fertility estimates from four national surveys is shown in Table 3.2. The total fertility rate in Vietnam has declined from 4.0 children per woman in 1987 to 3.8 in 1988-89, 3.3 in 1989-93, and 2.7 in 1992-96. The estimated TFR in the ICDS-94 (3.3) and in the VNDHS-II (2.7) indicate a decline in excess of half a child (0.6) in a period of three years. This is a substantial decline, especially considering the relatively low level, of fertility in Vietnam. Much larger declines over time periods of three to five years have been observed in countries with higher fertility levels (Mboup and Saha, 1988). However, even in countries with relatively low fertility declines of half a child or more have been observed over time periods of three to five years.' So, while the fertility decline has been rapid in Vietnam, it is within the range of experience observed elsewhere. Declines in the TFR similar to those observed for Vietnam have occurred in the following countries: Initial Subsequent Absolute Time TFR TFR d~cline period Thailand 3.2 2.3 0.9 5 years Sri Lanka 3.4 2.8 0.6 3 years Turkey 3.2 2.5 0.7 4 years Morocco 4.0 3.3 0.7 3 years Sources: Chayovan et al., 1988: DCS and IRD, 1958: Mboup and Saha, 1998: and Azelmat et al,, 1996. 29 Estimates of the TFR from the ICDS-94 and VNDHS-II also appear to be consistent when considering the change in the contraceptive prevalence rate (CPR) between the two surveys. The CPR for currently married women increased by 10 percentage points between the two surveys (65 versus 75 percent, see Chapter 4). Based on the observed relationship between the CPRs and TFRs in twenty-five countries (Rutenberg, et al., 1991), an increase in the CPR of 10 percentage points would predict a decline in the TFR of 0.7 children, almost exactly the observed change in Vietnam. When considering the likely impact on fertility of an increase in contraceptive use, shifts in the method mix should be considered. As discussed in the next chapter, between the ICDS-94 and VNDHS-II the method mix shifted toward the use of more reliable methods. In fact, use of traditional methods actually declined slightly between the two surveys so that all of the increase in the prevalence rate was due to the use of modern methods, primarily the IUD. A comparison of age-specific fertility rates from the VNDHS-II and from the earlier sources, indicates that fertility declines are proportionately greater for women aged 25 and older than for younger women. This pattern is common and plausible for populations experiencing a fertility decline. It occurs during the fertility transition when older women, who are more likely to have reached their desired family size, make a greater effort to limit their births than do younger women, who are likely to have not yet achieved their desired family size. Table 3.2 Trends in fertility rates Age-specific and total fertility rates, selected sources. Vietnam 1987-1996 Age VNDHS-I Census ICDS-94 VNDHS-II group 1987 1988-89 1989-93 1992-96 15-t9 20 35 38 39 20-24 "235 197 196 178 25-29 243 209 189 148 30-34 151 155 124 95 35-39 85 100 69 52 40-44 51 49 31 20 45-49 I1 14 2 4 TFR 3.98 3.80 3.25 2.67 Source: VNDHS-I rates are from NCPFP. 1990:1989 census rates and ICDS-94 rates are from GSO, 1995:33. Table 3.2. Fertility Differentials Table 3.3 presents fertility levels by urban-rural residence, project province status, region, and educational attainment. Two measures of fertility are shown: the total fertility rate and the average number of children ever born to women age 40-49. Overall, fertility is lower in urban areas (1.8 children per woman) than in rural areas (2:9). The highest fertility was observed in the Central Highlands (4.3 children per woman). This is almost one child greater than observed in the other regions. The Iow~st fertility levels were observed in the Southeast region, which includes Ho Chi Minh City (1.9), in the Red River Delta, which includes Hanoi City (2.3), and in the Mekong River Delta (2.3). Fertility differentials by education are substantial and are inversely related to educational attainment. Women who completed higher secondary school have the lowest fertility (1.9 children per woman) while those with no education have the highest fertility (4.0 per woman). There are only minor differences in fertility levels by project and province status. One procedure for examining fertility trends over time is to compare the total fertility rate with the average number of children ever born to women age 40-49. The former is a measure of the number of 30 children a woman will have at current age-specific fertility rates while the latter is a measure of the actual fertility performance of women at the end of their childbearing years. Comparison of the two measures provides an indication of the direction and magnitude of changes in fertility during the past 20- 25 years. The results of this comparison in Table 3.3 indicate that there has been a significant fertility decline in Vietnam during the past several decades and that the decline has been broadly experienced throughout the population. At the national level, women age 40-49 have had an average of 3.8 children, a little more than one child greater than the current fertility level of 2.7 children per women. The data for all population subgroups also indicate a fertility decline, although there are differences in the magnitude of the decline. The difference between the two fertility measures is greater for rural areas (I .3) than for urban areas (0.9). 3.2 Table 3.3 Fertility by background characteristics Total l~rtility rates for the live-year period 1992-96 and the mean numbers of children ever born (CEB) to woraen 40-49 )'ears of age. by selected background characteristics. Viemam 1997 Background characteristic Fertility rates Total Mean CEB fertility rate I (women 40-49) Residence Urban 1.84 2.71 Rural 2.90 4.17 Project province No 2.62 3.81 Yes 2.81 3.87 Region Northern Uplands 3.14 4.08 Red River Delta 2.28 3.09 North Central 3.26 4.(16 Central Coast 3.39 4.24 Central Highlands 4.28 4.65 Southeast 1.87 3.01 Mekong River Delta 2.31 4.65 Education No education 4,03 5, 13 Some primary 3.13 4.56 Completed primary 2.79 4.22 Completed lower secondary 2.53 3.30 Completed hi~her secondar3, + 1.91 2.29 Total 2.67 3.82 i Women 15-49 3,'ears Children Ever Born The distribution of all women and currently married women by age and number of children ever born is presented in Table 3.4. The table also shows the mean nurnber of children ever born to women in each five-year age gFoup. The data indicate that only 4 percent of all women age 15-19 have given birth. Oi1 average, women in their late twenties have given birth to fewer than two children while women age 45-49 have given birth to a little over four children. The statistics for currently married women do not differ greatly from those for all women at older ages: h,~wever, at younger ages the percentage o f currently married women who have had children is much higher than the percentage among all women. 31 Table 3.4 Chi ldren ever born and living. Percent distribution of all women and currently married women age 15-49 by number o f chi ldren ever born (CEB) and mean number ever born and living, according to five-year age groups. Vietnam 1997 Mean Mean number Number number of Age Children ever born of of living group 0 t 2 3 4 5 6 7 8 9 10+ Total women CEB children ALL WOMEN 15-19 96.5 3.4 01 00 00 0,0 00 0.0 0.0 0.0 0.0 100.0 1661 0.04 003 20-24 56.1 287 13.8 1.3 0,1 0.0 0.0 0.0 0.0 0.0 0.0 100,0 1377 0.61 0.58 25-29 25.1 25.4 32.2 I 1,4 4.7 1.2 0.2 0.0 0.0 0.0 0.0 100.0 1288 1.50 144 30-34 13.4 119 31.3 244 11.8 5 t 17 0.4 0.0 0.0 0.0 100.0 1343 2.33 2.21 35-39 9.8 7.1 240 23.0 16.8 10,7 5.8 1.8 1.0 0.2 0.0 100.0 1243 3.01 2.84 40-44 9.4 5.1 13.5 21.6 18.7 15.4 7.4 3.9 2.1 1.7 I.I 100.0 955 3.64 3,39 45-49 I 1,5 4.4 l 1.3 15.8 12.8 16.9 I 1.9 4.2 5.3 3.5 2.2 100.0 645 4.0g 3.75 Total 37.2 130 17.9 12.8 8.1 5.5 2.9 I.I 0.8 0.5 0.3 I000 8511 1.86 1.75 CURRENTLY MARRIED WOMEN 15-19 54.9 44.2 0.9 0.0 0.0 0.11 0,0 0.0 0.0 0.0 0.0 I00.0 129 0.46 0.45 20-24 17.4 537 26.1 2.5 0.2 0.0 0,0 0.0 0.0 0.0 0.0 I00,0 726 1.14 1.09 25-29 5.0 31.0 41.2 14.8 6.1 1.6 0.3 0,0 0.0 0.0 0.0 100.0 988 192 184 30-34 29 12.5 34.8 28.0 13.6 5.8 2.0 0.5 0.0 0.0 0.0 100.0 1153 2.65 2.51 35-39 0.6 6.5 260 259 18.8 12.3 6.6 2.0 1.I 0.2 0.0 100.0 1068 3.37 3.19 40-44 I I 3.9 134 23.8 21.6 17.2 8.8 4.4 2.4 2.0 1.4 1000 785 4.10 3.81 45-49 I7 39 10.5 17.3 14.8 207 14.4 4.6 59 3.9 2.3 100.0 502 4.65 4.29 Total 5.6 18.9 268 19.4 12.4 8.5 4.5 1.6 I.I 0.7 0,4 100.0 5340 2.80 2.64 A comparison of the mean number of children ever born (CEB) reported in the 1989 census (I .94), the ICDS-94 (I.90), and the VNDHS-II (1.86) is shown in Table 3.5. The comparison does not highlight recent changes in fertility, but rather is an indication of the cumulative changes in fertility over the decades prior to the surveys. The difference in the mean number of children ever born during the five-year period between I989 and 1994 is the same as the difference in the mean number of children ever born during the three-year period between 1994 and 1997 (0.04). Additionally, during the earlier period, change is restricted to women age 30 and older while in the later period change is evident for women age 20 and older. Table 3.5 Trends in the number of children ever born Mean number o f children evcr born and l iving children by age group, selected sources. V ietnam 1989-1997 Age Mean number o f CEB Mean number o f chi ldren l iving group 1989 1994 1997 1989 1994 1997 15-19 0.1)5 0.04 0,04 0.04 0.113 0.03 20-24 0.63 11.64 0.6I 0.62 0.60 0,58 25-29 t.67 1.66 1.50 1.64 1.56 1.44 30-34 2.77 2.57 2.33 2.61 2.46 2.21 35-39 364 3.49 3.01 3.411 3.09 2.84 40-44 4.36 4.12 3 .64 4.111 3.73 3.39 45-49 494 4.62 4.08 4.48 4.12 3.25 Total 1.94 1.90 1.86 1,81 1,74 1.75 Source: 1989 census statistics and ICDS-94 statistics are from GSO, 1995:42. Table 3.8. 32 3.3 Birth Intervals There is a considerable body of research which indicates that short birth intervals are harmfnl to the health of babies. This is particularly true for babies born at intervals of less than 24 months. Table 3.6 shows the percent distribution of non-first births that occurred in the five-year period before the VNDHS-11 by the number of months since the previous birth. The data show that birth intervals are generally long in Vietnam. Almost half (49 percent) of non-first births occur three or more years after the previous birth, while almost one-third (32 percent) take place 24-35 months after the previous birth. Fewer than 1 in 5 births (19 percent) occur after an interval of less than 24 months. The median birth interval is 36 months. This is somewhat longer than the median birth interval of 32 months reported in ICDS-94 (GSO, 1995). Younger women, who are more fecund and still in the process of family building, have shorter birth intervals than older women. The median birth interval for women age 20-29 is 30 months, compared with 43 months for women over age 40. A shorter median birth interval also prevails for children whose preceding sibling has died, compared with those whose preceding sibling is living. This pattern presumably reflects a shortened breastfeeding period due to the death of the prior sibling, as well as minimal use of contraception among women who have recently experienced the loss of a child. Differentials in the length of birth intervals by background characteristics are inversely related to fertility levels. The median duration is greater in urban areas (48 months) than in rural areas (35 months). Birth intervals are longest in the three regions where fertility is lowest: the Red River Delta, the Southeast region and the Mekong River Delta (48, 43, and 42 months, respectively). By level of education, mothers with a higher secondary education have a median birth interval of 48 months, which is 12 to I g months longer than the interval for mothers with less education. 33 Table 3.6 Birth intervals Percent distribution of births in the five years before survey by number of months since the demographic and background characteristics, Vietnam 1997 previous birth, according to Demographic and Months since previous birth background characteristics %17 18-23 24-35 36-47 48+ Total Number Median Age of mother 15-19 * * * * * 100.0 * * 20-29 9.4 16.3 40.5 17.0 16.8 100.0 877 29.9 30-39 4.6 9.7 25.9 18.5 41.2 100.0 1 .069 42.0 40+ 6.4 8.1 22.8 17.1 45.6 100.0 186 43.4 Birth order 2-3 7.2 I 1.7 31.6 16.4 33.2 100.0 1,423 35.7 4-6 4.8 13.9 31.7 20.6 29.1 100.0 605 35.9 7+ 11.5 11.6 33.0 20.1 23.7 100.0 105 33.1 Sex of prior birth Male 6.9 11.8 308 16.8 33.6 100.0 1.053 36.3 Female 6.5 12.8 32.6 18.6 29.5 IO0.O 1.080 35A Survival of prior birth Living 5.4 12.5 .31.6 18.3 32.3 100.0 2,025 36.3 Dead 32.3 9.0 33.7 7.1 17.8 100.0 108 24.9 Residence Urban 10.2 8.2 18.1 13.5 50.0 100.0 243 48.0 Rural 6.3 12.8 33.4 18.3 29.2 100.0 1,890 34.8 Project province No 7.0 12.5 31.3 19.2 30.1 100.0 1.501 35.6 Yes 6.2 11.9 32.7 14.3 34.9 100.0 632 35.7 Region Northern Uplands 7.9 15.7 41.5 18.6 16.3 100.0 495 30.1 Red River Delta 3.4 6.4 25.5 14.2 50.5 100.0 326 48.5 North Central 3.9 12.3 39.1 17.2 27.5 100.0 336 34.2 Cantral Coast 9.1 13.7 30.0 23.0 24.2 100.0 324 35.2 Central Highlands 8.g 17.5 33.5 8.0 32.2 100.0 128 33.6 Southeast 6.9 8.7 24.6 16.8 43. I 100.0 195 43. I Mekong River Delta 7.9 I 1.9 20.8 19.5 40.0 100.0 330 41.7 Education No education 10.9 12.5 40.4 17.1 19.2 100.0 151 30.4 Some primary 6.0 14.0 29.9 20.5 29.6 100.0 446 36.0 Completed primary 8.5 13.9 32.0 20.1 25.5 100.0 667 33.9 Completed lower secondary 5.3 I 1.4 32.9 15.2 35.2 100.0 629 36.3 Completed higher secondary+ 4.3 6.7 25.5 13.2 50.2 100.0 239 48.2 Total 6.7 12.3 31.7 17.7 31.6 100.0 2.133 35.6 Note: First births are excluded. The interval for multiple births is the number of months since the preceding pregnancy that ended in a live birth. A n asterisk indicates that a figure is based on fewer than 25 unweighted eases and has been suppressed. 3.4 Age at First Birth The age at which a woman has her first child has implications for her health and the health of her child, as well as for her economic opportunities in life. In many countries, postponement of first birtlis, reflecting an increase in the age at marriage, has contributed to overall fertility decline. Alternatively, ear ly onset o f ch i ldbear ing tends to increase the number o f ch i ldren a woman wi l l have dur ing her reproduct ive years. Even when fami ly p lann ing is widespread, the t iming o f f irst births can af fect completed fami ly s ize. 34 Table 3.7 presents the distribution of women by age at first birth, according to the current age. For women age 25 years and over, the median age at first birth is showfl in the last column of the table. The median age at first birth increases across age cohorts, from 22.6 years among women age 25-29 to 24.0 years among women age 45-49, due perhaps to historical disturbances. Nevertheless, in all age cohorts, the median age at first birth in 1997 is higher than was reported in the ICDS-94 (see Figure 3.2). Table 3.7 Ace at first birth Percent distribution of women aige 15-49 by aje at first birth, accordin~ to current a~e, Vietnam 1997 Women Number Age with no A~e st first birth gmep birth <15 15-17 18-19 5-19 96.5 0.0 1.6 1.9 20-24 56.1 0.3 3.8 14.8 25-29 25.1 0.1 4.4 15.3 30-34 13.4 0.1 ' 4.3 14.5 35-39 9.8 0.2 3.9 11.7 40.44 9.4 0.4 3.4 9.8 45-49 11.5 0.1 4.4 10.9 Median age of at first 20-21 22-24 25+ Total women birth NA NA NA I00.0 1,661 a 18.1 6.9 NA 100.0 1,377 a 25.2 22.3 7.5 100.0 1,288 22.6 20.9 28.3 18.5 100.0 1,343 22.9 21.0 30.6 22.8 100.0 1,243 23.2 19.5 33.1 24.5 100.0 955 23.2 16.7 27.0 29.3 100.0 645 24.0 NA = Not applicable ;a Omitted ber~ese Ices than 50 percent of the women in the a~e ~roep x to x+4 have had a birth by a~e x 24.5 24 23.5 23 22,5 22 21,5 21 20.5 Figure 3.2 Median Age at First Birth by Current Age, Vietnam, 1994 and 1997 • 23.2 25-29 40-44 35-39 Current .~p 45-49 24 35 Table 3.8 shows the median age at first birth for different subgroups of the population. The measures are presented for all women age 25-49 and for five-year age groups. There are substantial differences between urban and rural women in the median age at first birth. In all age groups, the median age at first birth is higher for urban women than for rural women. The median age at first birth is relatively high in the Southeast region (24.9 years), the Central Highlands (23.7 years), and the Red River Delta (23.5 years). Median age at first birth is lowest in the Northern Uplands (22.2 years) and the Mekong River Delta (22.7 years). Median age at first birth is inversely related to women's level of education. It does not differ by project province status. Table 3.8 A~e at first birth by background characteristics [ Median age at first birth among women age 25-49 years, by current age and ~ ~ Current age Background characteristic ~ ~ 35-39 I Residence selected background characteristics, Ages 40-44 45-49 25-49 Urban Rural Project province No Yes Region Northern Uplands Red River Delta North Central Central Coast Central Highlands Southeast Mekong River Delta Education No education Some primary Completed primary Completed lower secondary Completed higher secondary + a 25.2 24.9 25.1 24.6 a 22.0 22.5 22.8 22.8 23.8 22.7 22.8 22.8 23.1 23.3 24.0 23. I 22.2 23.1 23.4 23.0 23.9 23.1 20.9 21.7 22.7 23.6 23.9 22.2 22.5 23.2 23.9 23.3 24.2 23.5 22. I 23.2 22.8 23.5 24. I 23.0 22.7 22.7 23.0 22.8 24.4 22.9 22.4 22.6 24.6 24.9 25.5 23.7 a 23.7 24.1 25.6 25.0 24.9 23.3 23.2 22.3 22.2 22.4 22.7 22.3 22.6 22.6 21.4 24.6 22.4 20.7 21.4 22.4 22.5 23.0 21.9 22.0 22,4 22.5 22.4 23.0 22.5 22.6 22,9 23.2 23.7 24.2 23.2 24.4 25. I 25.2 26.2 25.7 a Total 22.6 22.9 23.2 23.2 24.0 23. I Note: The medians for age cohorts 15-19 and 20-24 could not be deten'ained because half the women had not yet had a birth. a Omillcd because less than 50 percent of the women in the age group x to x+4 had a birth by age x 3.5 Adolescent Fertility Table 3.9 shows the percentage of women age 15-19 who are mothers or pregnant with their first child. The sum of these two categories is defined as the percentage of teenage women who have begun childbearing. This statistic is important because of the association between early childbearing and high morbidity and mortality for both mothers and their children. The overall level of teenage childbearing in Vietnam is 5.7 percent, of which 3.5 percent have given birth and 2.2 percent are pregnant with their first child. Among teenage women who have given birth, just under half (1.6 percent) had their first child before age lg (Table 3.7). 36 There are significant differences in the level of teenage childbearing by residence. The level in rural areas (6.6 percent) is four times the level in urban areas (1.6 percent). By comparison, the difference in the level of teenage childbearing between project provinces (4.7 percent) and non-project provinces (6.1 percent) is small. By region, the percentage of teenage childbearing varies from 3.7 percent in the Central Highlands and 3.8 percent in the Mekong River Delta to 9.6 percent in the Northern Uplands. Table 3.9 Adolescent preanancy and motherhood Percentage of women age 15-19 who are mothers or pregnant with their first child by background characteristics. Vietnam 1997 Background characteristic Percentage who are: Percentage Pregnant who have with first begun Number of Mothers child chiEdbearing women Age 16 0.6 0.4 1.0 752" 17 1.4 11.6 2. I 327 18 4.2 4.2 8.4 283 19 12.5 6.8 19.3 298 Residence Urban 1.3 0.3 1.6 283 Rural 3.9 2.6 6.6 1,379 Project province No 3.7 2.4 6.1 1.191 Yes 2.9 1.8 4.7 470 Region Northern Uplands 6.9 2.7 9.6 355 Red River Delta 2.2 2.4 4.6 298 North Central 3.0 1.7 4.7 202 Central Coast 3.7 3.6 7.3 190 Central Highlands 10.0) (3.7) (3.7) 37 Southeast 2.2 1.9 4. I 203 Mekong River Delta 2.5 1.2 3.8 375 Education No education g.0 2.9 10.9 69 Some primary. 8.2 2.9 I I. I 252 Completed primary 3.9 2.4 6.3 640 Completed lower secondary 1.3 2.3 3.6 539 Completed higher secondary + 0.0 0.0 0.0 161 Total 3.5 2.2 5.7 1.661 Note: Figures in parentheses are based on 25-49 unweighted cases. "including women age 15 37 Teenage childbearing is strongly and inversely related to mother's level of education. As indicated in Figure 3.3. teenage childbearing is highest among women with no education (] ] percent), substantially lower among women who have completed lower secondary school (4 percent), and lowest among those who have completed higher secondary school (0 percent). 12 Figure 3.3 Percentage of Teenage Women Who Have Begun Childbearing by Education, Vietnam 1997 Percent 10 8 6 4 2 0 11 6 Vietnam No Some Completed Completed Completed education primary pdmaty lower higher primary secondary+ 38 CHAPTER4 FERTILITY REGULATION 4.1 Knowledge of Family Planning Methods Knowledge of family planning methods and places to obtain them are crucial elements in the decision of whether to use a method and which method to use. In the VNDHS-II, the respondent was first asked to report all the methods she had heard of without the interviewer mentioning any specific methods. Once she completed her spontaneous reporting, the interviewer read out the names and a short description of the remaining methods on the list and asked if she knew each of them. All methods recognized by the respondent after the .method was described were recorded as known after probing (prompted knowledge). Information on knowledge was collected for eight modern methods (the pill, IUD, injectables, implants, vaginal methods (foam, jelly, cream and diaphragm), the condom, female sterilization, and male sterilization) and two traditional methods (periodic abstinence and withdrawal). In addition, provision was made in the questionnaire to record any other methods named spontaneously by the respondent. In this analysis, overall levels of knowledge are presented---i.e., respondents are classified as knowing a method if they recognized it spontaneously or after probing. Trends in Knowledge of Methods Table 4.1 indicates that knowledge of at least one method of contraception is practically universal (99 percent) among currently married women of reproductive age. Among modern methods, Table 4.1 Trends in knowledge of contraceptive methods Percentage of ever-married women and of currently married women who know of at least one contraceptive method, by specific method. Vietnam 1988-1997 Ever-married women Currently married women Contraceptive me01od VNDtlS-I ICDS-94 VNDHS-II VNDHS-I ICDS-94 VNDHS-II (1988) (1994) (1997) (1988) (1994) (1997) Any method 94. I 96.54 98.8 94.7 97.0 98.9 Any modern method 93.6 95.73 98.5 94.3 96.2 98.7 Pill 46.4 68.07 89.0 46.8 69.0 89.5 IUD 91.8 94.15 97.3 92.5 94.7 97,6 h~iectables U 41.79 55.8 U 42.4 55.9 Vaginal methods U 13.45 I 0.0 U 13.6 10.1 Condom 44,5 75.66 92. I 45.0 76.6 92.5 Female sterilization 60.2 77.98 91.0 60.4 78. I 91.4 Male sterilization 49.2 73.53 89.0 49.7 74.3 89.5 Implants U U 12.3 U U 12.4 Any traditional method 43.0 61.22 80.0 U U 80.8 Periodic abstinence 40.3 60.58 68.3 43.6 62.2 69.0 Withdrawal 6.7 8.84 70.4 41.1 61.9 71,5 Other traditional method U U 2.0 6.8 8.9 2.0 Number of women U 10.490 ~.664 U 9.796 5,340 LI = Unknown (not available) Source: Vietnam Intercensal Demographic Survey 1994 (GSO, 1995:52, Table 4.1) 39 the most widely known are the IUD (98 percent), the condom (93 percent), female sterilization (91 percent), and the pill arid male sterilization (90 percent each). The proportion of currently married women knowing about injectables is 56 percent. The least recognized modern methods, implants and vaginal methods, were known by 12 and 10 percent of currently married women, respectively. Comparison of the levels of contraceptive knowledge between the 1988 VNDHS, the 1994 ICDS, and the 1997 VNDHS indicates that tire percentage of currently married women knowing specific methods has increased for every method. Knowledge of the IUD was already very high in 1988. Other methods, however,.show large increases: the condom, the pill, male sterilization and female sterilization increased by 50 percent or more between 1988 and 1997. Differentials in Knowledge of Methods Table 4.2 shows the percentage of currently married women who know any method of contraception and any modern method by background characteristics. Differentials in the VNDHS-II are minimal. The percentage knowing any modern method was less than 96 percent in only two groups: women in the Central Highlands (92 percent) and women with no education (93 percent). Table 4.2 Knowledee of contraceptive methods by backeround characteristics Percentage of current b' married women ~q~o know tit least one method ofconlraception and wlto kno~ at least one modern method, by background characteristics. Vietnam 1994-1997 Background characteristic Any method Any modern method ICDS-94 VNDHS-II ICDS-94 VNDHS-II (19943 0997) {19943 (19973 Number of currently married women Age group 15-19 87.3 97.0 86.0 96.4 129 20-24 94.8 97.6 93.3 97.5 716 25-29 97.6 98.9 96,9 98.7 988 30-34 98.1 99.7 98.0 99.6 1.153 35-39 98.4 99.6 97.8 99.4 1.06g 40-44 97.5 98.9 96.8 98.3 785 45-49 95.8 98.4 94.8 98.2 502 Residence Urban 99.0 99.6 98.7 99.4 Rural 96. I 98.8 95.6 98.5 Project province No U 99.1 U 98.8 Yes U 98.5 U 984 997 4.343 3.738 [,601 Education No education 80.6 93,6 780 92.6 252 Some primary 95.8 98,3 94.6 98.2 990 Completed pr ima~ 98. t 98.9 97.3 98.4 1.576 Completed lower secondary. 99.5 99.6 99.4 99.6 1,764 Completed higher seconda D' 4- t 000 100.0 99.7 99.9 757 Total 97.0 98.9 96.2 98.7 5.340 U = Unknown (not available) Source: Viemam Intereensal Demographic Survey 1994 (GSO, 1995:54. Table 4.2: GSO. 1996d:I 1. "Fable 2.2) 40 Region Northern Uplands 95.8 99.1 94.8 98.9 I.I 10 Red River Delta 99.7 100.0 99.7 ] 00.0 1.197 North Central 97.6 99,9 97.1 99.9 646 Central Coast 98.4 98.4 98.2 9%8 557 Central Highlands 68.9 92.4 67.3 92.4 470 Southeast 98.8 98.0 97.8 97.9 642 Mekong River Della 96.8 988 96.3 98.3 1,017 4.2 Ever Use of Family Planning Methods The VNDHS-II included a question asking women whether they had ever used a contraceptive meihod. Table 4.3 indicates that 84 percent of currently married women have used a method. The IUD is, by far, the most widely used modern method among currently married women (58 percent). Only 13 percent have used the condom, 10 percent have used the pill, and less than 10 percent have used all other modern methods combined. The level of e';,er use of traditional methods is high in Vietnam. Almost 26 percent of currently married women have used withdrawal and 18 percent have used period abstinence. Ever-use rates vary by age group and are lowest among the youngest women. However, the fact that 22 percent of currently married women age 15-19 and 62 percent of those age 20-24 have used contraception at some time indicates that women in Vietnam understand the advantages of practicing family planning early in their reproductive years. The level of ever use rises to a high of 95 percent for currently married women age 35-39, then declines to 82 percent among those age 45-49. Table 4.3 Ever use of contraception Percentage of ever-married woman and currently married women who have ever used a contraceptive method, by specific method and age, Vietnam 1997 Ale of women Contraceptive method 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total EVER-MARRIED WOMEN Any method 21.7 61.6 81.7 91.1 91.6 84.5 76.3 81.6 Any modern method 16.9 50.4 67.6 77.6 76.5 72.2 62.4 68.3 Pill 3.4 9.0 11.4 13.2 9.0 7.1 6.9 9.7 IUD I 1.5 39.5 56.6 63.0 64.2 59.1 49.8 56.0 lnjcctables 0.5 0.4 0.9 1.3 1. I 0.5 0.6 0.9 Vaginal methods 0.0 0.0 0.0 0. I 0.0 0.0 0.0 0.0 Condom 2.5 7.0 11.7 14.8 15.8 13.6 8. I 12.3 Female sterilization 0,0 0.0 1.9 7.4 8.2 10.2 9.7 6.1 Male sterilization 0.0 0.0 0.1 0.9 0.7 0.9 0.5 0.5 Any traditional method 4.8 20.3 30.0 35.4 43.1 34.9 32.6 33.0 Periodic abstinence 1.3 9,1 12.6 17.9 24.5 19.6 16.4 16.9 Withdrawal 3.4 15.3 24.0 27.6 31.8 24.9 24.5 24.9 Other traditional methods 0.0 0.0 0.3 0.6 0.9 0.8 0.3 0.5 Number of women t 29 732 1.016 I. 197 I. 134 876 581 5,664 CURRENTLY MARRIED WOMEN Any method 21.7 62.0 83.0 93.1 94.7 90.3 81.5 84.2 Any modern method 16.9 50.8 Pill 3.4 9.2 IUD I 1.5 39.8 It~iectables 0.5 0.4 Vaginal methods 0.0 0.0 Condom 2.5 7.0 Female sterilization 0.0 0.0 Male sterilization 0.0 0.0 Any traditional method 4.8 20.5 Periodic abstinence 1.3 9.3 Withdrawal 3.4 15.4 Other traditional methods 0.0 0.0 Number of women 129 716 68.7 79.4 79.2 76.9 66.4 70.4 I 1.3 13.5 9,5 7.6 7.6 10.1 57.7 64.4 66.6 63.2 53.5 57.8 0.9 1.3 1.2 0.6 0.5 0.9 0.0 0.1 0.0 0.0 0.0 0.0 I 1.9 15.3 16.5 14.4 8,7 12.7 1.9 7.6 8.7 I 1.1 10.3 6.3 0.1 0.9 0.8 0.9 (I.6 0.6 30.6 36.3 44.9 3%7 35.8 34.3 12.8 18.5 25.6 21.3 18.1 17.6 24.4 28.3 33.0 26.9 26.8 25.9 0.4 0.6 1.0 0.9 0.3 0.5 988 1,153 1,068 785 502 5.340 41 4.3 Current Use of Family Planning The level of current use of contraception is one of the indicators most frequently used to assess the success of family planning programs. It is also a widely used measure in the analysis o f fertility determinants. Current use of contraception is presented in Table 4.4 for currently married women age 15-49. In the VNDHS- I I , 75 percent o f currently married women reported use of family planning. This is an increase o f 10 percentage points from the rate in the ICDS-94 (65 percent), and 22 percentage points from the rate in the VNDHS-I (53 percent). A contraceptive prevalence rate of 75 percent is high compared with many developing countries in the world. As in 1988 and 1994, the most commonly used method in Vietnam is the IUD (39 percent of currently married women); the next most common method is withdrawal (12 percent). Current use of modern methods other than the IUD has increased since 1994 but is still very low: female sterilization (6.3 percent), the condom (5.9 percent), the pill (4.3 percent) and male sterilization and injectables (less than 1 percent each). Rates of current use increase with age, reaching a maximum among women age 35-39 (88 percent). Beginning with age group 20-24, more than half o f women are using contraception. Women in all age groups prefer the IUD. The proportion using the IUD peaks at 43 percent among wornen age 30- 34 while the proportion using female sterilization peaks at I 1 percent among women age 40-44. Table 4.4 Current use of contraception Percent distribution of currently married women by contraceptive method currently used. according to age. Vietnam 1997 A~e of women Contraceptive ~cthod 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total Any metJod 18.1 55.1 73.4 84.5 88.0 82.2 63.5 75.3 ~ty modern method 14.9 43.3 57.0 66.0 60.4 58.6 43.9 55.8 Pill 2.9 5.6 6.3 6.1 3.1 2.2 I.I 4.3 IUD 9.6 34.0 42.4 43.1 41.5 37.2 29.5 38.5 Ir0ectables 0.5 0.0 0.2 0.4 0.2 0.0 O.0 0.2 Condom 1.9 3.6 6.0 8.0 6.3 7.1 2.4 5.9 Female sterilization 0.0 0.0 1.9 7.6 8.7 I I. I 10.3 6.3 Male sterilization 0.0 0.0 0. I 0.9 0.7 0.9 0.6 0.5 Any traditional method 3.2 I 1.8 16.2 18,4 26.9 23.1 19.4 19.2 Periodic abstinence 0.7 3.9 4.3 6.4 12.3 I 0. I 0.8 7.3 Withdrawal 2.5 7,9 I 1.9 12.0 14.7 13.0 12.7 I 1.9 Other traditional methods 0.0 0.0 0.3 O. I 0.6 0.5 O. 1 0.3 Not currently using 81.9 44.9 26.6 15,5 12.0 17.8 36.5 24.7 Total I00.0 - IO0.O I00.0 IO0.O 100.0 I00.0 I00.0 I00.0 Number 129 716 988 1.153 1,068 785 502 5,340 42 Differentials in Current Use of Methods Differentials in the use of contraception among currently married women are shown in Table 4.5. Urban women are slightly more likely to use contraception than rural women (79 and 74 percent, respectively); this is because of greater use of traditional methods--particularly periodic abstinence by urban women (25 and 18 percent, respectively). Women living in project and non-project provinces are about equally likely to be current users (77 and 75 percent, respectively) and their patterns of rnethod use are similar. Regional variation in the level of current use is similar to that described earlier for ever-use. Currently married women in the Central Highlands report the lowest rate of current use of any method (64 percent) and of modern methods (44 percent). In contrast, the highest level of current use is in the Red River Delta (83 percent for any method and 66 percent for modern methods). The North Central region is the next highest (80 percent for any method and 63 percent for modern methods). There is little difference in current use in the remaining four regions where use of any method varies from 70 to 75 percent. It is worth noting, however, that use of traditional methods is greater in the three regions in the South: Mekong River Delta, Southeast, and Central Highlands (25, 22 and 20 percent, respectively). A strong positive relationship exists between education and current use of contraception. Significant differences in family planning are observed between women who never attended school and women who did attend school, even if they did not complete the primary level. Overall, the percentage of currently married women currently using contraception varies from 53 percent among women with no education to 82 percent among women who completed at least lower secondary school. The pattern of contraceptive use by number of living children is as expected. Prevalence is very low among women who have no children (8 percent), rises to a peak among women with three children (86 percent), and declines somewhat among women with four or more children. 43 Table 4.5 Current use of contraception by ~ackgroun~ characteristics Percent distribution of currently married women by contraceptive method currently used, according to selected background characteristics, Vietnam 1997 Modern method Traditional method Any Any modern Background characteristic method method Pill IUD Any Peri- Not Female Male tradi- odic cur- Numb Con- In- sterili- sterili- tional absti- With- Other rently of ~om jectables zation zation method nonce drawal rnedmd using Total women Residence Urban 79.3 54.0 4.1 32.5 0.0 11.8 5.3 0.3 24.9 14.2 10,7 0.4 20.7 100.0 997 Rural 74.4 56.2 4.4 39.9 0.2 4.5 6.6 0.6 17.9 5.7 12.2 0.3 25.6 100.0 4,343 Prnject province No 74.6 55.7 5.0 37.2 0.1 6.4 6.6 0.3 18.5 7.1 11.4 0.4 25.4 100.0 3,738 Yes 77.0 56.1 2.8 41.6 0.2 4.8 5.6 I,I 20.9 7.7 13.1 0.1 23.0 100.0 1.601 Region Northern Uplands 71.0 51.7 3.6 37.5 5.2 Red River Delta 83.3 66.3 2.2 51.6 7.0 North Central 80.1 63.4 1,0 50.3 3.5 Central Coast 70. I 54.4 4.2 33.4 7,8 Central Highlands 63.6 43.8 10.2 22.4 5.3 Southeast 74.6 52.9 7.0 27.2 7.3 Mekong River Delta 72.8 47.6 7.2 29.4 5. I Education No education 52.9 42,4 4.9 24.2 2.5 Some primary 68.7 50.4 6.9 33.4 2.3 Completed primary 72.2 52. I 5. I 34.5 5.4 Completed lower secondary 82.1 62.3 " 2.7 46.2 6.3 Completed higher secondary + 82.2 59.8 3.0 40.3 I 1.8 No. of living children None 8. I 2.7 0.9 1.6 0,0 I 66.3 48.7 5.2 35.6 6.9 2 85.0 62.5 4.6 46.0 8.5 3 86.0 63.7 4.5 44.3 6.3 4+ 78.7 59.8 4.1 36.5 3.3 Toial 75.3 55.8" 4.3 38.5 5.9 . , , , , , 0.0 5.2 0.1 18.7 7.8 10,9 0.6 29.0 100.0 I,I10 0.0 5,0 0.6 16.6 7.1 9.6 0.4 16.7 100.0 1,197 0.0 6.4 2.2 16.7 2.7 14,0 0.0 19.9 100.0 646 0.0 9.1 0.0 15.4 3.9 11.5 0.2 29.9 100.0 557 0.0 6.0 0.0 198 8,9 10.9 0.0 36.4 100.0 170 0.3 10.9 0.3 21.5 10.5 11,0 0.2 25.4 100.0 642 0.7 4.7 0.5 25.0 9.5 15,6 0.2 27.2 100.0 1,017 1.0 8.5 1.3 10,1 1.8 8.3 0.4 47.1 100~0 252 0.1 7.2 0.4 17.8 4.6 13,1 0.5 313 100.0 990 0.2 6,3 0.5 19.9 7.0 12.8 0.2 27.8 100.0 1,576 0.1 6.3 0.7 19.5 7.6 11.9 0.3 17.9 100.0 1,764 0.0 4.6 0.1 22.4 12.4 10,0 0.0 17.8 100.0 757 0.0 0.2 0.0 5.4 2.3 3.1 0.0 919 100.0 321 0.1 0.9 0.0 17.5 7.8 9,7 0.1 33.7 100.0 1.042 0.2 • 3.0 0.2 22.2 9.2 12.9 0.3 15.0 100.0 1,511 0.1 7.6 1.0 21.9 7.2 14,7 0.4 14.0 100.0 1,086 0.2 14.6 I.I 18.5 6,1 12,4 0.4 213 100.0 1,379 0.2 6.3 0.5 19.2 7.3 11.9 0.3 24.7 100.0 5,340 4.4 Number of Children at First Use of Contraception In order to investigate when during the family building process couples initiate contraceptive use, the VNDHS-I I included a question about the number of l iving children a woman had when she or her partner first used a method. Table 4.6 shows the percent distribution of ever-rnarried women by the number of living children at the t ime of first use. Overall, 31 percent of women first used contraception before having their second child and 53 percent first used it before having their third child. The data in Table 4.6 can be used to investigate changes between age cohorts in the stage of the family building process at which contraception is first used. Such an analysis indicates that younger Vietnamese women began using contraception earlier than older women. For example, almost half (49 percent) of women age 20-24 first used contraception before having the second child while only 25 percent of women age 35-39 and 10 percent of women age 45-49 first used contraception before their second child. The trend toward earlier use o f contraception in the family building process can also be seen by comparing data from the ICDS-94 and the VNDHS-I1. For example, focusing on the youngest age cohorts-----ever-married women age 15-19 and 20-24 the percentage reporting first use of contraception before their second child is greater in the VNDHS-I I (21 and 49 percent, respectively) than in the ICDS- 94 (13 and 41 percent, respectively). "Fable 4.6 Number of children al first use of contraception Percent distribution of ever-married women by number of living children at the time of first use oF contraception, according to current age. Vietnam 1997 Never Number of living children at first use of contraception Number used of Current age contraception 0 I 2 3 4+ Total women 15-19 78.3 4.9 16.3 0.5 0.0 0.0 100.0 129 20-24 38.4 4.5 44.1 12.1 0.8 0.0 100.0 732 25-29 18.3 3.2 42.7 24.9 7.6 3.2 100.0 1,016 30-34 8.9 2.9 33 7 27.3 16.9 10.3 100.0 I,I 97 35-39 8.4 2.4 23.0 27.4 17.8 20.9 100.0 I. 134 40-44 15.5 1.2 13.1 18.5 21.9 29.8 100.0 876 45-49 23.7 O.4 9.6 16.2 15.5 34.7 100.0 581 Total 18.4 2.6 28.5 21.8 13.6 15.1 100.0 5,664 4.5 Knowledge of the Fertile Period Seven percent of currently married women in the VNDHS- I I reported current use of periodic abstinence. For this method to be practiced successfully, a basic understanding of the monthly ovulation cycle and an awareness of the fertile period in that cycle are necessary. In the VNDHS-I[ , all respondents were asked when in the ovulatory cycle a woman is at greatest risk of becoming pregnant. The response categories for this question are designed to distinguish the correct response (i.e., the middle of the cycle) from other phases of the cycle. However, it should be noted that respondents had difficulty understanding what this question tneant and how it should be answered. Interviewers often had to repeat the question once or twice before the respondent gave an answer. This creates some doubt about whether the question actually measured what it was intended to measure. 45 Table 4.7 shows the distribution of responses to the question on the ovulatory cycle. Among all ever-married women, only 28 percent correctly identified the fertile period. Among current users of periodic abstinence, 60 percent correctly identified the fertile period. Although current users of periodic abstinence were clearly more knowledgeable about the ovulatory cycle than other women, 40 percent did not correctly identify the period of peak risk of pregnancy. Table 4.7 Knowledge of the fertile period Percent distribution of current users of periodic abstinence and of ever-married women by knowledge of the fertile period during the ovulatory cycle, Vietnam 1997 Current users Knowledge of the Ever-married ovulatory cycle Periodic abstinence Calendar rhythm women During period 0.0 0.0 0.0 After period ends 7.5 7.8 7.4 Middle of the cycle 59.5 59.1 27.8 Before period begins 0.6 0.7 0.9 At any time 20.6 20.9 34.0 Other 0.0 0.0 0.0 Don't know 11.7 11.6 29.9 Total 100.0 100.0 100.0 Number 389 376 5.664 4.6 Age at Steri l ization Information about the number of years since sterilization and the age at which women were steril ized is shown in Table 4.8. O f the 338 sterilized women, 29 percent were steril ized less than two 3'ears before the survey, another 42 percent were sterilized 2-5 years before the survey, and the remaining 29 percent were steri l ized six or more years before the survey. Overall , the median age at steril ization was 33 years. There is no discernable time trend in the median age at sterilization. Table 4.8 Timing of sterilization Percent distribution of currently married sterilized women by age at the lime of sterilization, and the number of years since the operation, Vietnam 1997 Number of Number of Median years since Age at sterilization sterilized age at sterilization <25 25-29 30-34 35-39 40-44 45-49 Total women sterilization <2 2.2 11.2 45.7 29.7 10.5 0.7 I00.0 99 33.3 2-3 0.0 24.3 33.2 31.9 10.5 0.0 100.0 81 32.7 4-5 1.6 27.7 36.3 28.3 6.1 0.0 100.0 60 31.7 6-7 3.8 26.4 32.9 29.2 7.7 0.0 1000 23 32.8 8-9 7.8 27.7 30.9 26.9 6.6 0.0 100.0 16 33.3 104" 3.3 28.2 49.6 18.9 0.0 0.0 100.0 59 Total 2.I 22.1 40.2 27.9 7.5 0.2 100.0 338 32.5 46 4.7 Source of Supply In order to evaluate the relative importance of various sources of contraceptive methods, current users o f modem methods were asl<ed to report the place from which they last obtained their method. Table 4.9 shows results for all methods combined and for specific methods, Table 4.9 and Figure 4.1 indicate the dominance of the public sector in providing contraceptive services in Vietnam. Eighty-eight percent of current users last obtained their method from the public sector while 12 percent obtained theirs from the private sector. By far the single most important source of contraception was the commune health center (43 percent), followed by government hospitals (27 percent) and mobile clinics (11 percent). In total, these three sources were the source of supply for 80 percent of current users. Table 4.9. Source of supply for modern contraceptive methods Percent distribution of currently married women who are currently using a modern contraceptive i'oclhod by most recent source ol supply, according to specific methods. Vietnam 1997 Method Female Male Source of supply Pill IUD Condom sterilization sterilization Total j Public 60.7 93.9 54.6 99.7 100.0 87.7 Government hospital 3.3 23.1 " 1.2 87.0 47.9 26.7 Delivery house 0.7 1.3 0.0 0.0 0.0 1.0 Commune health center 38.6 53.0 24.6 3.1 3.2 42.6 Family planning clinic 0.9 2.9 5.0 4.3 6.5 3.2 Mobile clinic 3.4 13. I 2.0 5.2 42.3 10.5 Public fieldworker 13.8 0.3 19.7 0.0 0.0 3.4 Other public " 0.1 0.2 2.0 0.2 0.0 0.4 Medical private 36.6 . 6.1 43.6 0.3 0.0 I 1.9 Private hospital/clinic 0.5 " 0.6 0.5 0.0 0.0 0.5 Pharmacy 32.9 0.5 40.6 0.0 0.0 7.3 Private doctor 2.4 4.5 2.2 0.3 0.0 3.7 Other private 0.8 0.6 0.4 0.0 0.0 0.5 Other private 2.7 0.0 1,8 0.0 0.0 0.4 Friends/relatives 2.3 0.0 1.2 0.0 0.0 0.3 Other 0.4 0.0 0.6 0.0 0.0 O. I Total 100.0 100.0 100.0 100.0 100.0 IO0.0 Number 232 2,056 315 338 29 2,979 * Includes 9 users of injectables. 47 Figure 4.1 Sources of Family Planning Among Current Users of Modem Contraceptive Methods, Vietnam 1997 11% e.~ ~.~ect, hosg~al ~iV~e dO 27% 4% O~f S% t~ctt'ra~ae 1.4a~ e ¢i~arrr~-./ /,~% 7% For specific methods, the most important sources of s,upply differed. Women using the IUD and pills obtained their supplies primarily from commune health centers, although pharmacies were also an important source for pills. Sterilization services were almost always provided by government hospitals for women and by government hospitals and mobile clinics for men. For condom users, the leading sources of supply were pharmacies and commune health centers. 4.8 Contraceptive Discontinuation Two important issues for family planning programs are the rate at which women discontinue use of contraception and their reasons for discontinuation. Life table discontinuation rates calculated from information collected in the five-year, month-by-month calendar in the VNDHS-II questionnaires are presented in Table 4.10. All episodes of contraceptive use between January 1992 and the date of the interview were recorded in the calendar, along with the main reason for discontinuation of use during this period. The discontinuation rates presented here are based on all segments of use that started between three and 62 months before the interview date for each woman. A segment is an uninterrupted period of use of a particular contraceptive method. The month of interview and the two preceding months are excluded from the analysis in order to avoid the bias likely to be introduced by unrecognized pregnancy. The rates presented in Table 4.10 are cumulative one-year discontinuation rates and represent the proportion of users who discontinue within 12 months of starting use. In calculating rates, the reasons for discontinuation are treated as competing risks (net rates). The reasons are classified into four mutually exclusive and exhaustive categories: method failure (pregnancy), desire to become pregnant, side effects/health reasons, and all other reasons. 48 Discontinuation rates are relatively low in Vietnam. For all methods combined, tile overall discontinuation rate at 12 months is 18 percent. Not surprisingly, discontinuation rates for tile pill (33 percent), condom (32 percent), periodic abstinence (29 percent), and withdrawal (19 percent) are higher than the rate for the I UD (10 percent). Table 4.10 Contraceptive discontinuation rates One-year discontinuation rates due to method lailure, desire lbr pregnancy, health reasons, or other reasons, according to specific methods. Vietnam 1997 Reason t~r discontinuation Desire Side effects/ Method to become health All other All Method failure pregnant concerns reasons' reasons Pill 7.9 3.7 10.2 I 1.5 33.2 IUD 1.4 0.8 7.2 0.9 10.3 Condom I I. 1 6.0 1.3 13.6 32.0 Periodic abstinence 12.4 6.7 0.2 9.7 28.9 Withdrawal 7.7 1.7 0. I 9.0 18.6 Total 5.2 2.4 4.3 5.7 17.6 T Includes dis¢ontinuations with missin~ reasons For all methods combined, the reasons for discontinuation during the first year of use were method failure (5 percent); desire to become pregnant (2 percent); side effects or health concerns (4 percent); and other reasons (6 percent). However. the relative ranking of reasons for discontinuation varies by method. Women who discontinued use of the pill, condom, periodic abstinence~ and withdrawal most frequently reported method failure or other reasons. IUD nsers most frequently cited side effects or health concerns as the reason for discontintdng use. Further information on the reasons for discontinuation is presented in Table 4.1 I and Figure 4.2. The table shows the percent distribution of all discontinuations in the five years preceding the survey, regardless of whether they occurred during or after the first 12 months of use: For all methods combined, the most common reasons for discontinuation are method failure (26 percent) and desire to become pregnant (27 percent). For most individual methods, method failure and desire to become pregnant are the most frequently cited reasons for discontinuation. For pill and IUD users, side effects and health concerns are frequently reported reasons. For periodic abstinence and withdrawal users, switching to a more effective method is an important reason; while for condom users, switching to a more effective method and method inconvenience are important reasons for discontinuing using the method. 49 Table 4.11 Reasons for dit¢ontinuation Percent dLqdbution of diseontintmtions of contraceptive methods in the last flve ycars among currently marriod women by main reason for discontinuation, according to specific methods. Vietnam 1997 i Method Main reason Periodic ¢~" ~;~"~;""~'+'~ Pill IUD Condom abstinence Withdrawal Total = 21.3 15.1 31.3 39.0 39.4 26.0 nant 17.[ 30.2 24.8 28.7 25.6 27.1 3.3 0.6 3.3 0.5 3,8 1.9 16.4 28.9 5.6 0.3 0.0 14.7 I5.0 12.0 2.0 0,6 1.4 7.3 1.9 0.0 0.0 0.0 0.0 0.2 J 3.9 4.0 I0.6 21.5 23.8 I 1.4 8.0 0.2 14.4 0.3 1.9 3. I 0.6 l.O 1.3 0.2 0.0 0.7 Cost 0.4 0.0 0.9 0.0 0.0 0.2 Menopause 2.6 1.6 0.4 5.0 1.8 2.1 Marital dissolution 0.0 0.3 0.0 0.0 0.0 O. I Other 9.6 5.8 4.8 4.0 2.3 5.2 Don't know 0.0 0.3 0,6 0.0 0.0 0.2 Total I00.0 1013.0 100.0 tO0.0 Number of discontinuations 188 835 238 252 ' Includes discontinued se~mants of use of in, iectables (12), vaginal methods ( t ) and lblk methods (4) 100.0 100.0 421 1,951 Figure 4.2 Reasons for Discontinuing Use of Family Planning Methods, Vietnam 1997 More eeect~e nmhod 11% e, . . . . e pregr~nt .>6% Desire to become pregnant 27% HeaRh ~n~ems 7% Side effects 15% 3ther 14% 50 4.9 Nonuse of Contraception Intentions Regarding Future Use To obtain information about future use o f contraception, currently married women who were not using contraception at the time of the survey were asked about their interest in using family planning methods in the future. Table 4.12 presents the distribution of currently married nonusers by their intention to use in the future according to the number of living children. Fifty-seven percent o f currently married nonusers said that they intended to use family planning in the future: 40 percent within the next 12 months, 15 percent sometime after 12 months, and 3 percent unsure about when. Eight percent o f nonusers indicated they were unsure about using contraception at all in the future and 35 percent indicated that did not intend to use in the future. Among nonusers, the t iming o f intended use varies with the number of living children; nonusers with no children are much less likely than nonusers with children to express an intetation to use within the next 12 months. Table 4.12 Future use of contraception Percent distribution of currently married women who are not currently using any contraceptive method by intention to use in the future, according to number of living children. Vietnam 1997 Number of living ch i ld ren ~ Future intention 0 I 2 3 4+ Total Intend to use in next 12 months 5.5 48.3 58.3 47.7 24.8 39.8 Intend to use later 26.5 18.2 17.2 10.4 4.2 14.7 Unsure about timing 5.9 5.1 1.9 1.4 0.5 2.9 Unsure about use 18.4 9.2 3.8 1.9 6.5 7.5 Does not intend to use 43.7 19.2 18.8 38.2 64.0 35.1 Missing 0.0 0.0 0.0 0.3 0.0 0.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 160 377 298 174 310 1.319 Includes currcnt pregnancy Reasons for Nonuse The reasons women do not intend to use family planning are o f particular interest to family planning program managers. In the VNDHS-I I , currently married women who were not using contraception and who said that they did not intend to use in the future were asked the main reason they did not intend to use family planning. Table 4.13 shows the results. The primary reasons womeu gave for not intetading to use a contraceptive method were that they wanted more children (25 percent), or that they were menopausal or had had a hysterectomy (25 percent). Other often-mentioned reasons inclnded infrequent sex (15 percent), health concerns (11 percent) and difficulty in becoming pregnant- - i .e , subfecuud or infecund (7 percent). Relatively few women (1 percent) mentioned their husband's opposition to family planning as the main reason they did not intend to use contraception. 51 There are significant differences in the answers given by women under age 30 and those age 30 and over. Nonusers under age 30' a,re more likely than older nonusers to mention the desire to have more children (76 percent and 15 percent, respectively), while infrequent sex is rnentioned more by older nonusers than by younger nonusers (18 percent and 4 percent, respectively). The lack of need for contraception because a woman is menopausal or has had a hysterectomy was a reason given almost exclusively by older women. rablc 4.13 Reasons tbr not using contraception Percent distribution of currently married women who arc not using a contraceptive method and who do not intend Io use a method in the linure by main reason for not intending to use. according to age. Vietnam 1997 Main reason Ibr not inlcnding to use conlraccption Age <30 30+ Total lnl?cqucnl sex 3.9 17.7 15.4 Menopausal~hysterectomy 0,0 30. I 24.9 %ubfectmd. ini~cmld 1.6 g.4 7.2 Wanls more children 76,0 14.5 25.0 Respondcnl opposed 1.3 0.4 0.5 I lusband opposed 4.2 0.5 1.2 Others opposed 2.4 0.5 0.8 Religious prohibition 1.2 0.0 0.2 Kno~t no method 0.0 1.0 08 Know no ~;ource 0.0 0.6 0.5 I lealth concerns 5.9 12.0 10.9 Fear side cfl~:ct 0.0 3.7 3.0 Lack of access 0.0 0.2 0.2 Inconvenient 0.0 0.7 0.6 hncrfcrc ~ith body 0.0 0.8 0.6 Other 1.0 8.4 7. I Don't know 2.6 0.7 I. 1 Total I00.0 |00.0 I0(/.0 Number 80.0 384 463 Preferred Methods Method preferences among women not using contraception at the time of the survey but who intend to use in tile fnture are shown ill Table 4.14. Tile table indicates that the vast majority of women who intend to use prefer modern methods (91 percent). Given tile high level of IUD use in Vietnam, it is not surprising that over 71 percent of nonusers who intend to use in tile future reported the IUD as tbeir • ( r --t preferred method (see Fz=ure 4.9). Less tban 10 percent said they preferred to use traditional metbods: periodic abstinence (4.6 percent), withdrawal (3.1 percent), and folk metbods (0. I percent). 52 Table 4.14 ~ mcqbud of contraccotioe for future use Percent distribution of currently married women who arc not using a contractive method but intend to use in the future by preferred method, accoMin~ to wh~thvr they intend to use in the next 12 months or lat~', Vietnam 1997 Intention to use,conlncepfion in the next 12 months Use in Unenm next 12 Use after about Method months 12 months timin~ Total Pill 10.9 7.5 8.7 9.9 |UD 71.8 69. I 77.2 71.4 Condom 0.5 2. I 0.0 0.9 Injeclablcs 6.2 4.5 2.2 5.6 Fumal¢ $u~'ilization 1.7 6.0 0.0 2.7 Periodic abstinence 3,7 7.2 4.7 4.6 Withdrawal 3.6 2.4 0.0 3.1 Folk method 0.0 0.5 0.0 O. I Missing 1.6 0.6 7.1 1.6 Total 100.0 100.0 100.0 100.0 Number of women 524 193 38 756 Figure 4.3 Preferred Method Among Nonusers Who Intend to Use in the Future, Vietnam 1997 tffD 71~ ~e 5% 53 4.10 Family Planning Messages Activities to inform and educate couples about the use of contraception are an important component of the Vietnamese family planning program. The VNDHS-II obtained information on a number of aspects of women's exposure to family planning information. Table 4.15 shows the percentage of ever-married women who had heard a message about family planning on radio or television during the last few months prior to the interview. At the national level, the effort to spread family planning information through radio and television has succeeded in reaching almost nine in ten ever-married women (87 percent). Table 4.15 also indicates that the majority of ever-married women had been exposed to messages on both radio and television. Table 4.15 Exposure to family planning messages on radio and television Percent distribution of ever-married women by whether they had heard a family planning message on radio or television in the last few months prior to interview, according to selected background characteristics. Vietnam 1997 . a Radio Radio TV Background characteristic and TV only only Heard about family planning on radio or TV Number Neither Total of women Age group 15-19 57.6 12.5 7.4 . 22.5 100.0 129 20-24 64.1 7.4 9.3 19.2 " 100.0 732 25-29 681 7.6 10.5 13.8 100.0 1.016 30-34 70:7 7.1 9.4 12,8 100.0 1.197 35-39 71.2 8.9 9.2 10,7 100.0 1,134 40-44 73.4 6.6 8.6 11,4 100.0 876 45-49 71.7 5.9 8.6 13,9 100.0 581 Residence Urban 81.0 1.3 I 1.9 5.8 100.0 1,069 Rural 67.1 8.9 8.7 15,3 100.0 4,595 Project province No 69.4 8.1 8~6 13,8 100.0 • 3.976 Yes 70.4 6.1 10.9 12.7 100.0 1,688 Region Northern Uplands 59.0 15.7 9.0 16.3 100.0 1.168 Red River Delta 81.3 2.2 13.1 3.4 100.0 1,247 North Central 76.5 7.3 10.3 5~9 100.0 681 Central Coast 72.4 8.8 4.8 14.0 100.0 599 Central Highlands 50.5 3.1 18.0 28.4 100.0 t82 Southeast 80.2 1.6 6.3 I 1.7 100.0 691 Mekong River Delta 58.8 8.7 7.4 25.I 100.0 1,097 Education No education 29.6 14.7 8.7 47. I 100.0 27l Some primary 50.4 ~ 153 7,5 26.8 100.0 1,078 Completed primary 69.2 8.2 8.5 14. I 100.0 1,665 Completed lower secondary 79.4 3.9 11.8 5.0 100.0 1,865 Completed higher secondary + 88. I 1.5 7.8 2.6 100.0 785 Total 69.7 7.5 9,3 13.5 100.0 5,664 54 There are some differertc~ !n the level of exposure to femil~ planni.a8 messages by age. Younger women (under 25) are less likely to have been exposed to broadcast medm than older women. Some 22 percent of women age 15-19 and 19 percent of women age 20-24 reported that they had neither heard a family planning message on the radio nor seen one on television, while among women age 25 and older only 11-14 percent reported no exposure to messages via the broadcast media. There were virtually no differences in exposure to family planning messages between women in project provinces end non-project provinces. Among regions, the proportion of ever-married women who had been exposed to a family planning message during the months before the interview varied from a high of 97 percent in the Red River Delta and 94 percent in the North Central regions to 75 percent in the Mekong River Delta and 72 percent in the Central Highlands regions. Exposure to family planning messages was strongly correlated with educational attainment. Only 53 percent of women with no education reported hearing a family planning message on radio or television, whereas 97 percent of" women with completed higher secondary education had heard a message. Fi~lure 4.4 Exposure to Family Planning Messages on Radio and Television by Region, Vietnam 1997 100 80 80 40 20 Peme~ Nonhem Red River North Central Centm~ So.beast Mekong Coast ~gh~nds River Delta 55 Women were also asked whether or not they considered it acceptable for family planning information to be provided on radio or television. Table 4.16 indicates that 92 percent of the women said that these messages were acceptable. Ambivalence (unsure) was more common among younger women, women in rural areas, women in the Central Highlands, Mekong River Delta, and Northern Uplands regions, and women with little education, regarding the acceptability of broadcasting family planning messages on radio and television. Table 4.16 Acceptability of media mes~ges on family planning Percentage of ever-married women who believe that it is acceptable to have messages about family planning on radio and television, by age and selected background characteristics, Vietnam 1997 Acceptability, of media message Number Not of Background characteristic acceptable Acceptable Unsure Total women Age group 15-19 4.2 85.0 10.8 100.0 129 20-24 0.7 89.7 9.6 100.0 732 25°29 I.I 92.5 6.4 100.0 1,016 30-34 0.5 93.4 6. I 100.0 I. 197 35-39 0.6 94.3 5.1 100.0 1,134 40-44 0.5 92.0 7.5 100.0 876 45-49 0.1 90.8 9. I 100.0 58 I Residence Urban 0.4 96.8 2.8 100.0 1.069 Rural 0.7 91.2 8.0 100.0 4.595 Project province No 0.9 92.2 6.9 100.0 3,976 Yes 0.1 92.4 7.5 100.0 1.688 Region Northern Uplands 1.7 88.7 9.5 100.0 I, 168 Red River Delta 0.2 97.7 2.2 100.0 1,247 North Central 0.0 96.5 3.5 100.0 68 I Central Coast O. l 95.8 4. | | 00.0 599 Central Highlands 0.2 8 I. I 18.7 100.0 182 Southeast 0.9 92.6 6.5 100.0 691 Mekong River Delta 0.8 87.0 12.2 100.0 1.097 Education No education 1.3 70.2 28.5 100.0 271 Some primary 2.2 82.7 15.2 100.0 | ,078 Completed primary 0.4 92.8 6.8 100.0 1,665 Completed lower secondary 0.2 97.6 2.2 100.0 1.865 Completed higher secondary + 0. I 99.4 0.5 100.0 785 Total 0.7 92.3 7. I 100.0 5.664 Women were also asked if they had read about poster, or leaflet during the last few months before the presented in Table 4.17. family planning in a newspaper, magazine, interview. Responses to these questions are Few women receive information about family planning through the print media. Overall, only 37 percent of women said that they bad read about family planning: 25 percent through newspapers or magazines, 23 percent through posters, and 9 percent through leaflets. As expected, women in rural areas were less likely to have read messages on family planning than urban women (31 and 62 percent, respectively). 56 Table 4.17 Exposure to lamilv planning messaaes in print media Percentage of ever-married women who have received a message about family planning in the print media in the last few months prior to the interview, by type of print media and selected background characteristics, Vietnam 1997 Any Number print media Newspaper/ LeafletJ of []ackground characteristic source magazine Poster brochure women Age group 15-19 25.8 I 1.6 16.0 6.4 129 20-24 32.1 19.9 2 I.I 8.4 732 25-29 33.9 22.6 21.0 8.6 1.016 30-34 40.6 26.2 24.9 I 1.0 I. 197 35-39 38.8 28.7 22.4 8.6 1.134 40-44 40.7 27.6 25.0 10,9 876 45-49 34. I 25.0 22.4 9.0 58 I Residence Urban 62.2 52.4 38.8 14.3 1.069 Rural 3 I.I 18.6 19.1 8.3 4.595 Project province No 37.8 25.3 23.7 10.3 3.976 Yes 35.1 24.4 20.7 7.3 1.688 Region Northern Uplands 42.2 23.5 27. I 14.7 1.168 Red River Delta 59.4 36.4 43.3 15.6 1,247 North Central 20.5 17.5 5.3 2.4 681 Central Coast 211.1 17.4 7.9 3.8 599 Central Highlands 24.2 2 I. I 14.4 8.7 182 Southeast 45.8 38.4 24.5 7.3 691 Mckong River Delta 21.9 14.8 14.1 5.6 1.097 Education No education 3.8 0.2 3.6 0.9 271 Some primary 14.9 6.1 9.8 2.3 1.078 CompleIed primary 27.9 17.5 16.2 7.1 1.665 Completed lower secondary 47.9 30.6 29.7 12.4 1.865 Completed higher secondary, + 71.9 62.2 44.7 20.2 785 Total 37.0 25,0 22.8 9.4 5,664 4.11 Family Planning Outreach Activities Visits by family planning fieldworkers from the Vietnamese Family Planning Program to nonusers are an important outreach activity. Additionally, when women visit health facilities the staff there should inform them about the benefits of family planning and the methods available through the Vietnamese program. Failure to do so represents a missed opportunity to provide services to potential users of contraception. Overall. 20 percent of nonusers reported being visited by a family planning fieldworker in the last 12 months (Table 4.18). Another 13 percent were not visited by a fieldworker but reported visit ing a health facility where they were told about the benefits of family planning. However, two-thirds of nonusers have neither received a visit from a fieldworker nor been informed about family planning by health facility staff in the last year (67 percent). 57 Table 4,18 Cot~taet ofnonusers;vith family planning providers Percent distribution of currently married nonusers by whether the), were visited by a family planning worker or spoke with a health facilit) staff member about family planning methods during the 12 months prior to interview, according to selected background characteristics, Vietnam 1997 Background characteristic Visited by lhmily plannhtg worker Not visited by family planning worker No l~nlily Visited health facilil-~ Visited health laeiIitv planning Did not Did not Did not Did not services or Discussed discuss visit Discussed discuss visit inlbrma- Number family family health Ihmily family heahh tion of planning plannin l~tci l ity planning plannin I~cilily provided Total women g g Age group 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Project province No Yes Region Nonhero. Uplands Red River Delta North Central Central Coast Central Highlands Southeast Mekong River Delta Education No education Some primary Completed primary Cot'apleted lower seeondat 3' Completed higher secondary + 4.8 1.7 I.I 6.2 16.g 69.5 16.3 100.0 105 9.9 2.11 4.0 16.8 19.3 48.1 67.4 100.0 322 9.0 4.9 10.6 16.1 21.0 38.5 59.4 100.0 262 12.6 2.2 9.7 5.2 16.1 44.1 60.2 100.1) 178 85 5.4 12.9 17.7 7.8 47,6 55.4 100.0 128 5.8 2.1 8,5 6,7 7,0 70.0 76,9 t0(L0 140 5.5 I).9 12.8 6.6 6.5 67.7 74.2 100.11 183 7.3 5.1 14.1 I 1.2 16.6 45.7 62.3 100.0 2116 8.7 2.3 7.4 13.6 14.4 53.6 68.0 100.11 I.I 12 9.0 2.8 8.2 12.5 14.8 52.6 67.5 100.0 951 7.0 2.7 9.1 15.0 14.6 51.6 66.2 100.0 368 11.9 1.8 3,7 10.6 18.1 54.0 72.1 100.0 322 10.5 3.9 7.9 13.0 24.6 40.2 64.7 100.0 2011 12.6 {I.5 4.3 211.0 12.1 50.4 62.5 100./I 128 2.2 1.7 9.8 10.2 14.6 61.4 76.1 100.0 167 3.2 39 22.9 20.7 3.2 46, I 49.3 100.0 62 9.7 4.9 8.7 21.7 7.9 47.1 55.0 1011.11 163 3.4 3.4 12.0 8.2 11.9 59.11 70.9 I 1)11.0 276 4.2 2.7 7.3 12.2 12.I 61.5 73.5 100.0 119 6.7 2.1 I1.1 11.6 9.1 59.3 68.5 100.0 310 7.8 2.7 7.4 I4.6 15.8 51.7 67.5 100.0 439 9.0 2.2 6.3 11.7 20,2 50.6 70,8 100.11 316 17.3 6.0 I 1.7 I6.5 14.3 34.3 48.6 I000 I35 Total 8.5 2.8 8.4 13.2 14.8 52.3 67.1 10011 1.319 The data indicate that there is a large pool of nonusers who have not been recently contacted by either family planning fieldworkers or heath facility staff. Moreover, most of these women did not visit a health facility during tile past year so the primary means 'of reaching them is through outreach efforts by family planning fieldworkers. However, those workers have contacted only one in five nonusers in tile past year. If the nonusers who are not being contacted are primarily womet~ who do not want or need contraception (e.g., young women trying to become pregnant or older menopausal women), tile failure of fieldworkers to contact nonusers might be understandable, but that does not appear to be the case. In all age groups, less than 27 percent of nonusers were visited by' a family planning fieldworker. Tile data suggest a need for greater effort by tbe outreach component of the family planning program. 58 4.12 Attitudes toward Family Planning among Couples All currently married women who knew a method of contraception and who were not sterilized were asked how often they talked with their husband about family planning in the past year. These women were also asked whether they approved or disapproved of the use of family planning and their perception about their husband's attitude toward family planning. Table 4.19 indicates that 80 percent reported discussing family planning with their spouse---50 percent on one or two occasions and 30 percent more frequently. Only one woman in five (20 percent) said she had not discussed the topic with her husband in the previous year. Two age groups of women were less likely to have discussed family planning with their husband than other women: the youngest and the oldest age groups (women age 15-19 and 45-49). Tahle 4.19 I)iscussion of thmilv plannintt with husband Percent distribution of currently married non-sterilized women who know a contraceptive method by the number of times they discussed IhmiJy planning with their husband in the past year. according to current age. Viemam 1997 Discussed family plannin~ witb husband Once or More than Nurnhcr Age group Never iwic¢ tx~ice Total O 1" ~,~, ~,) a le n 15-19 38.0 44.7 17.3 100.0 125 20-24 22.3 46.2 31.6 100.0 699 25-29 17.4 52.7 29.8 100.0 956 30-34 13.8 51.5 34.7 100.0 1,05 I 35-39 17.5 5(I.3 32.2 100.0 964 40-44 22.2 49.9 28.(I 100.0 68 I 45-49 31.7 45.7 22.5 100.0 439 Total 19.8 49.8 30.3 100.0 4.915 A positive altitude toward family planning is one of the prerequisites for the successful use of contraception. Data on respondents' attitudes and respondents' perceptions of their partner's attitude toward family planning are shown in Table 4.20. Overall, the data indicate a high degree of approval of family planning among Vietnamese couples. According to women, in 94 percent of couples both the wife and her husband approve of family planning. In only 2 percent of couples do either one partner or both partners disapprove of family planning. Because of the high level of approval of family planning by both husbands and wives, there is little room for variation by respondents' background characteristics. Nevertheless, it is worth noting that there is a positive correlation between approval by both spouses and respondents' education. Joint approval was reported by 83 percent of women with 11o education and by 98 percent of women who had completed higher secondary school. 59 Table 4.20 Attitudes of couples to,.~ard family planning Percent distribution of currently married non-sterilized women who know a contraceptive method by wife's attitude toward family planning and wife's perception of her husband's attitude toward family planning, according to selected background characteristics, Vietnam 1997 Wile Wife approves Wife disapproves unsure of Hus- Hus- Hus- her attitude band band's band's Both toward Both disap- attitude Husband attitude disap- tamily Background characteristic approve proves unknown approves unknown prove planning fotal Age group 15-19 84.9 0.0 6.9 1.7 1.2 0.8 4.4 100.0 20-24 90.7 0.6 3.3 0.2 0.6 0.0 4.6 100.0 25-29 . 95.3 0.5 1.6 0.1 0.4 0.4 1.8 100.0 30-34 95.9 0.4 1.3 0.3 0.2 0.2 1.8 100.0 35-39 94.0 1.5 1.7 0.5 0.5 0.3 1.5 100.0 40-44 94. I 0.7 2. I 0.2 0.3 0.1 2.5 100.0 45-49 90.0 1. I 2.4 0. I 0.4 0.0 6.0 100.0 Residence Urban 95.2 0.7 1.9 0.1 0.5 0. I 1.5 100.0 Rural 93.2 0.8 2.1 0.3 0.4 0.2 2.9 100.0 Project province No 93.6 0.8 2.1 0.2 0.4 0.2 2.7 I00.0 Yes 93.5 0.6 2. I 0.6 0.4 0.1 2.6 100.0 Region Northern Uplands 95.2 0.7 2.4 0.4 0.0 0.3 I. I 100.0 Red River Delta 95.8 0.3 2.7 0.I 0.1 0.0 1.0 100.0 North Central 97.7 1.5 0.6 0.1 0.0 0. I 0.0 100.0 Central Coast 95.6 0.6 2.0 0.0 0.2 0.2 1.4 100.0 Central Highlands 87. I 0.6 1.3 1.0 2.0 1.3 6.7 100.0 Southeast 92.6 0.5 2.0 0.I 0.5 0.3 3.9 I(10.0 Mekong River Delta 87.2 1. I 2.1 0.6 1.4 0.2 7.5 I00.0 Education No education 82.5 1.7 2.8 0.6 1.5 2.6 8.2 100.0 Some primary 89.0 0.9 2.7 0.3 0.6 0. I 6.4 100.(I Completed primary 92.9 0.8 2.5 0.4 0.5 0.1 2.8 100.0 Completed lower secondary 96.1 0.7 1.9 0.1 0.2 0.2 0.7 100.0 Completed higher secondary + 98.3 0.2 0.6 0.2 0. I t).0 0.6 100.0 Total 93.6 0.7 2. I 0.3 0.4 0.2 2.7 100.0 4.13 Abortion and Menstrual Regulation Chi ldbear ing can be regulated by de l iberate pregnancy terminat ion as we l l as by contracept ion. In V ie tnam, pregnancy terminat ion is legal and ava i lab le at both publ ic and pr ivate heal th faci l i t ies. Two procedures are used for pregnancy terminat ion : menstrua l regulat ion (vacuum asp i rat ion) for pregnanc ies with in f ive weeks o f concept ion, and abort ion (d i lat ion and curet tage) for p regnanc ies up to 12 weeks durat ion and somet imes longer. In format ion on pregnancy terminat ion was co l lected in the reproduct ive sect ion o f the VNDHS- II quest ionnaire . ' A word o f caut ion is in o rder concern ing the completeness o f the data. Internat ional exper ience wi th the co l lect ion o f data on de l iberate pregnancy terminat ion in housebo ld surveys is poor. Survey eligibil ity was limited to ever-married women. The omission of never-married women from the survey is not a serious concern for the calculation of fertility rates because relatively few births occur among never-married women. However, this is not the case when calculating abortion rates where it is estimated that about 10 percent of pregnancy terminations occur among never-married women. 60 ¸ Seriously defective data is virtually guaranteed for countries where pregnancy termination is illegal or where social stigma is attached to its use. While the practice of terminating unwanted pregnancies is legal and widely practiced in Vietnam, reporting of these events appears to have been seriously underreported in previous household surveys (GSO, 1996a and NCPFP and GTZ, 1995). These conclusions are based on a comparison between data from the surveys and data from the Ministry of Health. Rates of Pregnancy Termination The lifetime experience of ever-married women with pregnancy termination is shown in Table 4.21. Overall, 15 percent of women reported experience with pregnancy termination: 7 percent with abortion and 9 percent with menstrual regulation. These findings are similar to those of the ICDS-94 where 13 percent of ever-married women reported experience with pregnancy termination. Table 4,21 Lifetime experience with pregnancy termination Percentage of ever-married women who have had at least one pregnancy termination (menstrual regulation or abortion) and the mean number of pregnancy terminations by type and selected background characteristics. Vietnam 1997 Menstrual regulation Abortion Total Percent Mean number Percent Mean number Percent Mean number reporting among women reporting among women reporting among women at least with at least at least with at least at least with at least Background characteristic one event I one event one event I one event one event I one event Age group <20 2.1 1,7 0.3 1.0 2.4 1.6 20 -24 3.9 1.2 2.7 1.2 6.6 1.2 25-34 9.3 1.5 5,6 1.3 14.5 1.5 35 + 10.3 1.4 9.5 1.4 18.0 1.6 Residence Urban 12.5 1.4 6.8 1.3 17.8 1,5 Rural 7.8 1.5 6.8 1.4 13.8 1.5 Project province No 8.7 1.4 6.2 1.3 14.1 1.5 Yes 8.7 1.6 8.1 1.3 15.6 1.6 Region Northern Uplands 13.6 1.6 12.3 1.3 24.1 1.6 Red River Delta t 3.2 1.5 9.6 1.4 21.4 1.6 North Central 2.2 t.2 6. I 1.3 7.5 1.4 Central Coast 0.3 1.0 1.8 I. I 2.1 I. 1 Central Highlands 3.5 I. I 3.5 1.0 6.6 I. I Southeast 8.6 1.3 6.3 1.3 13.2 1.4 Mekdl'Rg River Delta 8.0 1.4 2.4 1.2 9.9 1.4 Education • No education 1.9 | .3 3.9 | .3 5.5 1.32 Some primary 6.6 1.5 4. I I. 1 10.4 1.4 Completed primary 7.2 1.4 5.7 1.4 11.9 1.5 Completed lower secondary 9.9 1.5 8.6 1.4 17.5 1.5 Completed higher secondary + 14.3 1.4 9.3 1.3 22.1 1.5 Total 8.7 1.5 6.8 1.3 14.5 1.5 A few respondents reported having experience with both menstrual regulation and abortion. Thus. the sum ofth¢ percentage of women having experience with these two types of pregnancy termination exceeds the percentage of women having experience with either type of event, 61 An evaluation of the ICDS-94 pregnancy termination data, based on comparison with MOH data, suggests underreporting by a factor of five (GSO, 1996a). While it is possible that events are overreported in the MOH system, it seems unlikely that the degree of overreporting Fs anything close to a factor of five. The more likely conclusion is one of considerable underreporting of events in both the ICDS-94 and VNDHS-II. There is also the possibility of differential underreporting of events between population subgroups in these surveys. Table 4.21 indicates that the percentage of ever-married women reporting experience with pregnancy termination increases with age and level of education. There are substantial differences by region with the highest percentages being reported especially in the Northern Uplands (24 percent) and Red River Delta (21 percent); also in the Southeast (13 percent) and Mekong River Delta regions (10 percent). Differences by residence are not large but the rate for urban areas (18 percent) exceeds that for rural areas (14 percent). Table 4.22 presents at~rtion rates for the five-year calendar period immediately preceding the survey, i.e., 1992-96. These are total abortion rates (TAR) and they are based on reporting of both menstrual regulation and abortion. The TAR is interpreted as the number of pregnancy terminations a woman would have in her lifetime at the observed age-specific rates in the period 1992-96.: The age- specific rates are all women rates and, as was the case with fertility rates, are derived by inflating the respondents to the women questionnaire (ever-married women) by a factor which compensates for never married women. Table 4.22 Abortion rates by background characteristics Total abortion rates for the five-year period 1992-96 and the mean number of pregnancy terminations among women age 40-49, by selected background characteristics, Vietnam 1997 Mean Total numberof abortion terminations Background characteristic rate~ (women 40-49) Residence Urban .37 .27 Rural .59 .20 'Project province No .49 .20 Yes .67 .25 Region Northern Uplands 1.14 .34 Red River Delta ,g7 .36 North Central .29 .16 Central Coast .02 .04 Central Highlands .21 .07 Southeast .30 .13 Mekong River Delta .2g .14 Education No education .17 .06 Some primary .37 .09 Completed primary .56 ,21 Completed lower secondary .65 .32 Completed higher secondary + .66 .30 Total .54 .22 4 Women 15-49 years. Includes both menstrual regulation and abortion. 2 Total abortion rates are analogous to total fertility rates and are calculated from age-specific rates of pregnancy termination in the same manner as total fertility rates are calculated from age-specific rates. 62 The TAR for Vietnam from VNDHS-II is 0.5 pregnancy terminations per woman which is well below the estimated TAR of 2.5 per woman for 1992 based on MOH data (Goodkind, 1994). Thus, these rates appear to suffer from underreporting to a degree similar to that o f rates for lifetime experience with pregnancy termination. Nevertlteless, Table 4.22 indicates that, in general, the differentials in the TAR occupy the same rank order as tbe differentials in Table 4.21, except in tbe case of residence. For . residence, there is a reversal o f rank order with the TAR for urban areas (0.4 per woman) being less than that for rural areas (0.6 per woman).' Use o f Contracept ion before Pregnancy Terminat ion Additional questions were included in the VNDHS-II for pregnancy terminations occurring in the tln'ee )'ears immediately preceding the survey. These questions concerned tire desired status of tire pregnancy at tbe time of conception, whether contraception was used at that time, wbether there were any health problems following the termination and, if so, whetlter in-patient medical treatment was required. Table 4.23 indicates that half (50 percent) of pregnancy terminations occurred among women wbo were using contraception at the time of becoming pregnant. The percentage is approximately the same for terminations by menstrual regulation (52 percent) and by abortion (48 percent). About one-third of all pregnancy terminations occurred among women using one of the following three methods of contraception: the condom (9 percent), periodic abstinence (9 percent), and withdrawal (16 percent). It appears clear that more diligence in the use of these metbods, or the use of more reliable methods of contraception, would reduce the need for pregnancy termination. Table 4.23 Use ofcontraccplion prior to preenancv termination I)CI'CCII[ distribtttion ol'prcgtlallcy terminations (ll"letlslrtt,ql regulation or abortioll) among ~nmcn who ~erc tlsJllg a contraceptive method by type of nlcthnd. according Io type of pregnancy termination. Vietnam 1997 fypa of pregnancy tern'linalion Menstrual Conlraccp/ivc moored regulation Aborlloti 'l'olal No contraception 51.9 47.9 50.4 Any contraceptive method 48.1 52. I 49.6 Any modern method 2 I. I 30.0 24.4 Pill 2.5 5.1 3.5 IUD 10.1 13.6 I 1.4 Diaphragm/Ibam/jelly 0.0 1.0 0.4 Condom 8.5 10.4 9.2 Traditional method 27.0 22.0 25.2 Periodic abstinence 10.5 7.0 9. I Withdrawal I 6.5 15.1 15.8 Total 100.0 100.0 I t)t).0 Number of women 252 148 400 This reversal is due to two factors, a sharper increase in abortions in rural areas than in urban areas in the recent past and fewer never-married women in rural areas than in urban areas. The latter factor means that in deriving the total number of women (for use in estimating age-specific rates) from ever-married women, urban ever-married women are multiplied by a larger conversion factor to compensate for the gremer percentage of never-married women as a result of later marriage in urban areas. 63 Complications and Treatment Table 4.24 indicates that about one-third of women reported having a heath problem following a pregnancy termination. Approximately half of these women sought medical advice or treatrnent and 2 percent were admitted to a health facility for treatment. The mean duration of the in-patient stay for these women was 10 days. As expected, fewer complications were associated with menstrual regulation than with abortion. Table 4.24 Health problems and treatment li)[Io',vinn prcenancv termination Percentage of pregnancy terminations follov, cd by health problems and tile percentage lbr which in-patient rnedical treatrnent was received. Vietnam 1997 Type of pregnancy I leallh problem termination and treatment Menstrual Total regulation Abortion tlealth problem rcporled 28.8 Sought medical advice or Ireatmcnt 14.4 Received in-patient treatment 0.5 Mean duration of in-patient treatment (days) 5.0 Number of pregnancy tcrrninations 157 4(~.7 33.3 20.4 16.8 4.7 2.4 10.3 I0.0 259 416 64 CHAPTER5 PROXIMATE DETERMINANTS OF FERTILITY In many societies, marriage signals the onset of womea's exposure to the risk of childbearing: postpartum amenorrhea and sexual abstinence affect the intervals between births: and the onset of menopause marks the end of women's reproductive years. These factors are important for tmderstanding fertility, since they determine the length and pace of reproductive activity. This chapter provides measures of these proximate determinants of fertility. Questions pertaining to the proximate determinants of fertility were included in the Women's Questionnaire, which was administered to all ever-married women age 15-49. However, in this chapter, a number of tables are based on all women, that is, they include both ever-married and never-married women. In constructing tbese tables, the denominators bave been expanded to represent all women by multiplying the number of ever-married women by an inflation factor equal to the ratio of all women to ever-married women reported in the Household Questionnaire. The inflation factors are calculated by single year of age, either for the population as a whole or, in cases where the results are presented by background characteristics, separately for each category of the characteristic in question. 5.1 Marital Status Table 5.1 shows the distribution of all women age 15-49 by marital status. The data indicate that one ill three women of reproductive age fias never been married, 63 percent are currently married, 2 percent are widowed and 2 percent are divorced or not living together. Although marriage is universal in Vietnam, the proportion never married declines sharply from 92 percent among women age 15-19 to 47 percent among women age 20-24 and further to 2I percent among women age 25-29. After age 30, the proportion never married is around 10 percent. Tbe most important cause of marital dissolution is widowhood, with the proportion widowed rising steadily with age from less than I percent among women under age 30 to 8 percent among women age 45-49 (Table 5.1). Divorce and separation also rise witb age, although tbe percentage separated by age 45-49 is less than half the percentage divorced, Table 5.1 Current marital status Percent distribution of women by current marital status, according to age. Vietnam 1997 Marital status Never Nttfnbcr of Age married Married Widowed Divorced Separated Total ~omen 15-19 92.3 7.7 0.0 0.0 0.0 100.0 1,661 20-24 46.9 52.0 0.2 0.4 0.5 100.0 1.377 25-29 2 l.I 76.7 0.6 I.I 0.5 100.0 1.288 30-34 10.9 85.8 1. I 1.2 0.9 100.0 1,343 35-39 8.7 85.9 2. I 2.3 0.9 100.0 1.243 40-44 8.3 82.2 5.6 2.5 1.4 100.0 955 45-49 9.9 77.8 8.0 3.1 1.2 100.0 645 Total 33.5 62.7 1.8 1.3 0.7 | 00.0 8.51 ] 65 Data from the 1989 census and various demographic surveys conducted in Vietnam show a general increase in the proportion of never-married women over the last 10 years (Table 5.2). This is especially obvious in the oldest age group, women 45-49. In 1988, only I percent of women in this age group remained unmarried compared with 10 percent in 1997. Table 5.2 Never-married women Percentage of ~oinen who have never married, according to age. Vietnam 1988-1997 Age group VNDI IS-I 1989 census SPCFP-93 ICDS-94 VNDHS-II 15-19 95.3 89.1 90.2 91.4 92.3 20-24 47.8 43.1 50.9 46.3 46.9 25-29 I5.2 18.0 21.1 20.4 21.1 30-34 8.4 I 1.2 7.6 10.5 10.9 35-39 6.5 8.9 3.3 9.1 8.7 40-44 4.0 6.0 1.8 6.9 8.3 45-49 1.3 3.5 1.2 6.4 9.9 Source: Reproductive llealth Surve), 1995 (NCPFP aod GTZ. 1995:76, ]'able VI-2 recalculated) 5.2 Age at Mar r iage In most cases, marriage marks the point in a woman's life at wbich cllildbearing commences. Early age at marriage often implies early age at childbearing and bigher fertility since women who marry early will have, on average, longer exposure to the risk of pregnancy. In the VNDHS-II, information on marriage was obtained by asking women the month and year (or age, if year was noi known) when they started living together with their husband (or first husband, in the case of women married more than once). Table 5.3 shows the median age at first marriage, wbich represents tbe exact age by which half of the women in a specific age cohort are married. In contrast to tile pattern seen in many countries, the median age at first marriage in Vietnam has not risen over the last 25 years. Instead, the median age has been stable at about 21 years for age cohorts 25-29 through 40-44. Tile recent history of Vietnam may Table 5.3 Age at first marriae_e Pcrccntage o f women age 15-49 v, ho were lirst married by exact age 15. 18. 2(I, current age. Vietnam 1997 22. and 25, and median age at lirst marriage, b,,' Percentage of wonlell who were lirst married by exact age: Current age 15 18 20 22 25 Percent Nunlbcr Median age never of at first married women marr iage 15-19 0.5 NA NA NA N A 92.3 1.661 a 20-24 0.9 12.4 35.9 NA NA 46.9 1.377 a 25-29 1.9 14.3 37,7 58,9 73.9 2 I. I 1.288 21,0 30-34 13 14.7 34,8 57,6 76.9 I O9 1.343 21.3 35-39 1.0 14. I 34.9 56.5 77.0 87 1.243 21.3 40-44 1.3 13.2 346 57,7 77.6 8.3 955 21.4 45-49 1.2 11 7 32.5 52.7 748 9.9 645 21.7 20-49 1.3 13.5 35.3 55.4 71.5 19,2 6.85(I a 25-49 1.4 13.8 35,2 57, I 76. t 12.2 5.474 21.3 NA = Not applicable " Omitted because Dss than 5[) percent o f the :',omen in the age group x to x+4 ,.,. ere first married by age x 66 explain this pattern. The long period of war which ended in 1975 may have disrupted the marriage prospects of older women who were in the prime marriage ages during this period. For the same reason, there may have been relatively fewer men to marry during this period. Alternatively, in the years following the war, the availability of more men of marriageable age and improved economic conditions may have contributed to the increasing numbers ofwomeu marrying at yotmger ages. The median age at first marriage by selected background characteristics is shown in Table 5.4. The almost 3-year difference in age at marriage by urban-rural residence is more pronounced among younger women than older women. The median age at marriage for urban women age 25-29 is 23.7 years compared with 20.5 years for their rural counterparts. There is no difference in the median age at marriage between proiect and non-project provinces; however, women residing in the Southeast region are more likely to marry la tHt least two years later than women residing in the Mekong River Delta and the Northern Uplands regions. Table 5.4 Median a,ee at first marr a~e Median a~c at first marriage among women age 25-49 bears, by current age and selected background characteristics. Viemam 1997 Current a~e Background characteristic 25-29 30-34 35-39 40-44 45-49 Median Ior woIv len 25-49 Residence Urban 23.7 23.7 23.4 23.9 22.7 23.5 P, ural 20.5 20.8 20,9 20.8 21.3 20.8 Project province No 21.1 21.2 21.3 21.5 21.6 21.3 Yes 20.8 21.5 21.4 21.1 21.9 21.3 Region Northern Uplands 19.2 19.9 20.8 21.1 22.2 20,3 Red River Delta 21.2 21,7 22.2 21.4 21.7 21.6 North Central 20.8 21.4 21.0 21.7 22.2 21.3 Central Coast 21.4 21.2 21.7 214 21.1 2L4 Central I lighlands 20.8 21.7 22.4 22.5 21.4 21.9 Southeast 24.5 22.3 22.4 22.6 23.0 22.9 Mekon 9 River Delta 21.4 21.5 20.4 2fl.6 20,2 20.9 Education No education 21.6 20.5 20.5 19.3 207 20.5 Some primary 19.2 20.1 20.4 20.1 20.6 20.(I Ctmlplctcd primal' 20.5 20.8 20.5 20.5 20.8 2().6 Completed lower sccondar b' 21.1 21.3 21.3 21.8 22.1 21.5 Completed higher sccondau,+ 22,9 23,7 24.0 24.3 24.0 23.7 Total 21.0 21.3 21.3 21.4 21.7 21.3 I I Note: The i11¢dJan I~)r ~xomen age 15-19 could not he determined because some ~onlen may still j get married before reaching age 20. The median lot age 20-24 is not shox~n because less than 50 I pcrccnl of the ~Aolllcn in most of the sub-categories x~crc first married h b age 2(I. t 67 There is a strong relationship between level of education and age at first marriage. The median age at marriage for women with no formal education is 20.5 years compared with 23.7 years for women who have completed higher secondary education. 5.3 Postpartum Amenorrhea, Abstinence and Insusceptibility The risk of pregnancy is much lower during postpartum amenorrhea, that is, the interval between childbirth and the return of menstruation. The duration and intensity of breasffeeding (which delays the resumption of menstruation) affects the length of this interval, as does the length of time sexual intercourse is delayed following a birtll. Women wllo are not exposed to the risk of pregnancy, either because they are amenorrheic or are still abstaining from sex are considered insusceptible. In the VNDHS-II. questions on the duration of postpartum amenorrhea and sextml abstinence were asked of all women who Ilad a birth in the three years preceding the survey. Table 5.5 shows the percentage of births in the three-year period preceding the survey for which the mother was postpartum amenorrheic, abstaining, and insusceptible, by the number of months since the birth, Postpartum amenorrhea is substantially longer than the period of sexual abstinence and is, therefore, the principal determinant of the length of postpartum insusceptibility to pregnancy in Vietnam. The median duration of amenorrhea is 9 months, the median duration of abstinence is 3 months, and the median period of insusceptibility is 9 months. Virtually all women are insusceptible during the first two months following birth and both amenorrhea and abstinence are contributing factors. However, from the second month onwards, abstinence is less important as more and more women resume sexual relations. At g-9 months after birth, about two-thirds of women are still amenorrheic while only 5 percent are abstaining. By 16-17 months postpartum, I in 5 women is insusceptible (20 percent), largely because of amenorrhea ( 18 percent). [abl¢ 5.5 Postpartum amenorrhea, abstinence, and insusceptibililv Percentage of births in the threc years preceding the survey Ibr which mothers arc pt)stpartum anlcnorrheic, abstaining, and insusceptible, by number of months since birth, and median and )ncan durations. Vietna)n 1997 Ntlnlbef Months since birth Amenorrhcie Abslaining Insusceptible o1" birlhs <2 98.3 96.7 ] O0.D 57 2-3 75.5 69.0 90.0 87 4-5 77.0 27.5 77.9 96 6-7 64.6 12.9 69,5 95 8-9 61.7 5.1 63.7 88 10-1 ! 32.2 7.4 33.1 107 12-13 26.0 3.8 28.3 102 14-15 16.3 0.7 16.3 97 16-17 18.3 I.I 19.5 92 18-19 5.0 1.4 6.4 89 20-21 4.2 1.2 5.4 I 15 22-23 1.3 5.4 6.8 148 24-25 1.9 0.0 1.9 I 14 26-27 0.9 O0 0.9 94 28-29 2.7 2.6 5.3 102 30-31 1. I O0 I. I 122 32-33 O.O 3.4 3.4 93 34-35 0.0 1.5 1.5 109 Tota[ 23.4 10.5 25.8 1.809 Median 8,8 3.3 9.l Mean I0.0 5. I 10.9 Prevalence/Incidence rnean ~ 8.3 3.7 9.2 ~Thc prevalence-incidence mean is defined as the number of children whose mothers are amenorrheic (prevalence) divided by the average nulnbcr of births per month (incidence), 68 Postpartum insusceptibility varies lit'lie by age of mother (Table.5.6). However, rural women, women who reside in the Northern Uplands region, and women who have not completed primary education have longer periods of insusceptibility than do other women. Table 5.6 Median duration of postpartum insusceptibility bv backaround characteristics Median number of months of postpartum amenorrhea, postpartum abstinence, and postpartum insusceptibility, by selected background characteristics, Vietnam 1997 Postparttlm Postpar tum Postpartum Number Background characteristic amenorrhea abst inence Insusceptibility of births Age <30 8.7 3.1 9.0 1.173 30+ 9.(] 3.6 9.3 636 Residence Urban 4,6 2.9 5.6 260 Rural 9.3 3.3 9.5 1,549 Project province No 8.8 3.2 9.3 1.275 Yes 8.6 3.5 8.8 534 Region Northern Uplands I 1.2 3.5 I 1.2 406 Red River Delta 9.1 2.3 9. i 30 I North Central 9.7 3.2 I 0. I 245 Central Coast 9. I 2.7 9.9 245 Central Itighlands 7.5 4.2 7.5 100 Southeast 5.5 3.8 6.3 2(]2 Mekong River Delta 7.7 4.0 7.8 309 Education No education 9.8 2.6 10.2 125 Some primary 10.3 4.3 10.7 341 Completed primary 8.5 3.0 &5 596 Completed lower secondary 7,3 2.9 7.5 508 Completed higher secondary+ 6.2 3.0 6.8 239 Total 8.8 3.3 9.1 1,809 Note: Medians are based on current stains. 5.4 Termination of Exposure to Pregnancy The risk of pregnancy declines with age as increasing proportions of women become infecund or subfecund. The age at onset of infecundity is difficult to determine for an individual woman, but it can be estimated for a population. One indicator of decreasing exposure to the risk of pregnancy is menopause. In the VNDHS-II, a woman is considered menopausal i f she is neither pregnant nor postpartum amenorrheic and has not had a menstrual period in the six months prior to the survey or if she identifies herself as being menopausal. Table 5.7 shows that the proportion of women who have reached menopause increases with age from I percent of women age 30-34 to 24 percent of women age 46-47 and 42 percent of women age 48-49. 69 l 'ablc 5.7 "l'crminalion of exposure Io the risk olSprcgilanc'+ Mcllop~'lusc alnong ctlrrclilly married women age 311-49. by age. Vicmam 1997 Mcnopaus+2 ~ Age Percent Numhcr 30-34 11.8 1.153 35-39 1.4 I.I168 411-41 30 347 42-43 4.3 3116 44-45 7.8 242 46-47 24.1) 210 48-49 42.3 175 Tmal 5.5 3.5117 ii)crcciii;i~c of II(IIlo~rC~lIilll{. IlOIl- anlCilorr]lcic currcntl) IllalricL[ 'o,O]llLZll who~;c ]iIs~ illCllglr{i;i] period occurred six (~r more nlon[]lS preceding Ihe sur,.cy ~r who report Ihnl 111¢', [ire IllCIlOpaUSa]. 70 CHAPTER 6 FERTILITY PREFERENCES The VNDHS- I I included a number of questions to ascertain fertility preferences, a useftd indicator of general attitudes toward childbearing and of the possible future course of fertility. Data on fertility preferences are also usefnl for assessing the unmet need for family planning and the number of tmwanted or mistimed births in the population. The focus of this chapter is respondents" childbearing attitudes such as desire for more children in the future, ideal number of ctdldren they would like to have, and perception of the ideal number of children their husbands would like to have. Total wanted fertility rates are calculated based on desired ideal family size and birth history infon'nation. 6.1 Des i re fo r More Ch i ld ren In order to obtain information on future childbearillg intentions, currently married respondents were asked: "Would you like to have another child or would you prefer not to have any more children?" I f they did indeed want another child, they were asked: "How long would you like to wait from now before the birth of another child?" I f the WOlnan had not yet had any children, these questions were appropriately phrased, and if the woman was pregnant, she was asked about her desire for more children after the baby she was expecting. Table 6.1 presents the percent distribution of currently married women by desire for more children, according to the number of living children. Two-thirds of currently married women (66 percent) do not want any more children, I percent more than in 1994. Another 9 percent either have been sterilized or say they cannot have any more children. Among women who express a desire for another child, the majority want to delay the next birth by two or more years (16 percent): only 5 percent of currently married women want another child soon (within two years) (see Figure 6.1). Table 6, I Fcrli l itv preferences by number of living children Percent dislribulion of currently married women by desire Ibr more children, according to number of living children. Vietnam 1997 Desire Ik~r more children Nurnber of living children' 0 +1 2 3 4 5 6+ l'otat Want another soon 2 72.2 8.7 1.0 0.5 0.4 0.2 0.8 4.8 Want another later 3 16.8 64.5 6.3 2.5 t).5 0.9 0.6 16.0 Want another, undecided when 2.0 2.6 0.8 0.7 0.0 0.0 0.3 1.0 Undecided 1.7 8.3 4.5 1.5 1.3 0.4 0.6 3.6 Want no more 0.4 13.8 83.6 85.3 80.3 78.6 77.2 65.9 Sterilized 0.4 0.9 3.0 84 15.2 15.7 15.7 6.9 I)cclarcd inlbcurLd 6.4 1.4 0.7 1.0 2.3 4.0 4.7 1.8 Total 100,0 100,0 100.0 I00.0 I00.0 100.0 I00,0 I00.0 Number of women 186 1068 1582 1108 677 392 326 5340 htcludes current pregnancy " Want next biflh within two years Want to delay next birth for two or more years. 71 Figure 6.1 Fertility Preference Currently Married Women 15-49 Want no mo~ SS~ St~'ilized/Infecund Want tmoth~ undecided Undecided V~nt another child later (2+ yr) 5% 16% itnott~w chik:l ~ (<2 yr) 5% There is a close association between the number of living children and the percentage of women who want no more children. Desire for additional children decreases as the number of living children increases. Less than 1 percent of women who have not yet begun childbearing reported wanting no more children and this increases to 14 percent among women with one living child and reaches a high of 85 percent among women with three children. Not surprisingly, the desire to have a child soon is most prevalent among women who have not yet begun childbearing: 72 percent of women with no chitdren want a child soon. Among women with one child, the majority (65 percent) want to delay the next birth. Table 6.2 shows the distribution of cu~.ently married women by the desire for more children, according to current age. The proportion wanting more children decreases sharply with age. While 83 per- cent of women in the youngest cohort want more children (7 percent lower than in 1994), only a small Table 6,2 Fertiliv,, nr~ferences and ate Percent distribution of currently married women Desire for more children by desire for more children, according to age. Vietnam 1997 A~¢ o[ women 13-19 Zg-24 Z3-2 ~) 3U°34 S3-J9 4U.44 4~-49 Total Want another soo+~, t 23.2 9.8 5.6 4.2 2.7 2.5 0.5 4.8 Want another later- 59.4 52.5 25.8 9.8 3.2 0.2 0.0 16.0 Want another, undecided when 0.7 2.3 ! .8 1.0 0.3 0.2 0.2 1.0 Undecided 3.7 6,6 6.9 4. I 2. I 0.4 0.0 3.6 Want no more 13.0 28.8 57.9 72. I 8 !.6 82. I 75.5 65.9 Sterilized 0.0 0.0 2.1 8.5 9.3 12.0 10,9 6.9 Declared infecund 0.0 0.0 0. I 0.3 0.7 2.6 12.9 I.g Totat 100.0 100.0 100.0 100.0 100.0 I00.0 100.0 100.0 Number of women 129 726 988 ]153 1068 785 502 5340 Want next birth within ~vo years 2 Want to dela~ next birth for two or more ~,ears 72 fraction of those age 30 and over do. The desire to space births is concentrated among young women (under age 25). Interest in limiting childbearing increases rapidly with age, from 13 percent among women age 15-I9 to 82 percent among women age 40-44. The proportion of women who want no more children is an important measure of fertility preference. Table 6.3 presents the percentage of currently married women who want no more children by number of living children. The results indicate that urban women want to limit family size at lower parities than rural women but the difference is not marked. For example, 90 percent of urban women with two children say they do not want another child, compared with 85 percent of rural women. The proportion of married women who want no more children in Northern Vietnam - the Northern Uplands, Red River Delta, and North Central regions - ranges from 76 to 79 percent compared with less than 70 percent among women living in the remaining four regions. The data in Table 6.3 also suggest that women in the Southeast and Mekong River Delta regions start wanting to limit family size at lower parities than women in the Central Coast and Central Highlands regions. For example, about 20 percent of women with one living child in the former regions say that they do not want another child compared with about 10 percent of women in the latter regions. Table 6.3 Want no more children bv background characteristics Percentage of currently married women who want no more children by number of living selected background characteristics. Vietnam 1997 children and Living children Background characteristic 0 I 2 3 4 5 6+ Total Residence Urban 0.0 19.8 90.4 95.2 93.6 98.4 98.0 67.4 Rural I.I 12.8 85.3 93.5 95.7 94.0 92.5 74.0 Project province No I.I 15.6 86.6 93.3 94.8 95.8 93.0 72.5 Yes 0.0 12.3 86.6 94.7 97.0 90.8 92.5 73.4 Region Northern Uplands 0.0 11.9 93.9 95.7 95.8 96.7 95.0 79.4 Red River Delta 0.0 12.5 94.6 98.5 98.0 92.5 88.0 76.2 North Central 0.0 5.4 78.8 92.9 96.8 98.4 92.6 76. I Cenlral Coast 0.0 9.4 72.5 87.8 92.2 90.3 87.2 66.2 Central IIishlands 0.0 11.5 62.3 81.4 96.8 67.8 71.0 60.8 Southeast 2.3 21.8 86.4 96.1 97.0 100.0 97.3 69.3 Mekong River Delta 1.6 20.0 80.8 87.9 91.7 95.3 96.5 67.3 Education No education 6.9 18.6 74.6 77.6 82.7 80.9 86.0 67.5 Some primary 0.0 19.5 77.7 86.5 95.4 94.7 94.1 75.8 Completed prirnary 0.0 13.4 78.0 94.3 95.9 95.5 93.4 68.6 Complete lower secondary. 1.6 13.1 91.1 97.1 96.1 96.4 97.4 76.3 Completed higher secondary. + 0.0 15.2 94.2 99.2 98.7 93.3 100.0 70.9 Total 0.9 14.7 86.6 93.7 95.5 94.4 92.9 72.8 73 The absence of a definite association between level of education and the proportion wanting no more children among all women is at least partially a result of the concentration of more educated women at lower parities, where women are more likely to express a desire for more children. However, among currently married women with two or more children, there is a strong positive relationship between level of education and the percentage wanting no more children. For example, among women with two children, 94 percent of those who have completed higher secondary school want no more children, compared with 75 percent of women with no education. There has been an increase at all education levels in the number of women who want no more children. As Figure 6.2 shows, the proportion of currently married women with two children who want no more children increased substantially between 1994 and 1997 for all levels of education. 9C 70 60 5C =0 3~ 4; C, Figure 6.2 Proportion of Currently Married Women with Two Children Who Want No More Children by Level of Education, Vietnam 1994 and 1997 Peree~ 7~ 7~ I~lU ~UUC.~d LKJ~ I oorDt l I~OITI ple(~lO L, o rn p le lOo primary primary lower secondary I L,omgqeleo higher secondary+ 6.2 Need for Family Planning Services Information on fertility preferences alone is not sufficient to assess the need for family planning services. Many women wilo do not want to have another child or who want to space the next birtll are already using contraception or are not exposed to the risk of pregnancy because they are menopausal or infecund. It is possible to estimate the extent to which couples' need For family planning is being met by examining information about contraceptive practice, desire for additional children, desired timing of the next child for women who want more children, and indicators of women's fecund status. Currently married women who are fecund and who say that they do not want any more children or that they want to wait two or more years before having another child, but are not using contraception, are considered to have an umne/need ~ for family planning. Current users of'family planning methods are • ~ A more complete description of the procedure for calculating unmet need is given in Table 6.4, footnote I . 74 said to have a met need for fami ly p lann ing. The total demand for fami ly p lann ing is the sum o f the met and tmmet need for fami ly p lann ing . Tab le 6.4 shows the percentage o f current ly marr ied women wi th unn let need and met need for family planning and the total demand for family planning services by background characteristics. Only 7 percent of currently married women in Vietnam have an unmet need for family planning services. Combined with the 75 percent of currently married women who are currently using a contraceptive method, the total demand for family planning is 83 percent. It is estimated that 92 percent of the total demand for family planning is being met. "Fable 6.4 Need Ibr family plannine services F'ercent of currcralv married v~on'tcn with tunlnllet need and met need for faintly plau'trfing, and tile Iotal demand Ibr fmnily planning, by selected back~rotnid characteristics. Vietnam 1997 ~ackground cl'~araclaristic Met need Ibr Unmct need R~r famil.,, planning Total demand Ibr lamil_v planning ~ (currently using)-" lilmily phmning Percentage For For For For For For of Nufnbcr spa- limit- spa- limit- spa- limit- demand of cing ing [otnl title ing TolaI cing ing ['otal slitis fled women Age 15-19 9.(1 1.7 9.7 17.4 0.8 18.1 26.3 1.5 27.8 65.1 129 20-24 11.2 2.1 13.3 38.3 16.8 55.1 50.6 18.8 6').5 80.9 716 25-29 5.5 4.0 9.5 27.8 45.6 73.4 34.0 511.0 84.0 88.7 988 30-34 2.4 3.8 6.2 13:5 71.1 84.5 16.0 75.1 91.1 93.2 1.153 35-39 0.e, 3.7 4.3 5.5 82.5 88.0 6.3 87.3 93.6 95.4 1.068 4O°44 (I.5 4.1 4.6 (I.7 81.5 82.2 1.2 86.1 87.3 94.8 785 45-49 0.0 3. I 3. I 0.0 63.5 63.5 0.0 66.6 66.6 95.3 502 Residence Urban 2.7 3.0 5.7 22.1 57.3 79.3 25.3 60.3 85.6 93.4 997 P, ural 36 3.6 7.2 13.1 61.3 74.4 17.1 65.3 824 91.2 4.343 Project province No 3.5 3.6 7.1 15.0 59.5 74.6 18.9 63.5 82.5 91.4 3.738 Yes 3.3 3.3 6.6 14.3 62.8 77.0 17.9 66.4 84.3 92.2 1.601 Region Northern Uplands 4.7 5.3 10.1 7.4 63.6 71.0 12.8 69.0 81.7 87.7 I.I I(1 Red River Delta 1.4 2.3 3.7 15.5 67.8 83.3 17.2 70.3 87.5 95.8 1.197 North Central 3.1 2.4 5.5 12.0 68.2 80. I 15.4 71.9 874 93.7 646 Central Coast 7.0 2.5 9.5 16.5 536 70.1 23.4 57.0 8(I.4 88.2 557 Central Ilighlands 4.6 5.5 10.1 17.4 46.2 63.6 22.6 52.3 75.0 86.5 170 Southeast 3.7 3.9 7.6 19.8 54.9 746 24.0 58.7 82.7 90.9 642 Mekong R. Delta 2.5 3.5 6.0 19.3 53.6 72.8 21.9 57.4 79.3 92.5 1.017 Education No education 6.0 6.3 12.3 7.2 45.7 52.9 13.2 53.0 662 81.4 252 Some primary 4.4 5.2 9.6 10.7 58.0 68.7 15.1 63.6 78.7 87.8 990 Completed pi'imar3' 4.5 3.4 7.9 15.8 56.3 72.2 20.6 60. I 80.7 90.2 1.576 Completed k)~ er secondarv 2.2 2.4 4.5 14.4 67.7 82.1 17.1 70.5 876 94.8 1.764 ('ompletcd higher; seconda~-y + 2.2 3.0 5.2 21.3 60.9 82.2 24.3 63.9 88.3 94. I 757 '['olal ~. .~.3 6.9 14.8 60.5 73~ 18.6 64.4 8.~.0 91.6 3 .~41 t l l ln lCt n~ed I()r sp~lClll~ incltldes pregnant ~on lcn ~11os¢ preananc~ ~as IlliSli1|led. a l l l cnorrhc ic %%onion ~11os¢ lasl birlh was 11JStillled. and "~%OlllCn 'd.bo arc neJlhgr pregnant nor amcnorrheic ~md x(ho ilrc not tlSlll~ an\ nlgtho[.l Of f~lllld% lII~lllllill~ bill SII'~ dlg\ ~ant to wah two or more ~ears Ibr their ncxl bimb. Also included in unnlct need fi~r sp~cin~ arc ~omen ~ho ~ir¢ unstlrC ~qlcfllc'r the ~. ~,ant anodlcr child or M{o ~ant anolhcr child but arc unsure ~ahen I(i ]la',e the birlh. Unmct need fin limiting re1~rs Io prC~llallt '~iOlllCll whose pre~nallC'r wils unwanted, alllcnorrhcic '~onlell ~]losg Ills[ child ~as [lll%anled. ~llld "~%OlllCn xqlo arc llCJt]ler plg~llalll nor anlellorr11¢ic ilnd M~o arc IiO[ klSill~ ail~ nlelIlod of 1~inli[} pIanllillg btl[ %~ail[ no lllOre children. Excluded i'rOIll the Linnlct lleqd categor} arc illCnopaLisa] or i l l l~Cund v, onlel l . -~.Jsllc, ors]~aclnolsdcllnedas'~(l~leTl%~,hl arctlSll~S(lllel et1~,~, t ~ I \ p 1 II~ l ds lx hcx x~anttohdycdnothurcb l ldor arc undecided whether to have another. Us i i l~ 1or I l l l l l I I I l~ IS dc l lned as ~OlllC]l ~l lO i|rc [iSlll~ and ~ [l() ~ i ln t no illOrc ch i ldren. Note that the specific methods used arc not taken i'i~lo account~hcrc. 75 Unmet need is slightly higher among rural than urban women (7 and 6 percent, respectively). It is also relatively high in the mountain regions (10 percent each in the Northern Uplands and Central Highlands) compared with the plains regions (4 percent in the Red River Delta and 6 percent in the Mekong River Delta). Unmet need in the North Central region is also very low (6 percent). The three latter regions have the highest percentage of demand satisfied (96, 93, and 94 percent, respectively). There is at] inverse relationship between level of education and percentage having an tmmet need for family planning. Unmet need varies from a high o f 12 percent among women with no education to a low of 5 percent among women who have completed lower secondary school. 6.3 Ideal Family Size Another attitudinal dimension of childbearing considered in the survey is the total number of children a woman would ideally like to have, if it were entirely up to her. In the VNDHS-I I , the ideal family size (preferred number of children) for women is estimated from responses to two questions. Women who had no l iving children were asked, " I f you could choose exactly the number of children to have in your whole life, how many would that be?" For women who had children, the question was rephrased as follows: " I f you could go back to the time you did not have any children and could choose exactly the number o f children to have in your whole life, how many would that be?" Table 6.5 shows the distribution of ever-married women by ideal family size, according to the number of living children. In spite of the hypothetical nature of these two questions most wolnen were able to give a numeric response. Table 6.5 Ideal and actual number of children Percent distribution of ever-married women by ideal number or children and mean ideal number o1" children for ever-married women and currently inarricd women, according to number of living children. Victllam 1997 Number of livir~g ebildre~ ~ Ideal number of children 0 I 2 3 4 5 6+ Total 0 0.0 0.0 0. I 0.0 0.0 0.0

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