Vietnam - Demographic and Health Survey - 2003

Publication date: 2003

V ietnam D em ographic and H ealth Survey 2002 Vietnam Demographic and Health Survey 2002 National Committee for Population, Family and Children Population and Family Health Project Hanoi—September 2003 Committee for Population, Family and Children Vietnam Demographic and Health Survey 2002 September 2003 General Statistical Office ORC Macro Hanoi, Vietnam Calverton, Maryland USA This report summarizes the findings of the 2002 Vietnam Demographic and Health Survey (VNDHS) carried out by the General Statistical Office. ORC Macro provided technical assistance for the survey through the worldwide Demographic and Health Surveys program, which is designed to assist developing countries to collect data on fertility, family planning, maternal and child health, nutrition, and HIV/AIDS. Additional information about the VNDHS may be obtained from the Committee for Population, Family and Children, 12 Ngo Tat To Street, Hanoi, Vietnam (telephone 843-2351; fax 843-8514). Additional information about the MEASURE DHS+ project may be obtained by contacting: MEASURE DHS+, ORC Macro, 11785 Beltsville Drive, Suite 300, Calverton, MD 20705 (telephone 301-572-0200; fax 301-572-0999; e-mail: reports@orcmacro.com; internet: www.measuredhs.com). Suggested citation: Committee for Population, Family and Children [Vietnam], and ORC Macro. 2003. Vietnam Demographic and Health Survey 2002. Calverton, Maryland, USA: Committee for Population, Family and Children and ORC Macro. CONTENTS Page Tables and figures . vii Preface . xiii Acknowledgments . xv Summary of findings . xvii Map of Vietnam. xx CHAPTER 1 INTRODUCTION 1.1 Geography, History, and the Economy.1 1.2 Population and Family Planning Policies and Programs .2 1.3 Health Priorities and Programs.3 1.4 Objectives, Organization, and Design of the Survey.3 1.5 Data Collection and Processing.6 CHAPTER 2 CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS 2.1 Characteristics of the Household Population.7 2.2 Housing Characteristics.14 2.3 Household Durable Goods .15 2.4 Background Characteristics of Women Respondents.15 CHAPTER 3 FERTILITY 3.1 Fertility Levels and Trends.27 3.2 Children Ever Born .31 3.3 Birth Intervals .32 3.4 Age at First Birth .34 3.5 Adolescent Fertility .35 CHAPTER 4 FERTILITY REGULATION 4.1 Knowledge of Family Planning Methods.37 4.2 Ever Use of Family Planning Methods .38 4.3 Current Use of Family Planning.39 4.4 Number of Children at First Use of Contraception .42 4.5 Knowledge of the Fertile Period.43 4.6 Age at Sterilization.44 Contents | iii Page 4.7 Source of Supply .44 4.8 Contraceptive Discontinuation.46 4.9 Nonuse of Contraception.48 4.10 Family Planning Messages .50 4.11 Family Planning Outreach Activities .53 4.12 Discussion of Family Planning with Husband .55 4.13 Attitudes toward Family Planning among Couples.55 4.14 Abortion and Menstrual Regulation.56 CHAPTER 5 PROXIMATE DETERMINANTS OF FERTILITY 5.1 Marital Status.61 5.2 Age at Marriage .62 5.3 Postpartum Amenorrhea, Abstinence and Insusceptibility .63 5.4 Termination of Exposure to Pregnancy.65 CHAPTER 6 FERTILITY PREFERENCES 6.1 Desire for More Children.67 6.2 Need for Family Planning Services .71 6.3 Ideal Family Size.73 6.4 Fertility Planning .75 CHAPTER 7 INFANT AND CHILD MORTALITY 7.1 Levels and Trends in Infant and Child Mortality .79 7.2 Socioeconomic Differentials in Infant and Child Mortality.81 7.3 Demographic Differentials in Infant and Child Mortality .83 7.4 High-risk Fertility Behavior.84 CHAPTER 8 MATERNAL AND CHILD CARE 8.1 Antenatal Care.87 8.2 Delivery Care .90 8.3 Vaccination of Children .95 8.4 Childhood Illness and Treatment .98 CHAPTER 9 INFANT FEEDING 9.1 Prevalence of Breastfeeding . 103 iv | Contents Contents | v Page 9.2 Supplementation . 104 9.3 Duration and Frequency of Breastfeeding . 106 CHAPTER 10 KNOWLEDGE OF AIDS 10.1 Knowledge of AIDS. 109 10.2 AIDS Prevention . 110 10.3 Perceptions of AIDS Risk. 112 10.4 Knowledge of Condoms and Sources for Condoms. 114 CHAPTER 11 AVAILABILITY OF HEALTH SERVICES 11.1 Availability of Family Planning Services . 115 11.2 Availability of Other Health Services . 119 REFERENCES . 123 APPENDIX A SAMPLE IMPLEMENTATION . 125 APPENDIX B SAMPLING ERRORS . 127 APPENDIX C DATA QUALITY TABLES . 143 APPENDIX D SURVEY PERSONNEL. 147 APPENDIX E QUESTIONNAIRES . 149 TABLES AND FIGURES Page CHAPTER 1 INTRODUCTION Table 1.1 Basic demographic indicators.2 Table 1.2 Sample results.6 CHAPTER 2 CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS Table 2.1 Household population by age, residence, and sex .7 Table 2.2 Population by broad age groups from selected sources .9 Table 2.3 Household composition.10 Table 2.4 Educational level of the male household population .11 Table 2.5 Educational level of the female household population .12 Table 2.6 School enrollment .13 Table 2.7 Housing characteristics .14 Table 2.8 Household durable goods.15 Table 2.9 Background characteristics of respondents .16 Table 2.10 Level of education .18 Table 2.11 School attendance and reasons for leaving school .19 Table 2.12 Employment status.20 Table 2.13 Type of employer .22 Table 2.14 Decision on use of earnings .23 Table 2.15 Child care while working .24 Table 2.16 Access to mass media .26 Figure 2.1 Number of persons reported at each age by sex.8 Figure 2.2 Population pyramid, Vietnam 2002 .9 Figure 2.3 School enrollment among children age 6-15 by age, sex, and urban-rural residence.13 Figure 2.4 Percentage of ever-married women who completed at least lower secondary education, by region.19 CHAPTER 3 FERTILITY Table 3.1 Current fertility rates .28 Table 3.2 Trends in fertility rates .29 Table 3.3 Fertility by background characteristics.30 Table 3.4 Children ever born and living.31 Table 3.5 Trends in mean number of children ever born .32 Table 3.6 Birth interval.33 Table 3.7 Age at first birth .34 Table 3.8 Median age at first birth by background characteristics.35 Tables and Figures | vii Page Table 3.9 Adolescent fertiliy .36 Figure 3.1 Total fertility rates by residence.28 CHAPTER 4 FERTILITY REGULATION Table 4.1 Trends in knowledge of contraceptive methods .37 Table 4.2 Ever use of contraception .39 Table 4.3 Current use of contraception .40 Table 4.4 Current use of contraception by background characteristics .41 Table 4.5 Number of children at first use of contraception .43 Table 4.6 Knowledge of fertile period.43 Table 4.7 Timing of sterilization .44 Table 4.8 Source of supply .45 Table 4.9 First-year contraceptive discontinuation rates.46 Table 4.10 Reasons for discontinuation .47 Table 4.11 Future use of contraception .48 Table 4.12 Reason for source of contraception.49 Table 4.13 Exposure to family planning messages on radio and television.51 Table 4.14 Acceptability of family planning messages in the media.52 Table 4.15 Family planning messages in print media .53 Table 4.16 Contact of nonusers with family planning providers .54 Table 4.17 Discussion of family planning with husband.55 Table 4.18 Attitudes of couples toward family planning.56 Table 4.19 Induced abortion rates.57 Table 4.20 Abortion rates by background characteristics .58 Table 4.21 Use of contraceptive method prior to pregnancy termination.59 Table 4.22 Health problems and treatment seeking following pregnancy termination .59 Figure 4.1 Current contraceptive use among currently married women .40 Figure 4.2 Current use of any contraceptive method among currently married women age 15-49, by background characteristics.42 Figure 4.3 Sources of family planning among current users of modern contraceptive methods .45 Figure 4.4 Reasons for discontinuing use of family planning methods .48 Figure 4.5 Preferred method among nonusers who intend to use in the future .50 CHAPTER 5 PROXIMATE DETERMINANTS OF FERTILITY Table 5.1 Current marital status.61 Table 5.2 Never-married women .62 Table 5.3 Age at first marriage .62 Table 5.4 Postpartum amenorrhea, abstinence and insusceptibility .64 Table 5.5 Median duration of postpartum insusceptibility by background characteristics .65 Table 5.6 Menopause .65 viii | Tables and Figures Page Figure 5.1 Differences in median age at marriage .63 CHAPTER 6 FERTILITY PREFERENCES Table 6.1 Fertility preferences .68 Table 6.2 Fertility preferences by age .69 Table 6.3 Want no more children by background characteristics .70 Table 6.4 Need for family planning .72 Table 6.5 Ideal and actual number of children .73 Table 6.6 Ideal number of children by background characteristics .74 Table 6.7 Fertility planning.75 Table 6.8 Wanted fertility rates .76 Figure 6.1 Fertility preferences among currently married women.68 Figure 6.2 Trend in proportion of currently married women with two children who want no more children, by level of education .71 CHAPTER 7 INFANT AND CHILD MORTALITY Table 7.1 Infant and child mortality.80 Table 7.2 Infant and child mortality by socioeconomic characteristics .82 Table 7.3 Infant and child mortality by demographic characteristics .83 Table 7.4 High-risk fertility behavior.85 Figure 7.1 Trends in infant and under-five mortality, VNDHS 1997 and VNDHS 2002 .80 Figure 7.2 Under-five mortality by residence and education.82 Figure 7.3 Under-five mortality by selected demographic characteristics .84 CHAPTER 8 MATERNAL AND CHILD CARE Table 8.1 Antenatal care .88 Table 8.2 Number of antenatal care visits and stage of pregnancy .89 Table 8.3 Tetanus toxoid injections .90 Table 8.4 Place of delivery .91 Table 8.5 Assistance during delivery .93 Table 8.6 Delivery characteristics: caesarean section, birth weight, and size .94 Table 8.7 Vaccinations by source of information .96 Table 8.8 Vaccinations by background characteristics.97 Table 8.9 Prevalence and treatment of acute respiratory infection (ARI) and fever .98 Table 8.10 Diarrhea prevalence .99 Table 8.11 Knowledge of diarrhea care . 101 Figure 8.1 Vaccination coverage among children age 12-23 months.96 Figure 8.2 Treatment of children under 5 with diarrhea. 102 Tables and Figures | ix Page CHAPTER 9 INFANT FEEDING Table 9.1 Initial breastfeeding . 104 Table 9.2 Breastfeeding status by child’s age . 105 Table 9.3 Median duration and frequency of breastfeeding by background characteristics. 107 Figure 9.1 Distribution of children by breastfeeding status according to age. 106 CHAPTER 10 KNOWLEDGE OF AIDS Table 10.1 Knowledge of AIDS. 110 Table 10.2 Knowledge of ways to avoid AIDS. 111 Table 10.3 Knowledge of HIV/AIDS-related issues and perception of the risk of AIDS . 113 Table 10.4 Knowledge of condoms and source for condoms . 114 CHAPTER 11 AVAILABILITY OF HEALTH SERVICES Table 11.1 Availability of family planning services in the community . 116 Table 11.2 Family planning and health campaigns in the past year . 117 Table 11.3 Distance to nearest family planning services. 118 Table 11.4 Distance to nearest provider of specific contraceptive method. 119 Table 11.5 Availability of health services in the community . 120 Table 11.6 Distance to nearest provider of maternal and child health services. 121 Table 11.7 Distance to nearest facility providing specific health services for women . 122 Table 11.8 Distance to nearest facility providing specific health services for children . 123 APPENDIX A SAMPLE IMPLEMENTATION Table A.1 Sample implementation. 125 APPENDIX B SAMPLING ERRORS Table B.1 List of selected variables for sampling errors . 130 Table B.2 Sampling errors for selected variables, total sample . 131 Table B.3 Sampling errors for selected variables, urban area . 132 Table B.4 Sampling errors for selected variables, rural area . 133 Table B.5 Sampling errors for selected variables, no special project . 134 Table B.6 Sampling errors for selected variables, special project . 135 Table B.7 Sampling errors for selected variables, Northern Uplands. 136 Table B.8 Sampling errors for selected variables, Red River Delta . 137 Table B.9 Sampling errors for selected variables, North Central . 138 Table B.10 Sampling errors for selected variables, Central Coast . 139 Table B.11 Sampling errors for selected variables, Central Highlands . 140 x | Tables and Figures Tables and Figures | xi Page Table B.12 Sampling errors for selected variables, Southeast. 141 Table B.13 Sampling errors for selected variables, Mekong River Delta . 142 APPENDIX C DATA QUALITY TABLES Table C.1 Household age distribution. 143 Table C.2 Completeness of reporting . 144 Table C.3 Births by calendar years . 144 Table C.4 Reporting of age at death in days . 145 Table C.5 Reporting of age at death in months . 146 PREFACE The 2002 Vietnam Demographic and Health Survey (VNDHS 2002) was the third DHS survey to be implemented in Vietnam, following similar surveys in 1988 and 1997. This survey was sponsored by the Population and Family Health Project of the National Committee for Population and Family Planning, which is now renamed the Committee for Population, Family and Children (CPFC). Technical assistance was provided by ORC Macro. The General Statistical Office was responsible for execution of the survey. The main objective of the VNDHS 2002 was to obtain current information on demographic con- ditions, family planning, infant and child mortality, and health-related information about breastfeeding, antenatal care, child immunizations, common children’s diseases, and HIV/AIDS. A major goal of the survey was to measure changes in family planning indicators since the 1997 survey, especially in areas covered by the CPFC project. This report presents the major findings from the VNDHS 2002 survey. Although the data were obtained from a sample survey, and weighted for the nation by main indicators, we hope the survey find- ings will be used by policymakers to formulate appropriate population and health policies and programs in Vietnam. It thus gives us great pleasure to present this report to all planners, policymakers, scholars, researchers, and concerned users. I wish to warmly thank all the institutions and individuals who partici- pated in the implementation of the survey and the compilation of this report. Although this is not the first time we have written a DHS report, it is hardly free from errors. We warmly welcome all comments from planners, policymakers and researchers, both within and outside Vietnam. Dr. Nguyen Thien Truong Vice-Chairman Committee for Population, Family and Children Preface | xiii ACKNOWLEDGMENTS On behalf of the Population and Family Health Project, I gratefully acknowledge leaders of the Committee for Population, Family and Children, and technical backstopping agencies: ORC Macro and the General Statistical Office for their fruitful contributions to the timely execution of survey activities, and the successful completion of the survey as planned. I am grateful to ORC Macro for its technical assistance in fieldworker training, fieldwork supervision and data processing, and to the staff of the General Statistical Office and the Committee for Population, Family and Children, both at the central and local levels, who have worked with enthusiasm and whole-heartedness for the survey’s success. Finally, I owe much gratitude to the survey respondents who generously donated their time to fully answer the survey’s many questions. Dr. Ngo Khang Cuong Director Population and Family Health Project Committee for Population, Family and Children Acknowledgments | xv SUMMARY OF FINDINGS Fertility Differentials. There are substan- tial differences in fertility levels in Vietnam. The TFR is a half a child higher in rural areas than in urban areas (2.0 children per woman compared with 1.4 children per woman). Regional differences are also marked; the highest fertility is in the Central Highlands (2.9 children per woman), while the low- est is in the Southeast region (1.5 children per woman), which includes Ho Chi Minh City. Differ- ences between project and nonproject provinces are minimal. The 2002 Vietnam Demographic and Health Survey (VNDHS 2002) is a nationally representative sample survey of 5,665 ever- married women age 15-49 selected from 205 sample points (clusters) throughout Vietnam. It provides information on levels of fertility, fam- ily 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 imple- mented in each of the sample clusters. As in most countries, fertility is inversely related to women’s education. Women who com- pleted higher secondary school have the lowest fer- tility (1.4 children per woman) while those with no education have the highest fertility (2.8 per woman). The survey was designed to measure change in reproductive health indicators over the five years since the VNDHS 1997, especially in the 18 provinces that were targeted in the Popu- lation and Family Health Project of the Commit- tee for Population, Family and Children. Conse- quently, all provinces were separated into “pro- ject” and “nonproject” groups to permit separate estimates for each. Data collection for the survey took place from 1 October to 21 December 2002. Unplanned Fertility. Despite the high level of contraceptive use in Vietnam, the VNDHS 2002 data indicate that unplanned pregnancies are com- mon. Overall, one-fourth of births in the three years preceding the survey were reported as unplanned: 14 percent were mistimed (wanted later) and 9 percent were unwanted. Nevertheless, this represents a slight improvement since 1997, when 15 percent of births were mistimed and 12 percent were unwanted. The total induced abortion rate shows a slight increase since 1997, from 0.5 to 0.6 abortions per woman. VNDHS 2002 data confirm the pattern of rapidly declining fertility that was observed in the VNDHS 1997. It also shows a sharp decline in child mortality, as well as a modest increase in contraceptive use. Differences between pro- ject and non-project provinces are generally small. Marriage Patterns. One factor that may help to explain the rapid decline in fertility is that women are staying single longer. Although there has been a slight increase in the overall proportion of women who are currently married from 63 percent in 1997 to 64 percent in 2002, the proportion of women age 15-24 who are currently married has declined. For example, 52 percent of women age 20-24 were married in 1997, compared with 46 percent in 2002. Since the age-specific fertility rates are highest at ages 20-24, reductions in the proportions of women married in that age group would be expected to have a larger effect on the overall level of fertility. FERTILITY Fertility Levels and Trends. The total fertility rate (TFR) for the five-year period prior to the survey (roughly 1998-2002) is only 1.9 children per woman, which places Vietnam at “below-replacement level” fertility. It also im- plies that Vietnam has experienced a precipitous decline in fertility from the level of 2.7 reported in the 1997 survey for the period 1992-96. This is especially remarkable, considering the steep declines recorded over the previous five-year period and the already low level of fertility in Vietnam. Summary of Findings | xvii Source of Modern Methods. In Vietnam, provision of modern contraceptive methods is domi- nated by the public sector. Eighty-six percent of current users obtain their family planning method from the public sector. By far the most important source of contraception is the commune health cen- ter (45 percent), followed by government hospitals (22 percent) and mobile clinics (9 percent). Never- theless, as the method mix moves away from de- pendence on the IUD and sterilization and toward supply methods like the pill, private sources of sup- ply may take on a somewhat larger role. FERTILITY REGULATION Knowledge of Contraception. Virtu- ally all married women of reproductive age know of at least one method of contraception. As in the previous VNDHS surveys, the most widely known methods are the IUD (99 per- cent), the condom (96 percent), the pill (95 per- cent), female sterilization (92 percent), and male sterilization (90 percent). Comparison with the VNDHS 1997 indicates that the percentage of currently married women knowing specific methods has increased for every method, albeit only slightly for some. Unmet Need for Family Planning. Only 5 percent of currently married women in Vietnam have an unmet need for family planning services, a very slight decline from 7 percent in 1997. Just un- der half of the unmet need is comprised of women who want to wait two or more years before their next child (spacers), while over half is comprised of women who want no more children (limiters). Use of Contraception. Increased use of contraception can only partially explain the steep decline in fertility over the past five years. Between 1997 and 2002, the contraceptive prevalence rate among married women increased from 75 to 79 percent, while use of modern methods barely changed, from 56 to 57 percent. Discontinuation Rates. Overall, one in four women (25 percent) discontinues use within 12 months of adopting a method. The 12-month discon- tinuation rate for the IUD is particularly low (13 percent), but rates are several times higher for the pill (36 percent), the condom (38 percent), periodic abstinence (32 percent), and withdrawal (30 per- cent). The desire for pregnancy and method failure are the two major reasons for discontinuing method use. Discontinuation rates have increased since 1997 for all methods analyzed. Contraceptive Method Mix. Over the last two decades, the IUD has been the most popular method of contraception in Vietnam. The VNDHS 2002 found that 38 percent of mar- ried women are currently using the IUD. Other modern methods used are the pill (6 percent), female sterilization (6 percent), and the condom (6 percent). Use of the IUD has declined slightly since 1997, while use of the pill has increased slightly. Availability of Services. Family planning services are widely available in Vietnam. The VNDHS 2002 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, almost all CBD workers and family planning fieldworkers pro- vide pills and condoms. In addition, about two-thirds of married women live within one kilometer of a health facility that offers family planning services and over 90 percent live within five kilometers of such a facility. Mobile family planning clinics visit communities where about 72 percent of women live. Two traditional methods account for a significant amount of current use, namely with- drawal (14 percent) and periodic abstinence (8 percent). Differential Contraceptive Use. Given the overall high rate of contraceptive use in Vietnam, there is little room for variation be- tween population subgroups. Nevertheless, the Central Highlands stands out from other regions as having a particularly low level of contracep- tive use (66 percent). There are also substantial differences by education, with contraception rates being higher among more educated wom- en. Differentials in contraceptive use by urban- rural residence are insignificant, as are differen- tials between project and nonproject provinces. xviii | Summary of Findings MATERNAL HEALTH CHILD HEALTH Maternal Health Care. The VNDHS 2002 data indicate substantial increases in the number of women receiving maternal care. Comparison with the VNDHS 1997 indicates that the percentage of women who receive ante- natal services from a doctor, nurse, or midwife, has increased from 71 percent in 1995-97 to 86 percent in 2000-02. All of the increase has oc- curred for doctors (25 to 46 percent), while the proportion of women receiving antenatal care from nurses and midwives has actually declined from 46 to 40 percent since 1995-97. The per- cent receiving no antenatal care also decreased over the same period from 28 to 13 percent. Child Mortality. VNDHS 2002 data imply a steep decline in child mortality over the past five years. Between 1992-96 and 1998-2002, infant mor- tality has declined from 28 to 18 deaths per 1,000 births, while under five mortality has declined from 38 to 24 per 1,000. Although a review of the data does not show any obvious defects in reporting, such extraordinarily low rates and rapid decline should be viewed cautiously. Breastfeeding Practices. Breastfeeding is nearly universal in Vietnam; 98 percent of children are breastfed. The median duration of breastfeeding is 16 to 17 months. The VNDHS 2002 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. There has been a similar increase in the proportion of births for which the mother said she received two or more tetanus toxoid injec- tions during pregnancy—from 55 to 71 percent. Childhood Vaccination Coverage. In the VNDHS 2002, mothers were able to show a health card with immunization data for only 40 percent of children age 12-23 months, although this represents a substantial increase from 13 percent in 1997. Ac- cordingly, estimates of coverage are based on both data from health cards and mothers’ recall. The data show that 67 percent of children 12-23 months are fully vaccinated against the major childhood ill- nesses, an increase from 57 percent in 1997. Proper medical attention and hygienic conditions during delivery can reduce the risk of serious illness among mothers and their babies. The VNDHS 2002 found that four out of five deliveries (79 percent) occurred in health facili- ties, a substantial increase from 62 percent re- ported in the VNDHS 1997. Awareness of AIDS. Knowledge of acquired immunodeficiency syndrome (AIDS) is high among ever-married women in Vietnam (95 percent). Television and radio are the pri- mary sources of information about AIDS. Among women who know about AIDS, most are aware that condom use and having only one sexual partner are ways to reduce the risk of be- coming infected with the virus. Almost four in five are aware that a healthy-looking person can have the AIDS virus, while 88 percent know that AIDS is a fatal disease. Three-fourths of ever- married women say they have no risk of con- tracting the disease. Child Illness and Treatment. Among chil- dren under three years of age, one in five was re- ported to have had symptoms of acute respiratory illness in the two weeks preceding the survey, of whom about seven in ten were taken to a health fa- cility or provider for treatment. Slightly more than one-fourth of children under five had a fever in the two weeks preceding the survey, while 11 percent had diarrhea. Forty percent of children with diarrhea were given solution prepared from oral rehydration salt (ORS) packets, while 63 percent received in- creased fluids. Summary of Findings | xix 1 2 3 4 5 67 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 4344 45 46 47 48 495051 52 53 54 55 56 57 58 59 60 61 xxii | Map of Vietnam VIETNAM China Thailand Laos Cambodia I. Red River Delta 1. Ha Noi 2. Hai Phong 3. Vinh Phuc 4. Ha Tay 5. Bac Ninh 6. Hai Duong 7. Hung Yen 8. Ha Nam 9. Nam Dinh 10. Thai Binh 11. Ninh Binh II. Northeast 12. Ha Giang 13. Cao Bang 14. Lao Cai 15. Bac Kan 16. Lang Son 17. Tuyen Quang 18. Yen Bai 19. Thai Nguyen 20. Phu Tho 21. Bac Giang 22. Quang Ninh III. Northwest 23. Lai Chau 24. Son La 25. Hoa Binh IV. North Central 26. Thanh Hoa 27. Nghe An 28. Ha Tinh 29. Quang Binh 30. Quang Tri 31. Thua Thien - Hue V. South Central Coast 32. Da Nang 33. Quang Nam 34. Quang Ngai 35. Binh Dinh 36. Phu Yen 37. Khanh Hoa VI. Central Highlands 38. Kon Tum 39. Gia Lai 40. Dak Lak 41. Lam Dong VII. Southeast 42. Ho Chi Minh City 43. Ninh Thuan 44. Binh Phuoc 45. Tay Ninh 46. Binh Duong 47. Dong Nai 48. Binh Thuan 49. Ba Ria - Vung Tau VIII. Mekong River Delta 50. Long An 51. Dong Thap 52. An Giang 53. Tien Giang 54. Vinh Long 55. Ben Tre 56. Kien Giang 57. Can Tho 58. Tra Vinh 59. Soc Trang 60. Bac Lieu 61. Ca Mau List of provinces/cities East Sea INTRODUCTION 1 1.1 GEOGRAPHY, HISTORY, AND THE ECONOMY Geography The Socialist Republic of Vietnam is located in southeast Asia bordering the Peoples Republic of China to the north, the Peoples Democratic Republic of Laos and the Kingdom of Cambodia to the west, and the Pacific Ocean to the east. With a coastline of thousands of kilometers from north to south, Vietnam has a land area of 330,000 square kilometers and a sea area of one million square kilometers. There are thousands of small and large islands, some of which are isolated, while others form archipelagos in the East Sea. Vietnam lies in the hot region of the tropics. The climate is monsoon and subtropical in the North, which has four distinct seasons. The southern provinces experience two seasons, a rainy season and a dry season. Some provinces in the center of the country are characterized by the ‘hot wind’ influence in summer caused by the Truong Son mountain range in the west adjacent to Laos. Vietnam includes tropical rain forests, hills and mountains, and fertile agricultural land. Mountains, highland and forests cover about 80 percent of Vietnam’s land area. These areas have low agricultural productivity. The Red River Delta in the North and the Cuu Long River Delta in the South provide the main source of food for the whole country. The country is divided into 61 provinces and cities directly belonging to the central government. There are three administrative levels in Vietnam: provinces, districts, and communes. At present, there are 600 administrative units at district level (districts, urban districts, cities belonging to provinces, and towns) and about 11,000 administrative units at commune level or equivalent (ward, town, let). History Feudalism existed in Vietnam for centuries until the French Empire came to dominate the country late in the 19th century. Thanks to the victory of the August Revolution, the Democratic Republic of Vietnam was founded on 2nd September 1945. Under the guise of disarming the Japanese army in the south, English troops paved the way for the return of French colonialism to Indochina. The Vietnamese launched a national war of resistance against the French from 1945 to 1954 to finally gain independence in the North. Vietnamese people established socialism in the North and continued the war of liberation in the South, which was won in 1975. Since 1975, along with overcoming the consequences of war, recovering and developing the economy, stabilizing the sociopolitical situation in the South, Vietnam had to develop a sense of national unity. In late June and early July 1976, Vietnam’s National Assembly was elected through a general election held throughout the country. The National Assembly decided to name the country the Socialist Republic of Vietnam, with Hanoi as the capital. Introduction | 1 Economy In the period of 1954-1975, the economy in North Vietnam was centrally planned and based mainly on agriculture. There were only two socialist sectors in the economy, the state sector and the co- operative sector. From 1975 to 1980, after the unification of the North and the South, the centrally planned model was applied in the South, pursuant to the second five-year plan (1976-1980). In the period 1981-1985, the contractual system was improved, with contractual quotas being given to working groups and individuals in agricultural co-operatives. In 1986-1991, Vietnam implemented institutional reforms with a market orientation and endeavored to stabilize the economy. In the 6th Assembly, the Vietnamese Communist Party recognized the existence of the private sector and established a policy of eliminating subsidies. In the period 1991- 1995, Vietnam accelerated economic reforms and built up “the multi-sector economy operating along market mechanisms with state management and a socialist orientation.” The period since 1995 has been characterized by a marked effort at reform and development. The structure of gross output in 2002 is as follows: agriculture-forestry-aquaculture sector (23.0 percent); industry and construction sector (38.5 percent); and service sector (38.5 percent). 1.2 POPULATION AND FAMILY PLANNING POLICIES AND PROGRAMS Population The major source of demographic data in Vietnam is the population census. Since unification in 1975, there have been three national population censuses, carried out in 1979, 1989, and 1999. Additional population data have been collected in nationwide demographic sample surveys and other related surveys. Some demographic indicators from the two most recent censuses are shown in Table 1.1. According to the 1999 census, Vietnam’s population grew at the rate of 1.7 percent annually, a decline from 2.1 percent as of the 1989 census. The total population in 2002 was estimated to be around 79.7 million persons. Thus, the population growth rate in the period 1999-2002 continued to decline. Table 1.1 Basic demographic indicators Selected demographic indicators, Vietnam Census year Indicator 1989 1999 Population 64,375,762 76,323,173 Intercensal growth rate (percent) 2.1a 1.7 Total area (km2) 329,241 329,241 Density (persons/ km2) 196 232 Percent urban 19.0 23.7 Sex ratio (number of men per 100 women) 94 96 Crude birth rate (o/oo) 30.0 19.9 Crude death rate (o/oo) 8.0 5.6 Total fertility rate (births per woman) 3.8 2.3 a Compared with the 1979 census 2 | Introduction Family Planning Policies and Programs The Democratic Republic of Vietnam in the North was among the first developing countries to adopt a policy to reduce the population growth rate. As early as 1961, spurred by the results of the 1960 population census in the North, the government of the Democratic Republic of Vietnam promulgated a decree to encourage married couples to restrict family size and space births to reduce population growth. The policy was motivated by pressure on cultivated land and chronic food shortages in the North, as well as by the related desire to improve women’s and children’s welfare, being part of the strategy to enhance labor productivity to meet the needs of the struggle for independence and reunification of the country. In the South of Vietnam, prior to unification, the standing government did not promote family planning until the U.S. Agency for International Development encouraged it to do so in 1971. Nevertheless, the family planning program in the South remained incomplete until the end of the war. After unification, the policies to reduce population growth received increasing attention of the government and efforts to extend coverage of birth control services throughout the country gained the highest priority. A series of government decisions and decrees in late 1988 showed the formal approval at the national level of a policy advocating a family norm of one to two children. The National Health Law approved by the National Assembly on 30 June 1989 legalized the principle of freedom for couples in choosing family planning practices. It emphasized that individuals must be free to choose the family planning method they wished and stated that “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 proposed the objective of “applying small-sized family,” and recommended that “each family should have one or two children” in order to lower fertility and stabilize population. The Strategy in Population and Family Planning to the Year 2000, the Strategy in Population for the Period 2001-2010, the Strategy in Reproductive Health for the Period 2001-2010, and the State Law on Population launched by the National Assembly’s Standing Committee are comprehensive and official plans to guide efforts to implement the above resolution. 1.3 HEALTH PRIORITIES AND PROGRAMS Health care activities in each community are influenced by a series of economic, social, cultural, and environmental factors. Although the economy is poor, Vietnam’s health care services are more advanced than that of many other developing countries in the world. The death rate of infants and children has declined sharply in recent years, presumably as a result of providing health education and primary health care services more widely. The Ministry of Health has expanded the system of primary health care services throughout the country. Almost all communes have their own health stations staffed with trained workers. Problems that cannot be handled at the commune 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 heath stations (GSO, 1995:7) 1.4 OBJECTIVES, ORGANIZATION, AND DESIGN OF THE SURVEY Objectives The Vietnam Demographic and Health Survey 2002 (VNDHS 2002) was the third DHS in Vietnam, with prior surveys implemented in 1988 and 1997. The VNDHS 2002 was carried out in the Introduction | 3 framework of the activities of the Population and Family Health Project of the Committee for Population, Family and Children (previously the National Committee for Population and Family Planning). The main objectives of the VNDHS 2002 were to collect up-to-date information on family planning, childhood mortality, and health issues such as breastfeeding practices, pregnancy care, vaccination of children, treatment of common childhood illnesses, and HIV/AIDS, as well as utilization of health and family planning services. The primary objectives of the survey were to estimate changes in family planning use in comparison with the results of the VNDHS 1997, especially on issues in the scope of the project of the Committee for Population, Family and Children. Organization The VNDHS 2002 was conducted by the General Statistical Office (GSO) on behalf of the Population and Family Health Project of the Committee of Population, Family and Children. Fieldwork took place from October to December 2002. The Demographic and Health Surveys division of ORC Macro in Calverton Maryland provided technical assistance to the project through several visits and through e-mails. Sample Design The sample for the VNDHS 2002 was based on that used in the VNDHS 1997, which in turn was a subsample of the 1996 Multi-Round Demographic Survey (MRS), a semi-annual survey of about 243,000 households undertaken regularly by GSO. The MRS sample consisted of 1,590 sample areas known as enumeration areas (EAs) spread throughout the 53 provinces/cities of Vietnam, with 30 EAs in each province. On average, an EA comprises about 150 households. For the VNDHS 1997, a subsample of 205 EAs was selected, with 26 households in each urban EA and 39 households for each rural EA. A total of 7,150 households was selected for the survey. The VNDHS 1997 was designed to provide separate estimates for the whole country, urban and rural areas, for 18 project provinces and the remaining nonproject provinces as well.1 Because the main objective of the VNDHS 2002 was to measure change in reproductive health indicators over the five years since the VNDHS 1997, the sample design for the VNDHS 2002 was as similar as possible to that of the VNDHS 1997. Although it would have been ideal to have returned to the same households or at least the same sample points as were selected for the VNDHS 1997, several factors made this undesirable. Revisiting the same households would have held the sample artificially rigid over time and would not allow for newly formed households. This would have conflicted with the other major survey objective, which was to provide up-to-date, representative data for the whole of Vietnam. Revisiting the same sample points that were covered in 1997 was complicated by the fact that the country had conducted a population census in 1999, which allowed for a more representative sample frame. In order to balance the two main objectives of measuring change and providing representative data, it was decided to select enumeration areas from the 1999 Population Census, but to cover the same communes that were sampled in the VNDHS 1997 and attempt to obtain a sample point as close as possible to that selected in 1997. Consequently, the VNDHS 2002 sample also consisted of 205 sample 1 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 18 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 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 | Introduction points and reflects the oversampling in the 20 provinces that fall in the World Bank-supported Population and Family Health Project. The sample was designed to produce about 7,000 completed household interviews and 5,600 completed interviews with ever-married women age 15-49.2 Prior to the fieldwork, GSO conducted a household listing operation in the 205 selected enumeration areas. All households residing in the selected areas were listed in a systematic manner by the teams, who also drew a sketch map of each of the selected area units, using mapping and listing forms specifically designed for the task. Questionnaire Content As in the VNDHS 1997, three types of questionnaires were used in the 2002 survey: the Household Questionnaire, the Individual Woman’s Questionnaire, and the Community/Health Facility Questionnaire. The first two questionnaires were based on the DHS Model A Questionnaire, with additions and modifications made during an ORC Macro staff visit in July 2002. The questionnaires were pretested in two clusters in Hanoi (one in a rural area and another in an urban area). After the pretest and consultation with ORC Macro, the drafts were revised for use in the main survey. 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 household. The main purpose of the Household Questionnaire was to identify persons who were eligible for individual interview (i.e. ever-married women age 15-49). In addition, the Household Questionnaire collected information on characteristics of the household such as water source, type of toilet facilities, material used for the floor and roof, and ownership of various durable goods. The Individual Questionnaire was used to collect information on ever-married women aged 15-49 in surveyed households. These women were interviewed on the following topics: • • • • • • • • • • Respondent’s background characteristics (education, residential history, etc.); Reproductive history; Contraceptive knowledge and use; Antenatal and delivery care; Infant feeding practices; Child immunization; 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 stations. The Community/Health Facility Questionnaire consisted of four sections. The first two sections collected information from community informants on some characteristics such as the major economic activities of residents, distance from people’s residence to civic services and the location of the nearest sources of health care. The last two sections involved visiting the nearest commune health centers and intercommune health centers, if these centers were located within 30 kilometers from the surveyed cluster. For each visited health center, information was collected on the type of health services offered and the number of days services were offered per week; the number of assigned staff and their training; medical equipment and medicines available at the time of the visit. 2 For a more detailed description of the sample design of the VNDHS 1997, see NCPFP, 1999. Introduction | 5 1.5 DATA COLLECTION AND PROCESSING Training and Fieldwork Training courses for field staff were carried out in two places. The first course was in Hanoi from 9 to 27 September 2002, and the second course was in Dalat City in Lam Dong Province from 16 September to 4 October 2002. Both courses consisted of instruction on interviewing skills and fieldwork procedures, detailed editing of questionnaires, mock interviews among trainees and practice interviews in households in areas outside the VNDHS sample points. Team leaders and field editors were trained in methods of editing, procedures for checking the data quality, and logistics of fieldwork coordination. Data collection was carried out by eight interviewing teams, each team consisting of one team leader, one field editor, four female interviewers, one interviewer for the Community/Health Facility interview, and one driver. Supervisors from the GSO were responsible for coordinating and directly supervising fieldwork activities. Data collection took place from 1 October to 21 December 2002. Data Processing The first stage of data editing was implemented by the field editors soon after each interview. Field editors and team leaders checked the completeness and consistency of all items in the questionnaires. The completed questionnaires were sent to the GSO headquarters in Hanoi by post for data processing. The editing staff of the GSO first checked the questionnaires for completeness. The data were then entered into microcomputers and edited using a software program specially developed for the DHS program, the Census and Survey Processing System, or CSPro. Data were verified on a 100 percent basis, i.e., the data were entered separately twice and the two results were compared and corrected. The data processing and editing staff of the GSO were trained and supervised for two weeks by a data processing specialist from ORC Macro. Office editing and processing activities were initiated immediately after the beginning of the fieldwork and were completed in late December 2002. 6 | Introduction Survey Response Rates Table 1.2 presents information on the results of the household and individual inter- views. The table shows high response rates. Of the 7,150 households selected in the sample, 7,056 households were occupied at the time of the interview, and 7,048 were successfully inter- viewed, for a household response rate of almost 100 percent. The household response rate was high in both urban and rural areas. A total of 5,706 eligible women were identified in the interviewed households, of whom 5,665 were successfully interviewed, yielding a response rate of 99 percent. Non- response was mainly due to the fact that respondents were not at home at the time of interview, nor for any of the return visits (callbacks) to try to find them. As for the household interview, response rates for the individual interview were high in both urban (99 percent) and rural (99 percent) areas. Table 1.2 Sample results Number of households, number of eligible women, and response rates, Vietnam 2002 Residence Result Urban Rural Total Household interviews Households selected 1,690 5,460 7,150 Households occupied 1,664 5,392 7,056 Households interviewed 1,660 5,388 7,048 Household response rate 99.8 99.9 99.9 Individual interviews Number of eligible women 1,316 4,390 5,706 Number of women interviewed 1,300 4,365 5,665 Individual response rate 98.8 99.4 99.3 CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS 2 The main objective of this chapter is to describe the general characteristics of the sample population, which include age and sex composition, residence, education, housing facilities, and presence of durable goods. This information is not only useful by itself, but can also be used to evaluate the quality of the 2002 VNDHS data and to investigate changes in social and economic conditions over time. Data in this chapter will be presented for households, persons within households, and women eligible for the individual interview. The other objective of this chapter is to describe the environment in which the respondents (ever-married women aged 15-49) and their children live. Factors believed to influence nuptiality, fertility, and contraceptive behavior, as well as maternal care and child morbidity and mortality, are discussed. 2.1 CHARACTERISTICS OF THE HOUSEHOLD POPULATION In the VNDHS 2002, 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 population was 19 percent urban and 81 percent rural. Table 2.1 Household population by age, residence, and sex Percent distribution of the de facto household population by five-year age groups, according to urban-rural residence and sex, Vietnam 2002 Urban Rural Total Age group Male Female Total Male Female Total Male Female Total 0-4 6.6 5.6 6.1 8.1 7.4 7.8 7.8 7.1 7.4 5-9 8.5 6.7 7.5 11.8 10.7 11.2 11.2 9.9 10.5 10-14 10.3 8.7 9.5 14.0 13.2 13.6 13.3 12.3 12.8 15-19 10.7 9.5 10.1 11.9 10.7 11.3 11.7 10.5 11.0 20-24 7.8 8.6 8.2 7.3 7.3 7.3 7.4 7.5 7.4 25-29 8.7 8.8 8.8 6.6 7.6 7.1 7.0 7.8 7.5 30-34 7.3 7.9 7.6 7.9 7.6 7.7 7.8 7.6 7.7 35-39 6.9 8.2 7.6 7.4 7.3 7.3 7.3 7.5 7.4 40-44 9.2 8.4 8.8 6.8 6.9 6.9 7.3 7.2 7.2 45-49 6.7 6.6 6.7 5.1 5.1 5.1 5.4 5.4 5.4 50-54 4.3 5.3 4.8 3.5 3.4 3.5 3.6 3.8 3.7 55-59 2.9 4.0 3.5 1.8 2.2 2.0 2.1 2.6 2.3 60-64 3.0 3.3 3.1 1.7 2.5 2.1 1.9 2.7 2.3 65-69 3.1 2.9 3.0 1.8 2.6 2.2 2.1 2.6 2.4 70-74 2.1 2.2 2.1 2.1 2.3 2.2 2.1 2.3 2.2 75-79 1.0 1.7 1.3 1.1 1.5 1.3 1.1 1.5 1.3 80 + 0.9 1.6 1.3 1.0 1.8 1.4 1.0 1.7 1.4 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 2,869 2,987 5,856 11,735 12,666 24,401 14,604 15,654 30,258 Characteristics of Households and Respondents | 7 As shown in Figure 2.1, there is a preference for certain ages, particularly those ending in 0, 5, 2 or 4. Errors are more obvious among the population age 40 and over, partly because younger people tend to have more education than older people and are more likely to know their date of birth. To obtain the most accurate age reporting for respondents, the VNDHS 2002 interviewers were instructed to (1) ask for legal documents or identity cards, (2) relate the respondent’s age to the age of another household member whose age was known or to a household event whose date had been ascertained, or (3) relate the respondent’s age to local or national events well known in the area. A chart used to convert reported dates from the lunar year calendar (named by 12 animals) to the solar year calendar was appended to the interviewers’ manual. The age pattern presented in Figure 2.1 show that age heaping is moderate. Age composition is affected by past levels of fertility, mortality and migration. The population pyramid (Figure 2.2) has a narrow top and a wide base, reflecting a pattern typical of countries with relatively high fertility in the past. The narrowing at the base was brought about by a rapid decline in fertility in the last decade. Figure 2.1 Number of Persons Reported at Each Age by Sex 0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 Age 0 50 100 150 200 250 300 350 400 450 500 Number of persons Female Male Vietnam 2002 There appears to be an excess of males over females at ages under 20. For ages over 20 and especially over 50, there are more females than males. The population pyramid shows no excess of women in the age group 50-54 compared with 45-49, which suggests that there has been no shifting of eligible wo en out of age group 45-49 by interviewers seeking to reduce their workload (as has occurred in some co ntries where similar surveys have been conducted). 8 | Characteristics of House m u holds and Respondents Population by Age from Selected Sources Table 2.2 compares the broad age struc- ture of the population from the 1989 Population Census, the 1994 Intercensal Demographic Survey (ICDS), the 1997 VNDHS, and the 2002 VNDHS. The proportion of the population less than 15 years has declined over time from 40 percent in 1989 to 30 percent in 2002. During the same period, the percentage of the population aged 15- 64 increased from 55 percent in 1989 to 63 percent in 2002. The most likely explanation for these changes is the recent rapid decline in fertility. Household Composition Table 2.3 persents information on the per- cent distribution of households by various charac- teristics such as sex of head of household and size of household. The size and composition of the household may affect the allocation of financial resources among household members, which in turn influences the wellbeing of these individuals. Household size may be associated with crowding in the dwelling, which can also lead to unfavorable health conditions. Single-parent families, especially if they are headed by females, usually have limited financial resources. Table 2.2 Population by broad age groups from selected sources Percent distribution of the population by broad age group, selected sources, Vietnam 1989-2002 Age group 1989 census 1994 ICDS 1997 VNDHS 2002 VNDHS Less than 15 39.8 36.8 35.0 30.1 15-64 55.4 57.5 58.6 62.7 65+ 4.8 5.7 6.3 7.2 Total 100.0 100.0 100.0 100.0 Median age 19.8 22.1 22.8 25.7 Note: Percentages may not add to 100 due to rounding. Sources: 1989 Population Census (GSO, 1991), Intercensal Demographic Survey 1994 (GSO, 1996a); Vietnam Demographic and Health Survey 1997 (NCPFP, 1999) Figure 2.2 Population Pyramid, Vietnam 2002 80+ 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-4 0246810 0 2 4 6 8 10 Vietnam 2002 Age Male Percent Female Table 2.3 shows that men head 73 percent of the households in Vietnam, with only 27 percent headed by women. Female-headed households are more common in urban areas than in rural areas (45 percent versus 22 percent). The average household size has decreased from 4.8 persons in the ICDS-94 to 4.7 persons in the VNDHS 1997, and 4.4 persons in the VNDHS 2002, possibly due to a decline in fertility. The average Characteristics of Households and Respondents | 9 household size in urban areas is only slightly lower than that in rural areas (4.3 versus 4.4). Almost two- thirds (64 percent) of households consist of 3 to 5 persons. As in the VNDHS 1997, four-person households are most common (24 percent in 1997 compared with 29 percent in 2002). The proportion of households with 5 or more persons has declined from 69 percent in the ICDS-94 to 50 percent in the VNDHS 1997 and 43 percent in the VNDHS 2002. This may be due to smaller family sizes as well as to improved socioeconomic conditions that have resulted in more young couples moving out to live on their own. Table 2.3 Household composition Percent distribution of households by sex of household head and household size, according to urban-rural residence, Vietnam 2002 Residence Characteristic Urban Rural Total Head of household Male 55.1 77.6 73.2 Female 44.9 22.4 26.8 Number of usual members 1 3.2 4.6 4.3 2 10.9 8.7 9.1 3 18.7 14.0 14.9 4 31.6 28.1 28.8 5 15.6 21.8 20.6 6 8.9 12.4 11.7 7 5.6 5.6 5.6 8 2.6 2.5 2.5 9+ 3.0 2.5 2.6 Total 100.0 100.0 100.0 Mean size 4.3 4.4 4.4 Note: Table is based on de jure household members, i.e., usual residents. Education Level of Household Population Educational attainment is closely associated with other socioeconomic factors such as income, housing conditions and with factors related to reproductive behavior, use of contraception, and health status of children. Education also influences an individual’s world view, and can open one’s mind to new ideas and technology. 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. Tables 2.4 and Table 2.5 indicate that among men and women there are significant differences in level of education by background characteristics. Overall, men are slightly better educated than women: 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 6-24. Above age 45 the gap widens substantially. 10 | Characteristics of Households and Respondents Table 2.4 Educational level of the male household population Percent distribution of the de facto male household population age 6 and over by highest level of education attended, and median number of years of schooling, according to background chracteristics, Vietnam 2002 Level of education Background characteristic No education Some primary Completed primary Completed lower secondary Completed higher secondary+ Total Number of men Median years of schooling Age 6-9 24.2 75.8 0.0 0.0 0.0 100.0 1,349 1.0 10-14 1.5 30.4 67.0 1.1 0.0 100.0 1,943 4.8 15-19 2.6 9.3 29.9 46.7 11.6 100.0 1,702 8.4 20-24 5.6 15.6 32.7 18.6 27.5 100.0 1,076 7.3 25-29 4.9 13.3 32.7 25.1 23.9 100.0 1,029 7.9 30-34 5.2 12.0 27.0 32.1 23.6 100.0 1,141 8.2 35-39 3.9 11.6 25.0 38.5 21.0 100.0 1,068 8.3 40-44 3.6 10.2 23.6 39.7 23.0 100.0 1,060 8.4 45-49 4.4 13.1 22.8 37.1 22.6 100.0 789 8.3 50-54 3.7 16.6 20.9 31.1 27.8 100.0 532 8.4 55-59 5.8 14.4 23.2 33.2 23.5 100.0 301 8.2 60-64 5.6 17.3 25.3 25.8 25.9 100.0 282 8.1 65+ 13.9 32.6 25.4 14.9 13.1 100.0 904 4.2 Residence Urban 4.3 13.6 25.2 21.2 35.7 100.0 2,636 8.5 Rural 7.1 25.3 31.5 25.4 10.7 100.0 10,539 6.0 Project province No 6.3 23.1 30.5 23.9 16.1 100.0 8,868 6.4 Yes 7.0 22.6 29.7 26.0 14.8 100.0 4,307 6.5 Region Northern Uplands 8.1 25.7 32.7 23.3 10.1 100.0 2,432 5.7 Red River Delta 2.9 13.3 20.9 36.2 26.7 100.0 2,949 8.4 North Central 4.7 22.5 30.9 30.4 11.4 100.0 1,729 6.8 Central Coast 6.6 22.8 32.3 23.1 15.2 100.0 1,398 6.2 Central Highlands 16.9 25.1 29.5 16.4 12.0 100.0 452 4.8 Southeast 5.6 20.1 32.2 19.9 22.2 100.0 1,580 6.8 Mekong River Delta 9.2 32.7 36.0 13.9 8.3 100.0 2,635 4.7 Total 6.5 22.9 30.3 24.6 15.7 100.0 13,175 6.5 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 50 compared with younger women and above age 65 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 6.5 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 45 after which the gap favoring males becomes wider. Characteristics of Households and Respondents | 11 Table 2.5 Educational level 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 background chracteristics, Vietnam 2002 Level of education Background characteristic No education Some primary Completed primary Completed lower secondary Completed higher secondary+ Total Number or women Median years of schooling Age 6-9 22.5 77.1 0.4 0.0 0.0 100.0 1,287 1.1 10-14 1.8 28.8 67.8 1.5 0.0 100.0 1,925 4.9 15-19 2.8 8.2 30.1 48.6 10.2 100.0 1,636 8.3 20-24 5.9 12.7 35.2 18.6 27.7 100.0 1,176 7.3 25-29 7.1 13.9 34.3 25.1 19.6 100.0 1,227 7.2 30-34 5.2 14.6 27.2 31.7 21.4 100.0 1,196 8.1 35-39 4.9 17.4 23.2 35.0 19.5 100.0 1,168 8.1 40-44 6.7 17.7 24.6 35.2 15.8 100.0 1,130 8.0 45-49 8.5 22.0 23.0 33.7 12.8 100.0 846 7.0 50-54 13.4 23.8 24.9 24.6 13.3 100.0 594 5.1 55-59 13.0 29.5 24.5 19.8 13.3 100.0 402 4.6 60-64 19.2 42.0 21.9 9.2 7.7 100.0 416 3.0 65+ 49.4 37.6 10.2 1.9 0.9 100.0 1,280 0.1 Residence Urban 5.8 18.1 25.4 21.3 29.3 100.0 2,788 8.0 Rural 12.8 27.6 30.2 21.9 7.5 100.0 11,494 4.9 Project province No 10.8 26.7 29.8 20.8 11.9 100.0 9,586 5.2 Yes 12.9 23.8 28.0 23.9 11.5 100.0 4,696 5.6 Region Northern Uplands 15.3 26.9 30.9 20.1 6.9 100.0 2,601 4.7 Red River Delta 7.8 15.4 22.6 34.9 19.2 100.0 3,305 8.1 North Central 10.2 23.1 31.2 26.5 8.9 100.0 1,948 5.8 Central Coast 10.4 27.9 31.4 17.8 12.3 100.0 1,507 5.0 Central Highlands 21.8 29.1 25.9 14.6 8.6 100.0 485 3.9 Southeast 8.2 25.0 31.6 16.1 19.0 100.0 1,724 5.8 Mekong River Delta 14.0 37.9 32.0 11.1 5.0 100.0 2,714 3.8 Total 11.5 25.8 29.2 21.8 11.8 100.0 14,282 5.3 Tables 2.4 and 2.5 also show that educational attainment is negatively associated with age: older persons are more likely to have no education or to stay in school for shorter periods. Urban residents are much more likely to have been to school and to have stayed in school longer than residents of rural areas. The proportion of the population with no education is twice as high in rural areas as in urban areas. As expected, the median number of years of schooling is also much higher in urban than in rural areas. Tables 2.4 and 2.5 present the differences in educational attainment by region for male and female population, respectively. The median duration of schooling for males is longer than for females in all regions. The median number of years of schooling is highest in the Red River Delta region (8.4 for males and 8.1 for females), followed by the Southeast and North Central region (6.8 for males and 5.8 for 12 | Characteristics of Households and Respondents females). The median number of years of schooling is lowest in the Central Highlands and the Mekong River Delta region. School Enrollment Table 2.6 presents the school enrollment rate for the population age 6-24 by age, sex and urban- rural residence. The data confirm that differences between boys and girls at the younger ages are minimal, with around 96 percent of both boys and girls age 6-10 enrolled in school (Figure 2.3). Urban-rural differences are also negligible. Nine in ten children age 6 to 15 years (91 percent) are attending school. School enrollment drops substantially after age 15 to only 41 percent among those age 16-20 years, and to 7 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. Nevertheless, enrollment rates have increased substantially since 1997. Table 2.6 School enrollment Percentage of the de facto household population age 6-24 years enrolled in school, by age, sex, and urban-rural residence, Vietnam 2002 Male Female Total Age group Urban Rural Total Urban Rural Total Urban Rural Total 6-10 96.8 96.5 96.5 96.7 95.9 96.0 96.7 96.2 96.2 11-15 91.8 88.6 89.1 88.6 84.2 84.8 90.2 86.3 86.9 6-15 94.1 92.4 92.7 91.8 89.7 90.0 93.0 91.1 91.3 16-20 59.6 42.2 45.4 53.2 33.7 37.1 56.6 38.0 41.4 21-24 22.1 5.2 9.0 13.3 3.4 5.7 17.4 4.3 7.2 Figure 2.3 School Enrollment Among Children Age 6-15 by Age, Sex, and Urban-Rural Residence 96.8 96.7 91.8 88.6 96.5 95.9 88.6 84.2 Male Female Male Female 0 20 40 60 80 100 Percent Urban Rural Vietnam 2002 Age 6-10 Age 11-15 Characteristics of Households and Respondents | 13 2.2 Housing Characteristics Socioeconomic conditions of households were assessed by asking respondents questions about their household environment. This information is sum- marized in Table 2.7. Housing characteristics are often important determinants of the health status of house- hold members, particularly children. Proper hygiene and sanitation practices can help to prevent major childhood diseases, such as diarrhea. Such charac- teristics can also be used as indicators of household socioeconomic status. Overall, 89 percent of households have elec- tricity, with all but a tiny fraction of urban households being electrified, compared with nearly 9 in 10 house- holds in rural areas. The proportion of households with electricity in rural areas increased from 74 percent in 1997 to 87 percent in 2002. Sources of drinking water differ widely by area of residence. In urban areas, piped water is a major source; 74 percent of households have water piped into their residence and another 2 percent obtain water from a public tap. One-fifth of urban households still use well water. In rural areas, only 7 percent of households have piped water. Well water is the main source for rural households (63 percent). Fifteen percent of rural households use rainwater. Because of the availability of piped water and wells in residences, the vast majority of households (96 percent) require less than 15 minutes to go to the water source, collect water and return, including waiting time. More than half of all households (56 percent) have a pit toilet, either a traditional pit toilet (45 per- cent) or a ventilated improved latrine (11 percent). In urban areas, 79 percent of households have their own flush toilet while 3 percent share a flush toilet. In contrast, pit toilets are the main type of toilet facility (66 percent) in rural areas. Notable is the fact that one- fifth of rural households have no toilet facility, com- pared with 4 percent in urban areas. Seventy percent of households in Vietnam have a finished floor made of ceramic tiles, cement, etc. Finished floors are more common in urban areas (95 percent) than in rural areas (64 percent). More than one third of rural households reside in houses with earth, sand, or rough wood/bamboo flooring (36 percent). Since 1997, access to adequate sanitation facilities and material used for flooring has improved in Vietnam, especially in rural areas. Table 2.7 Housing characteristics Percent distribution of households by housing characteristics, according to urban-rural residence, Vietnam 2002 Residence Characteristic Urban Rural Total Electricity Yes 99.4 86.6 89.1 No 0.6 13.4 10.9 Total 100.0 100.0 100.0 Source of drinking water Piped water Piped into residence 74.0 6.1 19.4 Public tap 1.9 0.4 0.7 Well water Well in residence 18.9 59.9 51.9 Public well 1.1 2.9 2.5 Spring 0.3 6.7 5.4 River, stream 1.2 7.7 6.5 Pond, lake 0.0 0.3 0.3 Dam 0.0 0.1 0.1 Rain water 1.7 14.7 12.1 Other 0.8 1.2 1.1 Total 100.0 100.0 100.0 Time to water source Less than 15 minutes 98.7 95.9 96.4 Sanitation facility Flush toilet Own flush toilet 78.8 11.6 24.7 Shared flush toilet 3.3 0.3 0.9 Pit toilet Traditional pit toilet 9.9 53.6 45.1 Vent. imp. pit toilet 4.0 12.8 11.1 No facility, bush 3.9 20.6 17.4 Other/missing 0.0 1.1 0.9 Total 100.0 100.0 100.0 Flooring Earth, sand 4.8 27.6 23.1 Rough wood/bamboo 0.5 8.7 7.1 Finished floor 94.6 63.6 69.7 Missing 0.1 0.0 0.1 Total 100.0 100.0 100.0 Persons per sleeping room <2 65.3 53.8 56.1 3-4 26.3 29.6 28.9 5-6 6.0 13.1 11.7 7 + 1.4 3.0 2.7 Missing /Don’t know 0.9 0.6 0.6 Total 100.0 100.0 100.0 Mean 2.5 3.0 2.9 Number of households 1,377 5,671 7,048 14 | Characteristics of Households and Respondents As a way of estimating the extent of crowding, information was gathered on the number of rooms in each household that are used for sleeping. Fifty-six percent of households have 1-2 persons per sleeping room, while about one-third (29 percent) have 3-4 persons per sleeping room. The mean number of persons per sleeping room is 2.9 and is somewhat lower for urban than rural households. The figure has declined from 3.3 persons per sleeping room in 1997. 2.3 HOUSEHOLD DURABLE GOODS Respondents were asked about ownership of particular household durable goods such as radios, televisions and telephones (to assess access to mass media), refrigerators (to assess access to food storage), bicycles, motorcycles and private cars (to assess access to modes of transportation). Table 2.8 Household durable goods Percentage of households possessing various durable consumer goods, by urban-rural residence, Vietnam 2002 Residence Consumer goods Urban Rural Total Radio 64.4 46.2 49.8 Television 91.1 64.9 70.0 Telephone 57.4 8.3 17.9 Refrigerator 49.4 5.8 14.3 Bicycle 79.3 77.3 77.7 Motorcycle 74.7 36.9 44.2 Private car 2.4 0.7 1.1 None of the above 1.7 7.9 6.7 Number of households 1,377 5,671 7,048 Table 2.8 shows that half of households have a radio, 70 percent have a television, 18 percent have a telephone, and 14 percent have a refrigerator. Urban- rural differences are marked, especially in terms of possession of a television set, a telephone, and a refrigerator. For example, half of urban households have a refrigerator, compared with only 6 percent of rural households. Urban-rural differentials can be also seen in the access to modes of transport: three-quarters of urban households own a motorcycle, compared to just over one-third of rural households. However, bicycles are the exception to this pattern, with almost 80 percent of both urban and rural households possessing a bicycle. Overall, very few households have a car. Only 7 percent of households do not own any of these consumer goods: 2 percent of urban households and 8 percent of rural households. Ownership of most durable goods has increased since 1997. For example, the proportion of households owning a telephone has increased from 50 percent to 70 percent, while the proportion owning a television has more than doubled from 7 to 18 percent. Motorcycle ownership has increased from 24 to 44 percent. The only exception to this pattern is radios, which have declined since 1997. 2.4 BACKGROUND CHARACTERISTICS OF WOMEN RESPONDENTS General Characteristics Table 2.9 shows the distribution of respondents by selected background characteristics including age, marital status, residence, education, religion, and ethnic group. Respondents were ever-married women age 15-49 who slept in the selected households the night before the interview. The table shows both the actual (unweighted) and weighted number of women interviewed. Weighting is necessary to compensate for differences in the selection probabilities and response rates. Because the sample design was not proportional, but rather included oversampling in certain areas, weighting is required to make the data reflect the actual proportional distribution in Vietnam. All results presented in this report are weighted. As indicated in Chapter 1, interviews were completed for a total of 5,665 ever-married women age 15-49. Characteristics of Households and Respondents | 15 Table 2.9 Background characteristics of respondents Percent distribution of ever-married women by background character- istics, Vietnam 2002 Characteristic Weighted percent Weighted Unweighted Age 15-19 1.2 67 20-24 9.7 552 550 25-29 17.6 1,000 983 30-34 1,105 1,063 35-39 19.4 1,098 1,125 40-44 18.5 1,046 1,056 14.0 795 821 Current marital status Married 94.2 5,338 5,341 Widowed 2.4 131 Divorced 2.2 126 131 Not living together 1.2 66 62 Residence Urban 19.1 1,081 1,300 Number of women 69 19.5 45-49 135 Rural 80.9 4,584 4,365 Project province No 67.3 3,814 3,591 Yes 32.7 1,851 2,074 Region Northern Uplands 19.4 1,099 1,081 Red River Delta 24.1 1,363 1,119 North Central 12.7 722 767 Central Coast 10.5 594 580 Central Highlands 3.2 183 218 Southeast 11.4 648 677 Mekong River Delta 18.6 1,056 1,223 Education No education 6.4 364 355 Some primary 17.0 966 993 Completed primary 28.2 1,599 1,593 Compl. lower secondary 31.5 1,783 1,768 Compl. higher secondary+ 16.8 953 956 Currently attending school Yes 0.1 8 No 99.8 5,656 5,653 Religion No religion 79.1 4,480 4,344 Buddhist 12.0 679 805 Catholic 5.1 287 310 Protestant 0.3 18 12 Cao Dai 1.7 97 90 Hoa Hao 1.4 81 90 Other 0.4 22 12 Ethnic group Vietnamese 83.9 4,755 4,885 Tay 2.7 155 125 Thai 4.4 248 161 Chinese 0.9 50 70 Khmer 1.7 95 78 Muong 1.0 58 74 Nung 1.5 84 39 Hre 0.4 22 37 Phu la 0.0 1 2 E de 0.3 17 19 Dao 0.5 28 34 Co tu 0.3 19 21 Cham 0.4 25 14 Other 1.8 103 102 Missing 0.1 4 4 Total 100 5,665 5,665 11 16 | Characteristics of Households and Respondents Women were asked two questions in the individual interview to assess their age: “In what month and year were you born?” and “How old are you?” Interviewers were trained to convert from the lunar calendar into Gregorian calendar whenever necessary. They were also trained to probe in situations where a respondent did not know her age or date of birth, and they were instructed as a last resort to record a best estimate of the respondent's age. The age distribution of women reveals that only about one in nine ever-married women is under age 25, while one-third are 40 or above. Women are mostly concentrated in the age group 30-39. This is because the survey interviewed ever-married women only, and there are fewer ever-married women in the younger age groups. The majority of ever-married women are currently married (94 percent) with a small minority widowed, divorced or separated (6 percent). Eighty-one percent of women reside in rural areas, the same proportion as in the VNDHS 1997. The distribution 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 country. The majority of ever-married women (94 percent) have been to school, 17 percent have some primary education but did not finish primary school, and about one-third of women have completed lower secondary (32 percent). Seventeen percent of women have completed at least higher secondary, which is slightly higher than the proportion reported in the ICDS-94 (13 percent) and the VNDHS 1997 (14 percent). Almost none of the respondents were enrolled in school at the time of the survey. A vast majority of the women surveyed are not religious (79 percent), while 12 percent are Buddhist, 5 percent are Catholic, and 4 percent belong to other religions. As for ethnic groups, 84 percent of ever-married women belong to the Kinh (Vietnamese) ethnic group, while 4 percent are Thai and 3 percent are Tay. Other ethnic groups account for less than 2 percent each. Differentials in Education Level The distribution of respondents by education and selected background characteristics is presented in Table 2.10. As noted in Table 2.9, 6 percent of women have no education, 17 percent of women have some primary education, 28 percent have completed primary education, 32 percent have completed lower secondary school, and 17 percent have completed higher secondary school. Rural women are more educationally disadvantaged than urban women; 8 percent of rural women have no education, compared with 2 percent of urban women. The urban-rural gap narrows somewhat at higher levels of education; nevertheless, nearly four times as many urban women have completed higher secondary school as rural women. 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 2.4 shows the distribution of women who have completed at least lower secondary education by region. The percentage of women who have completed lower secondary school is highest in the Red River Delta (82 percent) and lowest in the Mekong River Delta (17 percent). Characteristics of Households and Respondents | 17 Table 2.10 Level of education Percent distribution of ever-married women by the highest level of education completed, according to background characteristics, Vietnam 2002 Education Background characteristic No education Some primary Completed primary Completed lower secondary Completed higher secondary+ Total Number of women Age 15-19 6.6 20.8 42.9 27.0 2.6 100.0 69 20-24 8.8 16.5 41.3 20.6 12.8 100.0 552 25-29 7.6 15.0 34.6 25.8 17.1 100.0 1,000 30-34 5.3 14.5 27.5 32.1 20.6 100.0 1,105 35-39 4.5 17.7 23.3 35.0 19.5 100.0 1,098 40-44 6.2 17.3 24.6 36.1 15.9 100.0 1,046 45-49 7.8 22.0 22.6 34.8 12.8 100.0 795 Residence Urban 1.6 10.5 20.4 26.0 41.5 100.0 1,081 Rural 7.6 18.6 30.1 32.8 11.0 100.0 4,584 Project province No 6.2 18.3 29.3 29.9 16.2 100.0 3,814 Yes 6.8 14.4 26.0 34.6 18.2 100.0 1,851 Region Northern Uplands 12.5 17.5 29.0 29.0 11.8 100.0 1,099 Red River Delta 0.1 2.1 16.1 53.8 27.9 100.0 1,363 North Central 2.4 9.5 32.6 41.9 13.7 100.0 722 Central Coast 5.4 16.9 34.8 23.1 19.9 100.0 594 Central Highlands 24.6 14.1 24.6 20.3 16.5 100.0 183 Southeast 3.8 21.4 33.4 20.3 21.0 100.0 648 Mekong River Delta 10.1 38.9 33.8 11.7 5.6 100.0 1,056 Total 6.4 17.0 28.2 31.5 16.8 100.0 5,665 Figure 2.4 Percentage of Ever-Married Women Who Completed at Least Lower Secondary Education, by Region 41 82 56 43 37 41 17 Northern Uplands Red River Delta North Central Central Coast Central Highlands Southeast Mekong River Delta 0 20 40 60 80 100 Percent Vietnam 2002 18 | Characteristics of Households and Respondents Educational Attainment and Reasons for Leaving School Respondents age 15-24 were asked whether they were attending school at the time of the survey, and if not, the main reason for leaving school. Table 2.11 shows the distribution of those who had ever attended school by reason for leaving school. Table 2.11 School attendance and reasons for leaving school Percent distribution of ever-married women age 15-24 who have ever attended school by whether currently attending school and reason for leaving school, according to highest level of education attended, Vietnam 2002 Educational attainment Attendance/ reason for leaving school Some primary Completed primary Completed lower secondary Completed higher secondary+ Total Currently attending 1.0 1.4 0.6 4.1 1.5 Reason for leaving school Got married 11.0 11.1 11.5 17.2 12.0 Care for younger children 0.7 0.0 0.0 2.6 0.5 Family needed help 50.7 52.0 39.6 7.7 43.2 Could not pay school fees 0.7 1.4 0.8 3.6 1.4 Needed to earn money 5.5 2.5 4.8 2.3 3.5 Graduated/had enough schooling 0.4 2.4 4.1 32.8 6.3 Did not pass exams 1.1 1.7 18.0 25.2 8.4 Did not like school 8.9 22.9 13.7 4.5 15.8 School not accessible 12.3 0.9 1.7 0.0 3.1 Other 7.2 2.3 4.6 0.0 3.4 Don’t know/missing 0.4 1.5 0.5 0.0 0.9 Total 100.0 100.0 100.0 100.0 100.0 Number who ever attended school 105 257 132 73 568 Less than 2 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 the family (43 percent). Sixteen percent stopped school because they did not like it, and another 12 percent dropped out to get married; 8 percent left school because they did not pass their exams. Employment Status In the VNDHS 2002, respondents were asked if they worked aside from doing their housework, regardless of whether they were paid or not. Table 2.12 presents the distribution of ever-married women by employment status, according to background characteristics. Characteristics of Households and Respondents | 19 Table 2.12 Employment status Percent distribution of ever-married women by employment status, according to back- ground characteristics, Vietnam 2002 Currently unemployed Background characteristic Did not work in the last 12 months Worked in the last 12 months Currently employed Total Number of women Age 15-19 14.4 9.4 76.2 100.0 69 20-24 11.0 4.1 84.9 100.0 552 25-29 6.6 1.9 91.5 100.0 1,000 30-34 5.6 0.8 93.5 100.0 1,105 35-39 4.9 0.8 94.2 100.0 1,098 40-44 4.8 0.9 94.3 100.0 1,046 45-49 8.2 0.4 91.4 100.0 795 Residence Urban 15.0 2.0 83.0 100.0 1,081 Rural 4.5 1.2 94.2 100.0 4,584 Project province No 7.2 1.4 91.4 100.0 3,814 Yes 5.1 1.4 93.5 100.0 1,851 Region Northern Uplands 1.5 1.1 97.3 100.0 1,099 Red River Delta 2.6 0.9 96.5 100.0 1,363 North Central 2.9 0.4 96.7 100.0 722 Central Coast 7.0 0.5 92.5 100.0 594 Central Highlands 7.2 2.8 90.0 100.0 183 Southeast 17.8 2.7 79.6 100.0 648 Mekong River Delta 11.9 2.4 85.6 100.0 1,056 Education No education 6.3 1.4 92.3 100.0 364 Some primary 7.8 2.1 90.0 100.0 966 Completed primary 8.2 2.3 89.5 100.0 1,599 Compl. lower secondary 4.7 0.3 95.0 100.0 1,783 Compl. higher secondary+ 5.8 1.1 93.1 100.0 953 Total 6.5 1.4 92.1 100.0 5,665 The data indicate that a large majority of women are currently working (92 percent). An additional one percent of women worked in the last 12 months, but are currently unemployed, and 7 percent did not work in the last 12 months. Rural women are more likely to be employed (94 percent) than urban women (83 percent). There is little difference in terms of current employment between women living in project provinces (94 percent) and nonproject provinces (91 percent). Work status differs by region. Employment is highest in the Northern Uplands, North Central and Red River Delta regions (97 percent each) and lowest in the Southeast region where Ho Chi Minh City is located (80 percent). Surprisingly, work status differs little by education, ranging from a high of 20 | Characteristics of Households and Respondents 95 percent among those who have completed lower secondary education to a low of 90 percent among those who have primary education. Type of Employer Table 2.13 shows that 39 percent of currently employed women work for a family member, 37 percent are self-employed, 10 percent work for the government, 7 percent work in a cooperative, and 6 percent work for someone else. Table 2.13 Type of employer Percent distribution of currently employed, ever-married women by type of employer and background characteristics, Vietnam 2002 Employer Background characteristic Family member Cooperative Government Someone else Self- employed Total Number of women Age 15-19 68.3 1.9 3.0 1.9 24.9 100.0 53 20-24 51.8 4.0 7.5 8.1 28.2 100.0 469 25-29 40.3 7.7 12.5 6.2 33.3 100.0 914 30-34 41.2 7.7 7.9 7.4 35.7 100.0 1,033 35-39 37.0 7.3 9.1 6.4 40.3 100.0 1,035 40-44 34.5 8.5 11.1 5.0 40.8 100.0 987 45-49 35.8 7.8 9.9 4.8 41.7 100.0 727 Residence Urban 20.1 1.0 31.8 10.1 37.0 100.0 897 Rural 43.4 8.7 5.2 5.4 37.3 100.0 4,320 Project province No 41.4 6.0 9.7 7.5 35.3 100.0 3,487 Yes 35.5 10.1 9.8 3.5 41.1 100.0 1,730 Region Northern Uplands 50.2 5.7 6.6 1.0 36.5 100.0 1,069 Red River Delta 31.3 23.8 13.5 4.2 27.1 100.0 1,315 North Central 73.6 0.2 4.9 0.5 20.8 100.0 698 Central Coast 54.2 0.1 13.7 2.8 29.2 100.0 550 Central Highlands 32.7 0.2 14.2 2.8 50.1 100.0 165 Southeast 5.0 1.0 15.0 15.9 62.9 100.0 516 Mekong River Delta 23.9 0.4 5.6 16.7 53.3 100.0 905 Education No education 47.2 12.3 0.0 11.4 29.1 100.0 336 Some primary 40.4 3.7 1.0 11.4 43.4 100.0 869 Completed primary 45.5 3.8 2.4 4.9 43.3 100.0 1,431 Compl. lower secondary 42.3 11.8 3.9 4.5 37.4 100.0 1,694 Compl. higher secondary+ 20.1 6.6 44.9 4.3 24.1 100.0 887 Total 39.4 7.4 9.8 6.2 37.2 100.0 5,217 Rural women are much more likely to work for a family member (43 percent) than urban women (20 percent). On the other hand, 32 percent of urban women work for the government, compared with 5 percent of rural women. There is little variation in the type of employer between project and nonproject provinces. A high proportion of women who live in the Southeast, Mekong River Delta and Central Highlands are self-employed (63, 53, and 50 percent, respectively). Nearly one in four (24 percent) Characteristics of Households and Respondents | 21 women living in the Red River Delta region works in a cooperative. Women in the North Central and Central Coast regions predominantly work for a family member (74 and 54 percent, respectively). Level of education is related to type of employer. In general, as the level of education rises, the percentage of women working for a family member declines and the percentage working for the government increases. This is especially evident among women who have completed higher secondary school, 45 percent of whom work for the government. Women with primary education are equally likely to be self-employed or work for a family member. Cash Earnings All but a tiny fraction of women who work earn cash. Women earning cash for their work were asked who mainly decides how their earnings will be used. Table 2.14 indicates that 48 percent of respondents report that they decide jointly with their husband how their earnings will be used, while 31 percent decide by themselves, and 17 percent report that their husband decides. Among ever-married women who are not currently married, nine in ten decide themselves how to use their earnings. Urban working women are more likely to decide themselves on the use of their own cash earnings (42 percent) than rural women (28 percent). By region, the proportion of women who decide themselves on how to use their cash earnings is highest in the Central Coast (47 percent), followed by the Central Highlands (41 percent). Sole decision- making by women themselves is lowest in the Northern Uplands (20 percent), and Red River Delta (25 percent) regions. However, three in ten women in the Northern Uplands region state that their husband alone makes decisions about using cash earnings, whereas one in ten women in the Red River Delta decide jointly with their husband how cash earnings are used. There is a strong relationship between decisionmaking and level of education. The more educated a woman is, the less likely her husband is the sole decisionmaker. While 41 percent of women with no education report that their husbands alone make decisions as to how to use their earnings, the proportion drops to 9 percent among women with completed higher secondary education. 22 | Characteristics of Households and Respondents Table 2.14 Decision on use of earnings Percent distribution of employed women who receive cash earnings by person who decides how earnings will be used, according to background characteristics, Vietnam 2002 Person who decides how earnings are used Background characteristic Respondent Husband Jointly with husband Someone else Jointly with someone else Total Number of women Age 15-19 22.7 9.0 18.5 41.3 8.3 100.0 51 20-24 18.3 17.3 43.9 18.4 2.2 100.0 467 25-29 23.7 19.9 48.7 6.8 0.8 100.0 914 30-34 31.0 18.1 48.5 2.0 0.4 100.0 1,033 35-39 30.9 16.7 51.2 0.8 0.4 100.0 1,034 40-44 36.2 14.6 48.8 0.3 0.1 100.0 986 45-49 40.6 12.9 45.3 0.3 0.9 100.0 726 Residence Urban 42.4 7.3 46.1 3.2 1.0 100.0 895 Rural 28.4 18.5 48.4 4.1 0.7 100.0 4,315 Project province No 31.2 18.1 45.4 4.4 0.9 100.0 3,484 Yes 30.0 13.6 53.2 2.9 0.3 100.0 1,726 Region Northern Uplands 20.3 29.2 44.2 5.5 0.8 100.0 1,069 Red River Delta 24.7 10.7 62.1 2.1 0.3 100.0 1,315 North Central 34.8 18.3 44.0 2.6 0.2 100.0 698 Central Coast 46.5 16.9 33.4 2.6 0.6 100.0 550 Central Highlands 40.9 13.1 43.2 2.2 0.6 100.0 164 Southeast 38.0 9.4 47.8 3.0 1.8 100.0 513 Mekong River Delta 33.4 13.4 44.8 7.2 1.1 100.0 902 Education No education 24.1 41.2 30.0 4.4 0.4 100.0 335 Some primary 32.7 20.8 40.6 5.0 0.9 100.0 869 Completed primary 30.7 15.8 47.2 5.1 1.2 100.0 1,427 Compl. lower secondary 29.5 14.5 52.1 3.4 0.4 100.0 1,692 Compl. higher secondary+ 33.9 8.5 55.5 1.6 0.5 100.0 887 Current marital status Not married 89.3 0.0 0.0 6.5 4.0 100.0 314 Currently married 27.1 17.7 51.0 3.7 0.5 100.0 4,896 Total 30.8 16.6 48.0 3.9 0.7 100.0 5,210 Child Care While Working 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 at work. Characteristics of Households and Respondents | 23 Table 2.15 Child care while working Percent distribution of currently employed women by whether they have a child under six years of age and the percent distribution of employed mothers with a child under six by person who cares for the youngest such child while mother is at work, according to background characteristics, Vietnam 2002 — Employed ———————————————————————————————————————————————————————————————————— women Child’s caretaker, among employed women who have a child <6 years Number of ——————— ———————————————————————————————————— employed One or Number Not women No more of em- Other Neigh- Servant/ School Other Other worked with Background child children ployed Respon- Hus- rela- bor/ hired inst. female male since child characteristic <6 <6 women dent band tive friend help care child child birth Other Total <6 ————————————————————————————————————————————————————————————————————— Residence Urban 66.1 33.9 0,897 12.0 2.2 32.8 0.8 4.4 40.9 3.0 0.6 2.4 0.7 100.0 304 Rural 62.1 37.9 4,320 13.2 4.0 45.9 0.9 0.1 19.5 10.2 3.2 1.7 0.4 100.0 1,637 24 | Project province No 62.5 37.5 3,487 14.9 2.7 43.9 0.7 0.9 22.5 9.0 2.8 1.1 0.5 100.0 1,308 Yes 63.5 36.5 1,730 9.1 5.9 43.7 1.1 0.4 23.5 9.3 2.8 3.2 0.4 100.0 631 Region Northern Uplands 63.2 36.8 1,069 9.1 3.8 53.0 0.9 0.3 16.5 12.5 2.4 0.1 0.1 100.0 393 Red River Delta 67.2 32.8 1,315 5.6 3.2 38.2 0.3 0.5 40.5 4.0 0.0 6.3 0.1 100.0 431 North Central 61.1 38.9 698 5.0 5.9 47.7 1.4 0.0 21.9 11.4 4.8 1.5 0.2 100.0 272 Central Coast 49.9 50.1 550 26.1 3.5 34.1 1.3 1.0 19.3 10.2 2.5 0.2 1.0 100.0 276 Central Highlands 48.1 51.9 165 13.5 3.5 37.6 2.1 0.5 18.3 17.5 4.0 1.2 1.7 100.0 86 Southeast 67.3 32.7 516 17.9 2.6 32.2 0.0 4.2 28.8 6.5 4.9 0.7 0.4 100.0 169 Mekong River Delta 65.2 34.8 905 20.3 3.2 53.0 0.7 0.3 8.3 8.1 4.0 0.0 0.8 100.0 315 Education No education 53.5 46.5 336 11.3 1.9 48.5 1.1 0.0 0.6 26.8 7.2 0.0 0.9 100.0 156 Some primary 68.2 31.8 869 14.5 3.0 52.8 0.5 0.0 7.1 14.8 5.8 0.0 0.4 100.0 276 Completed primary 55.8 44.2 1,431 16.2 3.5 49.8 0.3 0.1 18.1 6.7 2.3 1.3 0.7 100.0 633 Compl. lower secondary 67.9 32.1 1,694 11.1 4.5 38.0 1.9 0.5 31.7 6.3 1.7 3.0 0.1 100.0 544 Compl. higher secondary+ 62.6 37.4 887 9.4 4.2 32.2 0.3 3.4 40.8 5.2 0.7 3.0 0.4 100.0 332 Work for family, others, self For family member 57.9 42.1 2,057 12.0 3.8 49.0 0.7 0.1 19.2 9.6 2.9 1.6 0.1 100.0 866 For someone else 64.5 35.5 1,216 5.6 3.4 42.5 0.5 2.4 32.6 9.0 1.0 2.5 0.5 100.0 432 Self-employed 67.0 33.0 1,942 19.1 3.8 37.6 1.3 0.6 21.1 8.5 3.8 1.6 0.8 100.0 641 Total 62.8 37.2 5,217 13.0 3.7 43.8 0.8 0.8 22.8 9.1 2.8 1.8 0.4 100.0 1,941 Overall, almost four in ten currently employed women have a child under 6 years of age. These women report that while they are at work, their children are cared for primarily by relatives (44 percent), by a school or institution that the children attend (23 percent), by the women themselves (13 percent), and by other female children (9 percent). Relatives other than the respondent’s husband and schools/childcare institutions are the most common caretakers for children of working women in both urban and rural areas. However, rural children are more likely than urban children to be looked after by other relatives (46 versus 33 percent), whereas urban children are more likely to attend school or receive institutional care than rural children (41 versus 20 percent). The role of female siblings in childcare in the absence of their mother is significant in rural areas and in families where the mother has limited education. Children living in nonproject provinces are more likely to be cared for by their mothers than children living in project provinces. Characteristics of Households and Respondents Educated women are more likely than women with little or no education to have their children attend school or receive institutional care or care by servants or hired help. Less educated women are more likely to have a child cared for by another female or male child or another relative other than the husband. Women who reside in the south of Vietnam more frequently care for their children themselves than those who reside in the north. 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 planning messages. Table 2.16 shows that 30 percent of women read a newspaper, 54 percent listen to the radio, and 86 percent watch television at least once a week. Nine percent of all respondents are not exposed to any of these mass media. Women in rural areas are less exposed to mass media than urban women. Ten percent of rural women have no exposure to mass media compared with 3 percent of urban women. Another significant finding is that 14-15 percent of women in the Mekong River Delta and Central Highlands reported having no media exposure, which is about twice as high as the national level. Conversely, one-third of women in the Red River Delta are exposed to all three media. There is a strong positive association between media exposure and level of education: as education increases, exposure to mass media increases. The proportion of women exposed to all three media rises from 0 among women with no education to almost half of those who have completed higher secondary school. Comparison with data from the VNDHS 1997 shows that exposure to television has increased over the last 5 years, from 77 to 86 percent of ever-married women. However, radio listenership has declined from 64 percent of women in 1997 to 54 percent in 2002, while newspaper readership has remained steady at 30-31 percent. Characteristics of Households and Respondents | 25 Table 2.16 Access to mass media Percentage of ever-married women who usually read a newspaper, listen to the radio, or watch television at least once a week, by background characteristics, Vietnam 2002 Media exposure Background characteristic No media exposure Reads newspaper Listens to radio Watches television All three media Number of women Age 15-19 16.2 30.5 52.4 78.5 24.5 69 20-24 11.5 30.7 52.7 81.2 19.8 552 25-29 10.3 30.0 51.6 83.1 19.2 1,000 30-34 7.1 28.6 54.8 86.6 19.6 1,105 35-39 7.0 29.8 52.3 87.9 19.4 1,098 40-44 8.4 31.4 56.3 86.8 21.1 1,046 45-49 7.7 27.3 55.3 87.9 20.0 795 Residence Urban 3.3 61.1 51.6 95.0 38.3 1,081 Rural 9.7 22.3 54.4 83.7 15.5 4,584 Project province No 8.9 30.4 52.4 85.3 20.2 3,814 Yes 7.7 28.0 56.9 86.9 19.1 1,851 Region Northern Uplands 11.8 20.6 60.4 74.3 14.2 1,099 Red River Delta 1.0 42.1 72.0 97.1 32.9 1,363 North Central 7.4 20.2 47.5 87.9 12.3 722 Central Coast 9.1 28.0 39.3 86.4 13.4 594 Central Highlands 14.2 25.4 32.5 80.7 13.7 183 Southeast 7.0 48.5 48.6 89.9 28.6 648 Mekong River Delta 15.0 19.6 43.2 79.9 13.7 1,056 Education No education 32.7 0.2 36.5 44.3 0.0 364 Some primary 19.2 10.0 42.1 72.9 6.6 966 Completed primary 7.3 21.5 50.4 87.5 13.2 1,599 Compl. lower secondary 3.2 31.0 60.5 93.2 21.6 1,783 Compl. higher secondary+ 0.4 71.9 65.7 98.3 49.0 953 Total 8.5 29.7 53.9 85.8 19.9 5,665 26 | Characteristics of Households and Respondents FERTILITY 3 An important objective of the VNDHS 2002 is to estimate fertility levels, trends, and differen- tials. Information on fertility will help to determine the impact of family planning use and changes in the age at marriage, use of induced abortion and other proximate determinants of fertility. In addition, data on fertility will help in monitoring the achievements of the government’s population policies and pro- grams. The fertility measures presented in this chapter are based on the reported reproductive histories of ever-married women 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 that did not end in a live birth (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 period preceding the sur- vey, which corresponds to the period 1998-2002. This period was chosen in order to be comparable to the VNDHS 1997 as well as to provide data on the inter-survey period. 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.1 Age-specific fertility rates are useful in understanding the age pattern of fertility. In an ever-married sample of women such as in the VNDHS, the calculation of all-women fertility rates makes the implicit assumption that no births occurred among women who have never married. The total fertility rate (TFR) is a useful summary measure of fertility levels. The TFR is calcu- lated by summing the age-specific fertility rates and multiplying by five. It is interpreted as the number of children a woman would bear during her lifetime if she were to experience the age-specific fertility rates prevailing 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. 1 Numerators for the age-specific fertility rates were obtained by classifying births during the 5-year period prior to the survey into standard five-year age groups, according to the mother’s age at the time of birth, and summing. De- nominators 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, 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-married in each age group. These factors were calculated 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 under- estimation of fertility from this source is negligible. Fertility | 27 Fertility estimates for Vietnam are shown in Table 3.1 and Figure 3.1. At the national level the TFR is 1.9 children per woman, which indicates that on av- erage, a Vietnamese woman will give birth to fewer than two children during her lifetime. In rural areas, the TFR is 2.0 children per woman, or 42 percent higher than the rate for urban areas (1.4 children per woman). On the other hand, the difference in the TFR between project and nonproject provinces is relatively small (1.9 and 1.8 children per woman, respectively). Fertility Trends A series of fertility estimates from five national surveys is shown in Table 3.2. The total fertility rate in Vietnam has declined precipitously from 4.0 children per woman in 1987 to 1.9 in 1998-2002. Between the 1997 and VNDHS 2002 surveys, the TFR declined by 0.8 children or 30 percent in a period of five and a half years.2 This is a remarkable decline, especially consid- ering the steep decline recorded for the 1992-96 period and the already low level of fertility in Vietnam. Table 3.1 Current fertility rates Age-specific and cumulative fertility rates and crude birth rate for the five-year period preceding the survey, by urban-rural residence and project-nonproject prov- ince, Vietnam 2002 Residence Project province Age Urban Rural No Yes Total 15-19 10 28 26 19 25 20-24 69 158 132 151 138 25-29 107 116 114 114 114 30-34 68 58 59 60 60 35-39 23 26 25 27 26 40-44 3 12 8 13 10 45-49 2 2 1 2 2 TFR 15-49 1.40 1.99 1.83 1.93 1.87 TFR 15-44 1.39 1.99 1.82 1.92 1.86 GFR 46 66 61 62 62 CBR 12.1 15.8 15.0 14.9 15.0 Note: Rates are for the period 1-60 months preceding the survey. Rates for age group 45-49 may be slightly biased due to truncation. TFR: Total fertility rate for ages 15-49, expressed per woman GFR: General fertility rate (births divided by number of women 15-44), expressed per 1,000 women 2 The TFR for the VNDHS 2 1998 to mid-2 28 | Fertility CBR: Crude birth rate, expressed per 1,000 population Figure 3.1 Total Fertility Rates by Residence 1.9 1.4 2.0 1.8 1.9 Vietnam Urban Rural Project province Nonproject province Vietnam 2002 the VNDHS 1997 was calculated for the calendar period 1992-96, with a mid-point of mid-1994. For 002, fertility rates refer to the 5-year period prior to the survey which corresponds roughly to mid- 002, with a mid-point of early 2000. Table 3.2 Trends in fertility rates Age-specific and total fertility rates, selected sources, Vietnam 1987-2002 Age 1988 VNDHS (1987) 1989 Census (1988-89) 1994 ICDS (1989-93) 1997 VNDHS (1992-96) 2002 VNDHS (1998-02) 15-19 20 35 38 39 25 20-24 235 197 196 178 138 25-29 243 209 189 148 114 30-34 151 155 124 95 60 35-39 85 100 69 52 26 40-44 51 49 31 20 10 45-49 11 14 2 4 2 TFR 15-49 3.98 3.80 3.25 2.67 1.87 Source: NCPFP, 1990; GSO, 1995:33; NCPFP, 1999:30 Nevertheless, several countries have experienced declines in the TFR of roughly this magnitude, e.g., Thailand, Sri Lanka, Turkey, and Morocco (Chayovan et al., 1988; DCS and IRD, 1988; Mboup and Saha, 1998; and Azelmat et al., 1996). However, a review of the rates of fertility decline between surveys in the DHS program would imply that the rate of decline measured in the VNDHS 2002 is unprecedented (Mboup and Saha, 1998; Rutstein, 2002).3 A review of the VNDHS 2002 data does not indicate any obvious flaws with the data. The most commonly suspected errors such as biases in the age reporting of women or deliberate displacement of the dates of births outside of the reference period used for fertility calculations are not likely to have much of an effect on the TFR for the five years before the survey. Similarly, examination of the weighting factors used to inflate ever-married women to represent all women does not show any significant problem. Omis- sion of births—either because respondents avoid or forget mentioning them or because interviewers de- liberately omit them to reduce their work—could be a factor in the low reported fertility rates and analysis of the recent childhood mortality rates suggests possible omission of recent neonatal deaths (see Chapter 7). Outright omission of births is difficult to detect. On the other hand, there is evidence to support the fact that there has been an extremely rapid fer- tility decline. Internal evidence from the pregnancy history in the VNDHS 2002 shows that the TFR for the period 5-9 years prior to the survey (roughly equivalent to 1992-96) was 2.8, very close to the TFR of 2.7 reported from the VNDHS 1997. Although contraceptive use has not increased significantly between the two surveys, there has been a decline in the proportions of women married at ages 15-24 (see Table 5.1). An increase in the total abortion rate (see Table 4.19) would also depress the TFR. A comparison of age-specific fertility rates from the VNDHS 2002 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. 3 Using the annual percentage decline formula: r = ln (TFR0/TFR1)/ t ×100, the decline in Vietnam is 6.4 percent. Of the 10 DHS countries examined by Mboup and Saha, the highest rate of decline between two surveys occurred in Kenya with 5.2 percent. Of the 21 DHS countries examined by Rutstein, the highest rate of decline was noted for Jordan at 3.5 percent (Rutstein, 2002:25). Fertility | 29 In summary, although there has no doubt been a precipitous decline in fertility over the past five years in Vietnam, it is also likely that there was some underreporting of births in 2002 relative to the pre- vious surveys. Consequently, the steepness of the decline may be exaggerated somewhat. Fertility Differentials Table 3.3 presents fertility levels by urban-rural residence, project province status, region, and educational attainment. Three measures of fertility are shown: the total fertility rate, the percentage of women who were pregnant at the time of the survey and the average number of children ever born to women age 40-49. Differentials in fertility by urban-rural residence have already been discussed. There is very little difference in fertility by whether the province falls within the NCPFP project or not. The highest fertility is observed in the Central Highlands (2.9 children per woman). This is considerably higher than in any other region. The lowest fertility levels are observed in the Southeast region, which includes Ho Chi Minh City (1.5), in the Red River Delta, which includes Hanoi City (1.7), and in the Mekong River Delta (1.7). Fertility differentials by education are substantial and are inversely related to educa- tional attainment. Women who completed higher secondary school have the lowest fertil- ity (1.4 children per woman) while those with no education have the highest fertility (2.8 per woman) or twice as high Another interesting fertility indicator is the percentage of women who are pregnant at the time of the survey. Although some women may not be aware that they are pregnant, while others may be reluctant to disclose a preg- nancy, the indicator can be useful as a rough gauge of future fertility, especially since it is not subject to recall errors. Only 3 percent of the ever-married women interviewed reported that they were pregnant at the time of inter- view. Differentials in current pregnancy gener- ally follow the same patterns as the TFR. 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 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. Table 3.3 Fertility by background characteristics Total fertility rate for the five years preceding the survey, per- centage currently pregnant, and mean number of children ever born to women age 40-49, by background characteristics, Vietnam 2002 Fertility indicator Background characteristic Total fertility rate1 Percent currently pregnant1 Mean CEB (40-49) Residence Urban 1.40 2.21 2.43 Rural 1.99 3.44 3.64 Project province No 1.83 3.18 3.34 Yes 1.93 3.21 3.40 Region Northern Uplands 2.01 2.52 3.89 Red River Delta 1.65 3.18 2.61 North Central 1.92 3.14 3.82 Central Coast 2.37 3.90 3.57 Central Highlands 2.90 3.51 4.64 Southeast 1.51 3.35 2.81 Mekong River Delta 1.69 3.31 3.73 Education No education 2.82 5.22 4.70 Some primary 1.98 2.89 4.04 Completed primary 2.13 3.52 3.59 Compl. lower secondary 1.71 2.29 3.01 Compl. higher secondary+ 1.39 3.92 2.25 Total 1.87 3.19 3.36 1 Women age 15-49 30 | Fertility The results of this comparison in Table 3.3 indicate that there has been a significant fertility de- cline 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 given birth to an average of 3.4 children, or one and a half children more than the current total fertility rate of 1.9 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 (1.7) than for urban areas (1.0). 3.2 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 number of children ever born and mean number of living children. The data indicate that only 2 percent of all women age 15-19 have given birth. On average, women in their early thirties have given birth to two children, while women in their early 40s have given birth to a three children. The statistics for currently married women do not differ greatly from those for all women at older ages; however, at younger ages the percentage of currently mar- ried women who have had children is much higher than the percentage among all women. Table 3.4 Children ever born and living Percent distribution of all women and currently married women by number of children ever born (CEB) and mean number ever born and living, according to age, Vietnam 2002 Children ever born Age 0 1 2 3 4 5 6 7 8 9 10+ Total Number of women Mean CEB Mean living children ALL WOMEN 15-19 98.3 1.7 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 1,630 0.02 0.02 20-24 61.2 28.5 9.5 0.8 0.1 0.0 0.0 0.0 0.0 0.0 0.0 100.0 1,155 0.50 0.49 25-29 22.8 29.8 36.0 8.3 2.8 0.3 0.0 0.0 0.0 0.0 0.0 100.0 1,221 1.39 1.34 30-34 10.3 14.1 46.7 19.5 7.7 1.2 0.4 0.1 0.0 0.0 0.0 100.0 1,197 2.06 1.98 35-39 6.6 9.6 36.5 25.8 13.2 4.9 2.0 0.8 0.5 0.1 0.0 100.0 1,162 2.59 2.45 40-44 8.4 5.3 25.7 22.5 19.4 10.4 5.4 2.0 0.7 0.2 0.2 100.0 1,128 3.08 2.89 45-49 6.7 4.9 18.1 19.3 21.6 10.8 8.0 4.9 2.4 1.6 1.7 100.0 838 3.74 3.43 Total 35.3 13.2 23.7 12.7 8.2 3.4 1.9 0.9 0.4 0.2 0.2 100.0 8,330 1.73 1.63 CURRENTLY MARRIED WOMEN 15-19 59.1 40.9 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 67 0.41 0.41 20-24 19.2 59.1 19.9 1.7 0.1 0.0 0.0 0.0 0.0 0.0 0.0 100.0 536 1.04 1.02 25-29 5.8 35.3 44.6 10.4 3.5 0.3 0.1 0.0 0.0 0.0 0.0 100.0 977 1.72 1.65 30-34 2.5 13.5 51.9 21.7 8.5 1.3 0.4 0.1 0.0 0.0 0.0 100.0 1,062 2.27 2.18 35-39 0.8 8.3 40.4 27.9 14.4 4.9 1.9 0.9 0.5 0.1 0.0 100.0 1,042 2.77 2.61 40-44 1.3 4.3 27.3 24.8 21.7 11.1 6.0 2.3 0.8 0.3 0.2 100.0 966 3.38 3.17 45-49 1.7 3.1 17.6 20.4 23.4 12.1 9.2 6.0 2.6 2.0 2.1 100.0 687 4.10 3.78 Total 4.9 18.4 35.6 19.0 12.1 4.8 2.7 1.4 0.6 0.3 0.3 100.0 5,338 2.56 2.41 A comparison of the mean number of children ever born (CEB) reported in the 1989 census (1.9), the ICDS-94 (1.9), the VNDHS 1997 (1.9), and the VNDHS 2002 (1.6) is shown in Table 3.5. The com- parison 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 data show almost no change in mean number of Fertility | 31 children ever born among younger women until the VNDHS 2002. The decline in fertility is seen almost exclusively among older women; for example, the mean number of children ever born among women age 45-49 has declined from 4.9 to 3.4 in 13 years. The fact that the overall mean has not fallen until 2002 is in part due to the increasingly older age distribution among women. Table 3.5 Trends in mean number of children ever born Mean number of children ever born by age group, selected sources, Vietnam 1989-2002 Age 1989 Census 1994 ICDS 1997 VNDHS 2002 VNDHS 15-19 0.05 0.04 0.04 0.02 20-24 0.63 0.64 0.61 0.49 25-29 1.67 1.66 1.50 1.34 30-34 2.77 2.57 2.33 1.98 35-39 3.64 3.49 3.01 2.45 40-44 4.36 4.12 3.64 2.89 45-49 4.94 4.62 4.08 3.43 Total 1.94 1.90 1.86 1.63 Source: NCPFP, 1999:32 3.3 BIRTH INTERVALS There is a considerable body of research that indicates that short birth intervals are harmful 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 2002 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 four or more years after the previous birth, while over one-third (36 percent) take place 24-47 months after the previous birth. Fewer than one in six births (16 percent) occurs after an interval of less than 24 months. The median birth interval is 47 months. This is considerably longer than the median birth interval of 36 months reported for the VNDHS 1997 (NCPFP, 1999) and the 32 months reported in the 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 32 months, compared with more than 60 months for other women. The shortest median birth interval prevails for children whose preceding sibling has died. 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. 32 | Fertility Table 3.6 Birth interval Percent distribution of births in the five years before the survey by length of interval (months) since previous birth and median length of birth interval, according to demographic and background characteristics, Viet- nam 2002 Months since previous birth Characteristic 7-17 18-23 24-35 36-47 48+ Total Number of births Median length of birth interval Mother’s age 20-29 9.4 14.7 31.8 12.0 32.1 100.0 594 32.1 30-39 2.5 6.0 15.8 13.9 61.8 100.0 622 60.0 40+ 4.9 6.5 17.6 6.7 64.3 100.0 102 59.5 Birth order 2-3 5.9 10.3 21.8 11.9 50.1 100.0 1,053 48.1 4-6 5.1 5.1 28.6 15.2 46.0 100.0 224 43.7 7+ (7.9) (27.9) (27.1) (12.7) (24.4) 100.0 41 (29.8) Sex of prior birth Male 5.0 10.3 24.5 12.3 47.9 100.0 610 46.9 Female 6.5 9.7 22.0 12.6 49.3 100.0 707 46.8 Survival of prior birth No 31.0 14.5 33.5 4.6 16.5 100.0 52 26.3 Yes 4.8 9.8 22.7 12.8 49.9 100.0 1,266 47.9 Residence Urban 0.9 4.5 11.8 9.6 73.2 100.0 166 65.7 Rural 6.5 10.8 24.8 12.9 45.1 100.0 1,152 43.2 Project province No 5.6 9.6 22.4 13.7 48.7 100.0 869 47.0 Yes 6.2 10.8 24.5 10.0 48.5 100.0 449 46.6 Region Northern Uplands 14.8 10.5 24.4 14.4 35.9 100.0 262 36.1 Red River Delta 4.1 5.5 13.9 12.5 64.1 100.0 246 58.3 North Central 3.9 9.5 25.6 14.3 46.7 100.0 195 46.3 Central Coast 2.6 12.3 25.9 12.8 46.4 100.0 199 46.0 Central Highlands 7.2 15.6 41.6 9.7 25.9 100.0 80 31.6 Southeast 2.2 10.7 23.5 11.0 52.6 100.0 130 50.2 Mekong River Delta 3.0 10.4 20.2 9.8 56.5 100.0 206 53.1 Mother’s education No education 16.8 18.9 31.6 8.0 24.6 100.0 151 30.2 Some primary 6.5 13.8 23.4 8.2 48.1 100.0 200 45.4 Completed primary 3.6 10.9 27.2 14.4 43.9 100.0 440 42.8 Compl. lower secondary 4.8 7.0 19.2 15.8 53.2 100.0 355 50.4 Compl. higher secondary+ 3.0 1.5 13.0 9.5 72.9 100.0 171 67.7 Total 5.8 10.0 23.1 12.5 48.6 100.0 1,318 46.9 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. Figures in parentheses are based on 25-49 unweighted cases. Fertility | 33 Differentials in the length of birth intervals by background characteristics are inversely related to fertility levels. The median duration is greater in urban areas (66 months) than in rural areas (43 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 (50-58 months). By level of education, mothers with a higher secon- dary education have a median birth interval of 68 months, compared with 30 months for mothers with no education. 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 births, reflecting an increase in the age at marriage, has contributed to overall fertility decline. Alternatively, early onset of childbearing tends to increase the number of children a woman will have during her repro- ductive years. Even when family planning is widespread, the timing of first births can affect completed family size. 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 shown 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 23.5 years among women age 45-49. Compared with data from the VNDHS 1997, the median age at first birth has either remained the same or declined slightly. Table 3.7 Age at first birth Percent distribution of women by exact age at first birth and median age at first birth, according to current age, Vietnam 2002 Age at first birth Age No birth <15 15-17 18-19 20-21 22-24 25+ Total Number of women Median age at first birth 15-19 98.3 0.2 0.6 1.0 na na na 100.0 1,630 a 20-24 61.2 0.2 3.7 12.0 14.2 8.6 na 100.0 1,155 a 25-29 22.8 0.3 7.3 17.6 20.9 20.9 10.1 100.0 1,221 22.6 30-34 10.3 0.0 2.3 18.0 30.4 25.4 13.5 100.0 1,197 21.9 35-39 6.6 0.2 4.2 14.1 23.5 29.3 22.1 100.0 1,162 22.7 40-44 8.4 0.0 2.8 12.8 19.0 32.1 24.9 100.0 1,128 23.2 45-49 6.7 0.3 3.6 11.5 19.2 28.8 30.0 100.0 838 23.5 na = Not applicable a = Omitted because less than 50 percent of women had a birth before reaching the age group Table 3.8 shows the median age at first birth for different subgroups of the population. The meas- ures 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 highest in the Southeast region (24.6 years) and lowest in the Northern Uplands (21.9 years). Median age at first birth is positively related to women’s level of educa- tion. It does not differ by project province status. 34 | Fertility Table 3.8 Median age at first birth by background characteristics Median age at first birth among women aged 25-49 years, by current age and background characteristics, Vietnam 2002 Current age Background characteristic 25-29 30-34 35-39 40-44 45-49 25-49 Residence Urban a 24.4 24.4 24.9 24.9 24.9 Rural 21.7 21.6 22.3 22.8 23.1 22.3 Project province No 22.7 22.0 22.7 23.3 23.4 22.8 Yes 22.2 21.8 22.8 23.0 23.7 22.7 Region Northern Uplands 20.5 21.8 21.7 22.6 23.4 21.9 Red River Delta 23.3 21.4 23.4 23.9 24.1 23.2 North Central 21.9 21.6 22.6 22.8 23.5 22.4 Central Coast 23.3 22.2 22.9 24.1 23.1 23.0 Central Highlands 22.9 22.1 25.2 22.1 23.0 23.0 Southeast a 25.6 23.6 23.8 24.9 24.6 Mekong River Delta 23.5 22.0 22.3 22.1 22.6 22.5 Education No education 19.9 21.1 21.8 21.6 21.9 21.2 Some primary 20.8 21.2 21.2 22.1 22.4 21.6 Completed primary 22.2 22.0 22.0 22.4 23.2 22.3 Compl. lower secondary 21.9 21.7 22.7 23.3 23.7 22.7 Compl. higher secondary+ a 23.3 24.6 25.0 25.8 24.9 Total 22.6 21.9 22.7 23.2 23.5 22.7 a = Omitted because less than 50 percent of women had a birth before reaching the age group. 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 slightly over 3 percent, of which half have given birth and half are pregnant with their first child. There are significant differences in the level of teenage childbearing by residence. The level in rural areas (4 percent) is double the level in urban areas (2 percent). By comparison, the difference in the level of teenage childbearing between project provinces and nonproject provinces is small. Fertility | 35 36 | Fertility By region, the percentage of teenage childbearing varies from 2 percent in the Central Highlands to 5 percent in the Central Coast. Teenage childbearing is strongly and inversely related to level of educa- tion. Teenage childbearing is highest among women with some primary education (10 percent), substan- tially lower among women who have completed lower secondary school (2 percent), and lowest among those who have completed higher secondary school (less than one percent). Table 3.9 Adolescent fertility Percentage of teenagers 15-19 who are mothers or pregnant with their first child, by background characteristics, Vietnam 2002 Teenage pregnancy Background characteristic Mothers Pregnant with first child Percentage who have begun childbearing Number of teenagers Age1 15 0.6 0.0 0.6 398 17 0.2 0.3 0.5 646 18 3.2 3.4 6.6 321 19 5.3 5.2 10.5 265 Residence Urban 0.7 0.9 1.6 275 Rural 2.0 1.8 3.7 1,351 Project province No 2.0 1.4 3.5 1,099 Yes 1.1 2.0 3.1 531 Region Northern Uplands 2.8 1.5 4.3 336 Red River Delta 0.7 1.8 2.5 330 North Central 1.6 1.1 2.8 235 Central Coast 3.1 1.7 4.8 152 Central Highlands 0.0 1.8 1.8 53 Southeast 0.7 2.3 3.0 184 Mekong River Delta 2.1 1.4 3.4 335 Education No education (1.3) (6.2) (7.5) 45 Some primary 7.0 3.0 10.0 135 Completed primary 3.0 1.5 4.5 490 Compl. lower secondary 0.5 1.4 1.9 794 Compl. higher secondary+ 0.0 0.5 0.5 167 Total 1.7 1.6 3.4 1,630 Note: Figures in parentheses are based on 25-49 unweighted cases. 1 No ever-married women age 16 were interviewed. FERTILITY REGULATION 4 4.1 KNOWLEDGE OF FAMILY PLANNING METHODS Knowledge of family planning methods and places to obtain them are crucial elements in the de- cision of whether to use a method and which method to use. In the VNDHS 2002, each respondent was first asked to mention all the methods she had heard of. When the respondent failed to mention a particu- lar method spontaneously, the interviewer read the name and a short description of the method and asked if she knew it. All methods recognized by the respondent after the method was described were recorded as known after probing (prompted knowledge). 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. 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. Table 4.1 indicates that virtually all women of reproductive age know of at least one method of contraception. As in the previous VNDHS surveys, the most widely known methods are the IUD (99 per- cent of currently married women), the condom (96 percent), the pill (95 percent), female sterilization (92 percent), and male sterilization (90 percent). Eighty-one percent of currently married women have heard of withdrawal and 70 percent know about the rhythm method or periodic abstinence. The proportion of currently married women who have heard of injectables is 60 percent. The least recognized methods— implants and vaginal methods—were known by 15 and 10 percent of currently married women, respec- tively. 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 1988-2002 Ever-married women Currently married women Contraceptive method 1988 VNDHS 1997 VNDHS 2002 VNDHS 1988 VNDHS 1997 VNDHS 2002 VNDHS Any method 94.1 98.8 99.5 94.7 98.9 99.6 Any modern method 93.6 98.5 99.4 94.3 98.7 99.5 Pill 46.4 89.0 95.0 46.8 89.5 95.3 IUD 91.8 97.3 98.3 92.5 97.6 98.5 Injections u 55.8 59.4 u 55.9 60.1 Vaginals u 10.0 10.1 u 10.1 10.3 Condom 44.5 92.1 96.0 45.0 92.5 96.3 Female sterilization 60.2 91.0 92.0 60.4 91.4 92.4 Male sterilization 49.2 89.0 89.8 49.7 89.5 90.3 Implant u 12.3 14.2 u 12.4 14.6 Any traditional method 43.0 80.0 84.1 u 80.8 85.3 Periodic abstinence 40.3 68.3 69.3 43.6 69.0 70.2 Withdrawal 6.7 70.4 79.5 41.1 71.5 80.6 Other methods u 2.0 0.8 6.8 2.0 0.8 Number of women u 5,664 5,665 u 5,340 5,338 u = Unknown (not available) Fertility Regulation | 37 Comparison of the levels of contraceptive knowledge between the VNDHS 1988, the VNDHS 1997 and the VNDHS 2002 indicates that the percentage of currently married women knowing specific methods has increased for every method. Knowledge of the IUD has increased the least (6 percentage points in comparison with the VNDHS 1988 and 1 percentage point in comparison with the VNDHS 1997) due to the fact that knowledge of the IUD was already very high in 1988. Other methods, however, show large increases: knowledge of the condom, the pill, male sterilization and withdrawal all doubled during period from 1988 to 2002. Knowledge of female sterilization increased from 60 to 92 percent over the same period. Increases in contraceptive knowledge since the VNDHS 1997 are more modest. The largest gain is in knowledge of withdrawal, which increased from 72 to 81 percent of currently married women and for injectables, which increased from 56 to 60 percent. Knowledge of at least one modern method of contraception is so high that there are almost no dif- ferences by background characteristics (data not shown). For example, there is only one group of cur- rently married women—those age 15-19—for whom the percentage knowing any modern method is less than 95 percent. 4.2 EVER USE OF FAMILY PLANNING METHODS All women interviewed in the VNDHS 2002 who said they had heard of a method of family planning were asked if they had ever used that method. Table 4.2 indicates that 9 out of 10 currently mar- ried women have used a method (91 percent). As in the previous surveys, the IUD is by far the most widely used method among currently married women (65 percent), having increased by 7 percentage points since 1997. The proportions of women who have ever used other modern methods have also in- creased. For example, the proportion of currently married women who have ever used condoms has in- creased from 13 percent in 1997 to 19 percent in 2002, while the proportion who have ever used the pill has increased from 10 to 18 percent. Six percent of currently married women reported having been steril- ized. Few women have used other modern methods. The level of ever use of traditional methods is high in Vietnam. More than one in three currently married women (38 percent) has used withdrawal, while al- most one-fourth have used periodic abstinence (23 percent). In 1997, 26 and 18 percent, respectively, had used these methods at some time. Ever-use rates vary by age group and are lowest among the youngest women. However, the fact that 29 percent of currently married women age 15-19 and 70 percent of those age 20-24 have used con- traception 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 an astoundingly high level of 96 percent for currently married women age 35-39, then declines to 92 percent among those age 45-49. 38 | Fertility Regulation Table 4.2 Ever use of contraception Percentage of ever-married women and of currently married women who have ever used any contraceptive method, by specific method and age, Vietnam 2002 Contraceptive method Age Any method Any modern method Pill IUD Injec- tions Dia- phragm foam, jelly Con- dom Female steri- lization Male steri- lization Any tradi- tional- method Periodic absti- nence With- drawal Other methods Number of women EVER-MARRIED WOMEN 15-19 31.0 21.2 3.2 15.0 0.0 0.0 4.7 0.0 0.0 13.8 5.1 11.3 0.0 69 20-24 69.9 58.5 17.4 41.3 0.5 0.0 9.9 0.1 0.0 26.0 9.6 21.8 0.0 552 25-29 89.3 78.5 20.3 62.6 0.9 0.2 16.7 0.7 0.2 39.0 15.9 33.7 0.0 1,000 30-34 92.8 82.7 21.9 68.1 1.4 0.0 21.8 3.3 0.3 47.6 24.0 38.5 0.2 1,105 35-39 94.1 83.1 18.2 68.7 1.1 0.2 21.7 9.0 0.9 50.3 26.4 42.8 0.1 1,098 40-44 91.5 80.6 14.6 67.2 2.2 0.2 19.8 9.9 0.7 50.0 29.1 41.1 0.4 1,046 45-49 86.7 76.0 11.4 62.8 1.2 0.0 13.1 10.3 0.5 45.9 25.0 37.5 0.5 795 Total 88.4 77.6 17.4 63.1 1.3 0.1 17.9 5.8 0.5 44.3 22.5 36.8 0.2 5,665 CURRENTLY MARRIED WOMEN 15-19 29.3 19.2 0.9 15.4 0.0 0.0 4.8 0.0 0.0 14.2 5.2 11.6 0.0 67 20-24 70.0 58.7 17.4 41.4 0.5 0.0 10.2 0.1 0.0 26.2 9.9 21.9 0.0 536 25-29 90.2 79.4 20.7 63.6 0.9 0.2 16.7 0.7 0.2 39.4 16.1 34.1 0.0 977 30-34 94.6 84.5 22.5 69.5 1.5 0.0 22.2 3.4 0.3 48.7 24.6 39.6 0.2 1,062 35-39 96.3 85.3 18.7 70.6 1.1 0.2 22.5 9.3 0.9 51.6 26.9 44.1 0.1 1,042 40-44 95.1 83.9 15.6 70.2 2.0 0.2 21.1 10.4 0.8 52.7 30.7 43.4 0.3 966 45-49 91.5 80.2 12.3 66.4 1.4 0.0 14.1 11.1 0.6 49.1 26.6 40.6 0.5 687 Total 90.5 79.6 18.1 64.9 1.3 0.1 18.6 5.9 0.5 45.7 23.1 38.1 0.2 5,338 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 of fertility de- terminants. Data on current use of contraception is presented in Table 4.3 for currently married women age 15-49. The survey results indicate that almost 79 percent of currently married women are using family planning, an increase of 3 percentage points from the rate in the VNDHS 1997 (75 percent). Use of mod- ern methods (57 percent) is much higher than use of traditional methods (22 percent). By far, the most commonly used method in Vietnam is the IUD, which is being used by 38 per- cent of currently married women (Figure 4.1); the next most common method is withdrawal (14 percent). Current use of modern methods other than the IUD is much lower; female sterilization, the condom, and the pill are each used by 6 percent of married women, while use of male sterilization and injectables are reported by less than 1 percent of women. Despite its predominance as the leading method in Vietnam, use of the IUD has actually declined slightly since 1997 (from 39 to 38 percent). Use of the pill has in- creased slightly (from 4 to 6 percent). Fertility Regulation | 39 Table 4.3 Current use of contraception Percent distribution of currently married women by contraceptive method currently used, according to age, Vietnam 2002 Contraceptive method Age Any method Any modern method Pill IUD Injec- tions Condom Female steri- lization Male steri- lization Any tradi- tional method Periodic absti- nence With- drawal Other methods Not currently using Total Number of women 15-19 22.8 14.1 0.0 14.1 0.0 0.0 0.0 0.0 8.6 2.6 6.0 0.0 77.2 100.0 67 20-24 57.7 44.5 9.0 30.9 0.4 4.1 0.1 0.0 13.2 1.6 11.6 0.0 42.3 100.0 536 25-29 73.4 56.9 8.0 42.2 0.4 5.4 0.7 0.2 16.5 3.8 12.8 0.0 26.6 100.0 977 30-34 83.1 63.3 9.2 42.9 0.4 7.1 3.4 0.3 19.6 7.8 11.8 0.2 16.9 100.0 1,062 35-39 90.2 65.0 5.3 42.3 0.3 7.0 9.3 0.8 25.2 8.5 16.8 0.0 9.8 100.0 1,042 40-44 88.8 60.1 4.7 36.9 0.5 6.9 10.4 0.7 28.7 11.2 17.5 0.0 11.2 100.0 966 45-49 68.2 42.3 1.9 25.4 0.2 3.0 11.1 0.6 25.8 10.5 15.3 0.1 31.8 100.0 687 Total 78.5 56.7 6.3 37.7 0.4 5.8 5.9 0.5 21.8 7.5 14.3 0.1 21.5 100.0 5,338 Rates of current use increase with age, reaching a maximum among women age 35-39 (90 per- cent). Beginning with age group 20-24, more than half of women are using contraception. Women in all age groups strongly prefer the IUD. The proportion using the IUD peaks at 43 percent among women age 30-34, while the proportion using female sterilization is highest among women age 45-49 (11 percent). Figure 4.1 Current Contraceptive Use Among Currently Married Women Differential Diffe and Figure 4 compared to 40 | Fertility Regulation Vietnam 2002 Not using 22% Withdrawal 14% Periodic abstinence 8% Other 1% Female sterilization 6% Condom 6% IUD 38% Pill 6% s in Current Use of Methods rentials in the use of contraception among currently married women are shown in Table 4.4 .2. The urban-rural differential is almost nonexistent, with 79 percent of urban women using, 78 percent of rural women. Surprisingly, urban women are slightly more likely than rural women to use traditional methods, while rural women are more likely than urban women to use modern methods (57 versus 55 percent, respectively). Women living in project and nonproject provinces are about equally likely to be current users (78 and 79 percent, respectively) and their method mix is similar. While contraceptive use has barely changed in the project provinces since 1997 (from 77 to 77.5 percent), it has increased slightly faster in the nonproject provinces (from 75 to 79 percent). Currently married women in the Central Highlands report the lowest rate of current use of any method (66 percent) and of modern methods (42 percent). In contrast, the highest level of current use is in the Red River Delta (83 percent for any method and 59 percent for modern methods). The North Central region is the next highest for overall use (80 percent for any method), while the Central Coast is the next highest for use of modern methods (59 percent). There is little difference in current use in the remaining four regions where use of any method varies from 76 to 78 percent. Table 4.4 Current use of contraception by background characteristics Percent distribution of currently married women by contraceptive method currently used, according to background characteristics, Vietnam 2002 Contraceptive method Background characteristic Any method Any modern method Pill IUD Injec- tions Con- dom Female steri- lization Male steri- lization Any tradi- tional method Periodic absti- nence With- drawal Other methods Not currently using Total Number of women Residence Urban 79.1 54.9 6.9 30.3 0.2 12.6 4.8 0.2 24.1 11.8 12.3 0.1 20.9 100.0 1,005 Rural 78.4 57.1 6.2 39.5 0.5 4.2 6.2 0.6 21.2 6.5 14.8 0.0 21.6 100.0 4,333 Project province No 79.0 56.9 7.0 37.5 0.4 6.3 5.5 0.3 22.1 7.1 14.9 0.0 21.0 100.0 3,586 Yes 77.5 56.2 5.0 38.3 0.5 4.8 6.8 0.9 21.2 8.2 13.0 0.1 22.5 100.0 1,752 Region Northern Uplands 78.4 56.6 4.7 44.4 0.2 3.7 3.2 0.3 21.7 5.3 16.4 0.1 21.6 100.0 1,049 Red River Delta 82.8 59.4 4.5 42.2 0.3 7.0 5.0 0.4 23.4 10.8 12.6 0.0 17.2 100.0 1,307 North Central 79.8 57.3 3.1 42.4 0.4 3.9 6.2 1.2 22.3 8.4 13.9 0.2 20.2 100.0 677 Central Coast 77.2 58.7 3.5 36.2 0.4 10.8 7.0 0.8 18.5 3.5 15.0 0.0 22.8 100.0 547 Central Highlands 66.3 41.6 2.0 21.2 0.6 5.5 12.3 0.0 24.7 8.1 16.6 0.0 33.7 100.0 172 Southeast 75.7 52.9 10.1 25.7 0.4 7.6 9.2 0.0 22.8 10.1 12.7 0.0 24.3 100.0 598 Mekong River Delta 76.7 56.6 12.7 32.5 0.7 3.9 6.3 0.4 20.0 5.2 14.9 0.1 23.3 100.0 989 Education No education 65.7 53.9 9.3 33.4 0.4 0.6 9.3 0.8 11.5 4.6 7.0 0.2 34.3 100.0 343 Some primary 76.1 57.7 11.1 34.5 0.6 2.9 8.2 0.4 18.3 4.0 14.3 0.1 23.9 100.0 886 Complete primary 77.7 56.4 5.8 38.7 0.5 4.3 6.6 0.5 21.2 5.3 15.9 0.1 22.3 100.0 1,506 Compl. lower secondary 82.8 58.4 3.9 42.2 0.4 5.5 5.7 0.7 24.4 9.2 15.2 0.0 17.2 100.0 1,684 Compl. higher secondary+ 79.2 54.1 5.8 32.7 0.1 13.6 2.0 0.0 25.1 12.3 12.8 0.0 20.8 100.0 919 No. of living children 0 6.7 3.8 2.2 0.3 0.0 1.0 0.3 0.0 2.9 1.6 1.3 0.0 93.3 100.0 265 1 67.6 46.6 7.8 32.2 0.1 5.5 1.0 0.0 21.0 6.0 15.0 0.0 32.4 100.0 1,022 2 88.8 66.6 6.8 46.7 0.6 8.4 3.7 0.5 22.0 8.4 13.6 0.1 11.2 100.0 2,007 3 86.7 61.0 6.4 40.7 0.4 4.4 8.6 0.5 25.7 8.3 17.5 0.0 13.3 100.0 1,050 4+ 79.6 56.5 4.7 32.3 0.4 3.7 14.2 1.1 23.0 7.9 15.1 0.1 20.4 100.0 994 Total 78.5 56.7 6.3 37.7 0.4 5.8 5.9 0.5 21.8 7.5 14.3 0.1 21.5 100.0 5,338 Fertility Regulation | 41 79 78 79 78 78 83 80 77 66 76 77 66 76 78 83 79 RESIDENCE 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 Compl. lower secondary Compl. higher secondary+ 0 20 40 60 80 100 Percent Vietnam 2002 Figure 4.2 Current Use of Any Contraceptive Method Among Currently Married Women Age 15-49, by Background Characteristics A strong positive relationship exists between education and current use of contraception. Signifi- cant 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 cur- rently married women currently using contraception varies from 66 percent among women with no educa- tion to 83 percent among women who completed lower secondary school. It falls back slightly among women who have completed at least higher secondary school (79 percent). While contraceptive use has increased since 1997 for all education categories except the highest, the increase is the largest for women with no education. In 1997, only 53 percent of married women with no education were using contracep- tion; in 2002, the rate was 66 percent. The pattern of contraceptive use by number of living children is as expected. Prevalence is very low among women who have no children (7 percent), peaks among women with two children (89 per- cent), and declines slightly among women with three or more children. 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 2002 included a question about the number of living children a woman had when she first used a method. Table 4.5 shows the percent distribution of ever-married women by the number of living children at the time of first use. Overall, almost half (46 percent) of women first used contraception be- fore having their second child and 70 percent first used before having their third child. The data in Table 4.5 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 Viet- namese women began using contraception earlier than older women. For example, 61 percent of women age 20-24 first used contraception before having the second child, compared to only 43 percent of women age 35-39 and 24 percent of women age 45-49. 42 | Fertility Regulation Table 4.5 Number of children at first use of contraception Percent distribution of ever-married women by number of living children at time of first use of contraception and median number of children at first use, according to current age, Vietnam 2002 Number of living children at first use of contraception Age Never used contraception 0 1 2 3 4+ Total Number of women 15-19 69.0 8.7 22.4 0.0 0.0 0.0 100.0 69 20-24 30.1 10.4 50.9 8.5 0.1 0.0 100.0 552 25-29 10.7 7.5 56.0 21.9 2.9 1.0 100.0 1,000 30-34 7.2 4.7 52.0 26.7 6.6 2.7 100.0 1,105 35-39 5.9 3.1 40.3 29.0 13.9 7.7 100.0 1,098 40-44 8.5 2.0 30.9 26.0 15.4 17.1 100.0 1,046 45-49 13.3 1.5 22.6 22.8 15.2 24.5 100.0 795 Total 11.6 4.5 41.9 23.5 9.5 8.8 100.0 5,665 The trend toward earlier use of contraception in the family building process can also be seen by comparing data from the VNDHS 1997 and the VNDHS 2002. For example, focusing on the youngest age cohorts—ever-married women age 15-19 and 20-24—the percentages reporting first use of contracep- tion before their second child are higher in 2002 (31 and 61 percent, respectively) than in 1997 (21 and 49 percent, respectively). 4.5 KNOWLEDGE OF THE FERTILE PERIOD Eight percent of currently married women in the VNDHS 2002 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 survey, all respondents were asked when in the ovulatory cycle a woman is at greatest risk of becoming preg- nant. 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 is often difficult for respondents to understand what this question means and it is also difficult to divide the ovulatory cycle into precise time periods. Table 4.6 shows the distribution of responses to the question on the ovulatory cycle. Among all ever-married women, slightly less than half (47 percent) correctly identified the fertile period as falling in the middle of the cycle. One-fourth of all ever-married women said they do not know when the fertile period is, while 18 percent believe that it can be at any time. Current users of periodic abstinence are clearly more knowl- edgeable about the ovulatory cycle than other women, with 85 percent correctly identifying the ovulatory cycle. Table 4.6 Knowledge of fertile period Percent distribution of women by knowledge of the fertile period during the ovulatory cycle, ever- married women and currently married women using periodic abstinence, Vietnam 2002 Periodic abstinence Perceived fertile period Current users of periodic abstinence All ever- married women During period 0.0 0.1 After period ends 5.4 8.7 Middle of the cycle 84.9 46.5 Before period begins 1.2 1.3 At any time 4.6 18.1 Other 0.0 0.2 Don't know 3.8 25.0 Missing 0.0 0.1 Total 100.0 100.0 Number of women 399 5,665 There has been an enormous improvement in knowledge of the ovulatory cycle. In 1997, only 28 percent of ever-married women and 60 percent of periodic abstinence users could correctly identify the fertile period. Fertility Regulation | 43 4.6 AGE AT STERILIZATION Information about the age at which women are sterilized is shown in Table 4.7. Of the 317 steril- ized women, 28 percent were sterilized before age 30, while 37 percent were sterilized in their early 30s. Overall, the median age at sterilization was 32 years. There is no discernable time trend in the median age at sterilization. There has also been no change in the median age at sterilization since 1997. Table 4.7 Timing of sterilization Percent distribution of currently married sterilized women by age at the time of sterilization, according to the number of years since the operation, Vietnam 2002 Age at sterilization Years since sterilization <25 25-29 30-34 35-39 40-44 45-49 Total Number of women Median age at sterilization1 <2 (2.0) (8.8) (26.0) (39.5) (15.4) (8.3) 100.0 29 35.2 2-3 (9.4) (16.0) (34.6) (23.2) (16.7) (0.0) 100.0 40 32.0 4-5 2.6 12.7 38.5 30.4 15.8 0.0 100.0 49 33.4 6-7 3.8 22.9 28.4 37.7 7.2 0.0 100.0 67 33.5 8-9 0.0 29.7 41.0 25.1 4.2 0.0 100.0 52 32.5 10+ 6.7 36.0 46.3 11.1 0.0 0.0 100.0 80 a Total 4.3 23.6 37.1 26.1 8.1 0.8 100.0 317 32.4 Note: Numbers in parentheses are based on 25-49 unweighted cases. a = Not calculated due to censoring 1 Median age is calculated only for women sterilized at less than 40 years of age to avoid problems of censoring. 4.7 SOURCE OF SUPPLY In order to evaluate the relative importance of various sources of contraceptive methods, current users of modern methods were asked to report the place from which they last obtained their method. Ta- ble 4.8 shows results for all modern methods combined and for specific methods. Table 4.8 and Figure 4.3 indicate the dominance of the public sector in providing contraceptive services in Vietnam. Eighty-six percent of current users last obtained their method from the public sector, compared to 14 percent who obtained their methods from the private sector. By far the single most impor- tant source of contraception is the commune health center (45 percent), followed by government hospitals (22 percent) and mobile clinics (9 percent). In total, these three sources were the source of supply for 76 percent of current users. For specific methods, the most important sources of supply differ. Women using the IUD ob- tained their supplies primarily from commune health centers, although government hospitals are also an important source for the IUD. Pills are almost equally obtained from public fieldworkers, pharmacies, and commune health centers. Sterilization services are almost always provided by government hospitals for women and by government hospitals and mobile clinics for men. For condom users, the leading source of supply is the pharmacy, followed by commune health centers and fieldworkers. There has been a shift since 1997 in source of supply from the public sector to the private sector. A majority of condom users now obtain their method from pharmacies. Since 1997, there has also been a shift in the source of supply for pill users, away from reliance on commune health centers towards greater use of fieldworkers. 44 | Fertility Regulation Table 4.8 Source of supply Percent distribution of currently married women who currently use a modern contraceptive method by most recent source of supply, according to specific method, Vietnam 2002 Method Source of current method Pill IUD Condom Female sterilization Male sterilization Total Public 65.1 93.9 40.4 99.8 (100.0) 85.7 Government hospital 1.2 18.6 1.1 81.1 (55.7) 21.7 Delivery house 0.0 0.5 0.2 0.0 (0.0) 0.3 Commune health center 28.3 58.5 18.0 2.6 (2.4) 44.7 Family planning clinic 0.4 3.9 1.0 4.9 (4.3) 3.3 Mobile clinic 0.0 11.3 1.8 11.0 (37.6) 9.1 Public fieldworker 33.1 0.2 16.1 0.0 (0.0) 5.5 Other public 2.0 1.0 2.3 0.2 (0.0) 1.1 Private medical 33.1 5.9 57.0 0.0 (0.0) 13.7 Private hospital, clinic 0.4 3.5 0.5 0.0 (0.0) 2.4 Pharmacy 30.1 0.0 52.6 0.0 (0.0) 8.8 Private doctor 2.3 2.2 3.8 0.0 (0.0) 2.3 Other private 0.3 0.2 0.1 0.0 (0.0) 0.2 Other source 1.8 0.0 2.3 0.0 (0.0) 0.4 Friends, rela Other Missing Total Number of wo Note: Total in tives 0.2 0.0 1.4 0.0 (0.0) 0.2 1.6 0.0 0.8 0.0 (0.0) 0.3 0.0 0.1 0.3 0.2 (0.0) 0.1 100.0 100.0 100.0 100.0 100.0 100.0 men 337 2,015 310 317 25 3,026 cludes 21 users of injection. Figures in parentheses are based on 25-49 unweighted cases. Figure 4.3 Sources of Family Planning Among Current Users of Modern Contraceptive Methods Vietnam 2002 Commune health center 45% Private doctor 2% Other public 10%Private pharmacy 9% Mobile clinic 9% Government hospital 22% Other 3% Fertility Regulation | 45 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 2002 questionnaires are presented in Table 4.9. All episodes of contraceptive use between January 1997 and the date of the inter- view were recorded in the calendar, along with the main reason for discontinuation of use during this pe- riod. The discontinuation rates presented here are based on all segments of use that started between 3 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 4.9 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 ef- fects/health reasons, and all other reasons. Table 4.9 First-year contraceptive discontinuation rates Percentage of currently married contraceptive users who discontinued use of a method within 12 months of starting its use, by reasons for discontinuation and method, Vietnam 2002 Reason for discontinuation Contraceptive method Method failure To become pregnant Side effects, health All other reasons1 Total Pill 6.0 6.9 13.8 9.5 36.1 IUD 2.0 1.2 8.2 1.1 12.5 Condom 8.3 9.7 3.4 16.5 37.8 Periodic abstinence 15.1 6.0 0.3 11.0 32.4 Withdrawal 13.6 4.1 0.0 12.2 29.9 Total 7.5 4.1 5.3 7.9 24.8 Note: Table is based on episodes of contraceptive use that began 3-59 months prior to the survey. 1 Includes missing reasons Discontinuation rates are relatively low in Vietnam, although they have been increasing. The data in Table 4.9 shows that one-fourth of all users stop using within 12 months of starting use. Not surpris- ingly, discontinuation rates for the condom (38 percent), the pill (36 percent), periodic abstinence (32 per- cent), and withdrawal (30 percent) are higher than the rate for the IUD (13 percent). For all methods combined, the reasons for discontinuation during the first year of use were method failure (8 percent); desire to become pregnant (4 percent); side effects or health concerns (5 per- cent); and other reasons (8 percent). However, the relative ranking of reasons for discontinuation varies by method. Women who discontinued use of periodic abstinence and withdrawal most frequently reported method failure. IUD and pill users most frequently cited side effects or health concerns as the reason for discontinuing use. Those who discontinue condom use are likely to cite a desire to get pregnant and method failure. 46 | Fertility Regulation Compared with data from the VNDHS 1997, discontinuation rates have increased. Overall, dis- continuation in the first year of use has risen from 18 to 25 percent of users. Rates have increased for all five of the major methods used in Vietnam. Further information on the reasons for discontinuation is presented in Table 4.10 and Figure 4.4. The table shows the percent distribution of all discontinuations in the five years preceding the survey, re- gardless of whether they occurred during or after the first 12 months of use. For all methods combined, the most common reasons for discontinuation are desire to become pregnant (26 percent) and method failure (25 percent). Side effects (17 percent) and switching to a more effective method (12 percent) also account for a sizeable proportion of discontinuations. Reasons for discontinuation vary by individual method. For pill and IUD users, side effects are the most frequently reported reasons, followed by the desire to become pregnant. For periodic abstinence and withdrawal users, method failure is the most commonly reported reason, followed by switching to a more effective method and the desire to become pregnant. For condom users, the desire to get pregnant, failure of the method, and inconvenience of the method are the most common reasons for discontinuation. Table 4.10 Reasons for discontinuation Percent distribution of discontinuations of contraceptive methods in the five years preceding the survey among currently married women by main reason for discontinuation, according to specific method, Viet- nam 2002 Contraceptive method Reason for discontinuation Pill IUD Condom Periodic abstinence With- drawal Total Became pregnant 15.5 9.9 21.0 43.2 44.2 25.3 To become pregnant 22.1 32.2 32.0 21.6 20.0 26.0 Husband disapproved 0.4 0.1 4.5 1.7 2.6 1.5 Side effects 26.4 37.1 5.2 0.3 0.0 17.4 Health concerns 8.5 7.1 0.2 0.2 0.4 3.8 Access/availability 0.8 0.0 1.0 0.0 0.0 0.2 More effective method 5.7 1.7 10.9 24.2 24.3 12.2 Inconvenient to use 7.0 0.4 14.9 1.0 1.6 3.4 Infrequent sex 5.6 1.5 3.9 1.3 2.7 2.6 Cost 0.0 0.0 2.5 0.0 0.0 0.3 Menopause 1.3 3.6 1.6 2.7 2.9 2.9 Other 6.7 6.2 2.4 3.9 1.1 4.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 364 942 316 359 698 2,697 Note: Total includes discontinuations of injection (14), vaginal methods (2), and other methods (2). Fertility Regulation | 47 Intentions Regarding Future Use To obtain information about future use of 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 4.11 presents the distribution of currently married nonusers by their intention to use in the future, according to the number of living children. Table 4.11 Future use of contraception Percent distribution of currently married women who are not using a contraceptive method by inten- tion to use in the future, according to number of living children, Vietnam 2002 Number of living children 1Timing of intention to use contraception Figure 4.4 Reasons for Discontinuing Use of Family Planning Methods Vietnam 2002 Desire to become pregnant 26% Became pregnant 25% More effective method 12% Other 15% Side effects 17% Health concerns 4% 4.9 NONUSE OF CONTRACEPTION 0 1 2 3 4+ In next 12 months 6.5 57.5 56.3 17.4 44.8 After 12 months 15.1 12.9 5.2 1.7 13.3 2.9 1.4 0.8 1.0 0.0 1.1 Total 58.7 39.9 Unsure about timing Unsure about use 9.8 3.0 1.8 2.9 1.5 3.1 Does not intend to use 41.0 23.0 25.3 32.4 79.4 37.3 Missing 0.0 0.0 0.5 2.2 0.0 0.4 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 122 360 290 162 212 1,146 1 Includes current pregnancy 48 | Fertility Regulation Fifty-nine percent of currently married nonusers say that they intend to use family planning in the future: 45 percent within the next 12 months, 13 percent some time after 12 months, and 1 percent unsure about timing. Three percent of nonusers indicate they are unsure about using contraception at all in the future and 37 percent indicate that do not intend to use in the future. Among nonusers, the timing of intended use varies with the number of living children. Nonusers with no children are much less likely than nonusers with children to express an intention to use within the next 12 months. Reasons for Nonuse The reasons women do not intend to use family planning are of particular interest to family planning pro- gram managers. In the VNDHS 2002, 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 4.12 shows the results. The primary reasons women give for not intending to use a contraceptive method are that they are menopausal or had a hysterectomy (32 per- cent) or that they want more children (17 percent). Other often-mentioned reasons included infre- quent sex (10 percent), difficulty in becoming pregnant— i.e., subfecund or infecund (7 percent), and health con- cerns (7 percent). Relatively few women mentioned reli- gious proscriptions (2 percent) or their husband’s opposi- tion to family planning (less than 1 percent) as the main reason they do not intend to use contraception. There are significant differences in the answers given by women under age 30 and those age 30 and over. Nonusers under age 30 are much more likely than older nonusers to mention the desire to have more children (53 percent and 13 percent, respectively), while infrequent sex is mentioned more by older nonusers than by younger nonusers (11 percent and 3 percent, respectively). The lack of need for contraception because of menopause or hysterectomy was mentioned almost exclusively by older women. Table 4.12 Reason for nonuse of contraception Percent distribution of currently married women who are not using any contraceptive method and who do not intend to use one in the future by main reason for not intending to use, according to age, Vietnam 2002 Age Main reason not intending to use a method <30 30+ Total Infrequent sex (3.1) 10.6 9.9 Menopausal, hysterectomy (3.5) 35.5 32.2 Subfecund, infecund (5.1) 7.7 7.4 Wants more children (52.7) 13.2 17.2 Husband opposed (3.8) 0.2 0.5 Religious prohibition (0.0) 2.2 2.0 Knows no method (3.5) 0.8 1.1 Knows no source (5.4) 1.5 1.9 Health concerns (11.1) 6.2 6.7 Fear side effects (2.7) 2.9 2.9 Lack of access (0.0) 0.3 0.2 Inconvenient to use (1.3) 0.9 1.0 Interferes with body (3.9) 3.3 3.4 Other (0.0) 14.5 13.1 Don’t know (3.7) 0.1 0.5 Total 100.0 100.0 100.0 Number of women 43 384 427 Note: Figures in parentheses are based on 25-49 cases. Preferred Methods Method preferences among women not using contraception at the time of the survey but who in- tend to use in the future are shown in Figure 4.5. The chart indicates that the vast majority of women who intend to use prefer modern methods (84 percent). Given the high level of IUD use in Vietnam, it is not surprising that 60 percent of nonusers who intend to use in the future report the IUD as their preferred method. Fourteen percent say they prefer to use the pill, while another 14 percent prefer traditional meth- ods, withdrawal and periodic abstinence. Fertility Regulation | 49 4.10 FAMILY PLANNING MESSAGES IUD Condom Pill Other Withdrawal Periodic abstinence Figure 4.5 Preferred Method Among Nonusers Who Intend to Use in the Future Vietnam 2002 9% 14% 3% 10% 4% 60% Activities to inform and educate couples about the use of contraception are an important compo- nent of the Vietnamese family planning program. The VNDHS 2002 obtained information on a number of aspects of women's exposure to family planning information. Table 4.13 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 televi- sion has succeeded in reaching almost nine in ten ever-married women (88 percent). Table 4.13 also in- dicates that the majority of ever-married women have been exposed to messages on both radio and televi- sion (66 percent). There are some differences in the level of exposure to family planning messages by age. Younger women (under 25) are less likely to have been exposed to broadcast media than older women. Three in ten ever-married women age 15-19 and two in ten women age 20-24 reported that they had neither heard a family planning message on the radio nor seen one on television in the few months prior to the inter- view, while among women age 25 and older only 9 to 13 percent reported no exposure to messages through the broadcast media. Urban women are slightly more likely than rural women to have been exposed to family planning messages, especially those on television. There are only very slight differences in exposure to family planning messages between women in project provinces and nonproject provinces. Among regions, the proportion of ever-married women who have been exposed to a family plan- ning message during the months before the interview varied from a high of 98 percent in the Red River Delta, 81 percent in the Mekong River Delta and 79 percent in the Central Highlands. 50 | Fertility Regulation Exposure to family planning messages is strongly correlated with educational attainment. Only 68 percent of women with no education reported hearing a family planning message on radio or television, compared with 96 percent of women with completed higher secondary education. Except for women in Northern Uplands and women without schooling, all women are more likely to see family planning mes- sages on television than to hear them on the radio. Table 4.13 Exposure to family planning messages on radio and television Percent distribution of ever-married women by whether they had heard a radio or television message about family planning in the few months preceding the interview, according to background characteris- tics, Vietnam 2002 Heard family planning message on radio or TV Background characteristic Radio and television Radio only Television only Neither radio nor television Total Number of women Age 15-19 46.6 4.7 18.9 29.8 100.0 69 20-24 58.6 7.0 15.6 18.9 100.0 552 25-29 63.8 7.4 16.4 12.4 100.0 1,000 30-34 68.8 4.5 17.1 9.7 100.0 1,105 35-39 67.8 4.9 17.3 10.0 100.0 1,098 40-44 67.6 5.5 17.1 9.8 100.0 1,046 45-49 65.1 3.6 18.5 12.8 100.0 795 Residence Urban 68.1 1.1 21.6 9.2 100.0 1,081 Rural 65.2 6.4 16.0 12.4 100.0 4,584 Project province No 64.8 5.3 17.8 12.1 100.0 3,814 Yes 67.7 5.6 15.5 11.2 100.0 1,851 Region Northern Uplands 64.9 14.2 11.4 9.6 100.0 1,099 Red River Delta 82.7 2.7 12.4 2.2 100.0 1,363 North Central 67.2 6.7 13.6 12.5 100.0 722 Central Coast 55.4 2.0 28.0 14.7 100.0 594 Central Highlands 46.8 3.2 29.2 20.8 100.0 183 Southeast 60.9 1.7 19.9 17.4 100.0 648 Mekong River Delta 55.7 3.5 21.4 19.4 100.0 1,056 Education No education 26.4 24.1 17.9 31.6 100.0 364 Some primary 49.2 7.7 20.6 22.5 100.0 966 Complete primary 66.0 4.6 17.7 11.7 100.0 1,599 Compl. lower secondary 75.4 3.2 15.2 6.2 100.0 1,783 Compl. higher secondary+ 79.0 1.3 15.7 4.0 100.0 953 Total 65.7 5.4 17.1 11.8 100.0 5,665 Women were also asked whether or not they considered it acceptable for family planning infor- mation to be provided on radio or television. Table 4.14 indicates that 93 percent of women consider such messages to be acceptable. Ambivalence (“unsure”) regarding the acceptability of broadcasting family planning messages on radio and television is more common among younger women, women in the Me- kong River Delta, and Southeast regions, and women with little or no education. More than one-fourth of uneducated women were not sure about using electronic mass media to broadcast messages about family planning. Fertility Regulation | 51 Table 4.14 Acceptability of family planning messages in the media Percentage of ever-married women who believe that it is acceptable to have messages about family planning (FP) on the radio or television, by background characteristics, Vietnam 2002 Acceptability of FP messages in the media Background characteristic Not acceptable Acceptable Unsure Total Number of women Age 15-19 0.0 82.5 17.5 100.0 69 20-24 0.4 91.7 7.9 100.0 552 25-29 0.8 93.1 6.1 100.0 1,000 30-34 0.8 93.5 5.7 100.0 1,105 35-39 0.2 95.6 4.2 100.0 1,098 40-44 0.6 93.7 5.7 100.0 1,046 45-49 1.1 90.1 8.8 100.0 795 Residence Urban 1.1 94.5 4.3 100.0 1,081 Rural 0.5 92.8 6.7 100.0 4,584 Project province No 0.5 92.6 6.9 100.0 3,814 Yes 0.8 94.1 5.1 100.0 1,851 Region Northern Uplands 0.3 93.0 6.7 100.0 1,099 Red River Delta 0.4 99.0 0.6 100.0 1,363 North Central 0.7 96.0 3.3 100.0 722 Central Coast 0.3 94.9 4.7 100.0 594 Central Highlands 1.3 90.9 7.8 100.0 183 Southeast 1.1 89.7 9.3 100.0 648 Mekong River Delta 1.0 85.1 13.9 100.0 1,056 Education No education 1.0 71.4 27.5 100.0 364 Some primary 0.6 86.5 12.9 100.0 966 Complete primary 0.6 94.4 4.9 100.0 1,599 Compl. lower secondary 0.5 97.1 2.4 100.0 1,783 Compl. higher secondary+ 0.7 98.5 0.9 100.0 953 Currently married women 0.6 93.1 6.3 100.0 5,665 Women were also asked if they had read about family planning in a newspaper, magazine, poster, or leaflet during the last few months before the interview. Responses to these questions are presented in Table 4.15. Far fewer women receive information about family planning through the print media than through the electronic media. Overall, 59 percent of women said that they had read about family planning: 31 per- cent through newspapers or magazines, 48 percent through posters, and 22 percent through leaflets or brochures. As expected, women in rural areas are less likely to have read messages on family planning than urban women (54 and 78 percent, respectively). Women in Red River Delta and Southeast regions, as well as better educated women, are more likely to have received a family planning message through the printed media. 52 | Fertility Regulation Table 4.15 Family planning messages in print media Percentage of ever-married women who saw a message about family planning in the print media in the few months preceding the interview, by background characteristics, Vietnam 2002 Background characteristic Any print source Newspaper, magazine Poster Leaflet/ brochure Number of women Age 15-19 41.6 31.7 27.3 24.1 69 20-24 54.8 30.1 44.0 19.5 552 25-29 58.8 29.1 47.9 21.7 1,000 30-34 58.8 28.9 49.9 22.5 1,105 35-39 61.4 32.7 50.1 23.3 1,098 40-44 60.5 32.1 49.6 23.5 1,046 45-49 56.1 29.8 47.8 21.1 795 Residence Urban 78.2 57.6 65.0 27.8 1,081 Rural 54.1 24.2 44.5 20.9 4,584 Project province No 58.3 31.2 47.8 21.2 3,814 Yes 59.5 29.2 49.7 24.5 1,851 Region Northern Uplands 50.6 23.6 40.6 22.9 1,099 Red River Delta 78.1 43.8 64.7 37.2 1,363 North Central 54.1 23.6 43.7 24.9 722 Central Coast 52.2 31.3 41.4 16.1 594 Central Highlands 49.4 27.8 41.7 6.6 183 Southeast 67.3 47.7 54.6 16.5 648 Mekong River Delta 45.0 14.9 40.1 10.2 1,056 Education No education 23.0 1.3 22.2 3.4 364 Some primary 35.2 11.7 30.4 7.6 966 Complete primary 52.2 22.1 42.5 18.5 1,599 Compl. lower secondary 69.0 33.2 56.0 29.0 1,783 Compl. higher secondary+ 87.5 70.0 72.2 38.0 953 Total 58.7 30.5 48.4 22.3 5,665 There has been a substantial increase in reported exposure to family planning messages in the print media since 1997. The proportion of women who say they have read a message in the few months prior to the survey increased from 37 percent in 1997 to 59 percent in 2002. 4.11 FAMILY PLANNING OUTREACH ACTIVITIES Visits by family planning fieldworkers from the Vietnamese Family Planning Program to nonus- ers 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 Viet- namese program. Failure to do so represents a missed opportunity to provide services to potential users of contraception. Overall, 15 percent of nonusers reported being visited by a family planning fieldworker in the last 12 months (Table 4.16). Another 19 percent were not visited by a fieldworker but reported visiting a health facility where they were told about the benefits of family planning. However, two-thirds of nonus- Fertility Regulation | 53 ers have neither received a visit from a fieldworker nor been informed about family planning by health facility staff in the last year (66 percent). The data indicate that there is a large pool of nonusers who have not been recently contacted by either family planning fieldworkers or health facility staff. Moreover, most of these women did not visit a health facility during the 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 seven nonusers in the past year. If the nonusers who are not being contacted are primarily women who do not want or need con- traception (e.g., young women trying to become pregnant or older menopausal women), the failure of fieldworkers to contact nonusers might be understandable, but that does not appear to be the case. In all age groups, less than 20 percent of nonusers were visited by a family planning fieldworker. The data suggest a need for greater effort by the outreach component of the family planning program. Table 4.16 Contact of nonusers with family planning providers Percent distribution of currently married nonusers by whether they were visited by a family planning (FP) worker or spoke with a health facility staff member about family planning methods during the 12 months preceding the interview, according to background characteristics, Vietnam 2002 Visited by FP worker Not visited by FP worker Background characteristic Visited health facil- ity, dis- cussed FP Visited health facility, did not discuss FP Did not visit health facility Visited health facility, discussed FP Visited health facility, did not discuss FP Did not visit health facility No FP services or information Total Number of women Age 15-19 0.0 0.0 1.7 31.3 37.9 29.1 67.0 100.0 52 20-24 11.1 6.2 1.1 18.8 39.6 23.2 62.8 100.0 227 25-29 12.2 4.0 2.1 24.2 36.3 21.2 57.5 100.0 260 30-34 8.7 3.2 3.3 24.4 35.0 25.4 60.4 100.0 180 35-39 9.9 3.2 4.3 18.2 28.0 36.2 64.0 100.0 102 40-44 6.3 4.2 8.0 10.0 27.5 44.0 71.5 100.0 108 45-49 5.8 0.0 3.8 11.0 26.7 52.7 79.4 100.0 218 Residence Urban 5.2 2.0 4.3 13.4 41.9 33.4 75.2 100.0 210 Rural 9.7 3.6 2.9 20.4 31.5 31.8 63.3 100.0 936 Project province No 8.6 3.0 2.7 19.3 32.2 34.1 66.3 100.0 753 Yes 9.5 3.9 3.9 18.7 35.8 28.2 64.0 100.0 394 Region Northern Uplands 5.9 4.8 2.0 26.9 26.9 33.5 60.4 100.0 226 Red River Delta 17.4 4.9 1.3 25.0 36.2 15.2 51.4 100.0 225 North Central 6.7 0.9 2.3 23.9 33.3 32.5 65.8 100.0 137 Central Coast 13.2 0.5 5.3 12.3 29.4 39.3 68.7 100.0 125 Central Highlands 15.8 4.2 8.4 25.3 23.5 22.7 46.2 100.0 58 Southeast 4.0 3.6 1.0 14.1 37.5 39.8 77.3 100.0 145 Mekong River Delta 3.9 2.8 5.4 8.1 39.2 40.5 79.8 100.0 231 Education No education 9.3 3.7 2.8 18.6 24.0 41.6 65.6 100.0 118 Some primary 5.6 4.7 3.6 9.4 31.7 45.0 76.7 100.0 212 Complete primary 8.5 3.6 3.1 22.0 33.9 28.7 62.6 100.0 337 Compl. lower secondary 13.4 3.4 3.4 21.9 31.9 26.1 58.0 100.0 289 Compl. higher secondary+ 6.1 1.0 2.6 20.7 42.6 27.1 69.7 100.0 191 Total 8.9 3.3 3.1 19.1 33.4 32.1 65.5 100.0 1,146 54 | Fertility Regulation 4.12 DISCUSSION OF FAMILY PLANNING WITH HUSBAND 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 4.17 indicates that 77 percent of currently married women reported discussing family plan- ning with their husbands—36 percent on one or two occasions and 41 percent more frequently. Only one woman in four (23 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). Table 4.17 Discussion of family planning with husband Percent distribution of currently married non-sterilized women who know a contraceptive method by the number of times they discussed family planning with their husbands in the past year, according to current age, Vietnam 2002 Number of times family planning discussed with partner Age Never Once or twice Three or more times Missing Total Number of women 15-19 45.2 29.9 24.9 0.0 100.0 63 20-24 23.6 35.6 40.7 0.0 100.0 530 25-29 18.4 36.3 45.3 0.0 100.0 965 30-34 18.6 38.9 42.5 0.0 100.0 1,022 35-39 20.4 37.4 42.2 0.1 100.0 936 40-44 25.6 33.1 41.0 0.2 100.0 858 45-49 36.7 33.4 29.9 0.0 100.0 601 Total 23.2 36.0 40.8 0.1 100.0 4,975 4.13 ATTITUDES TOWARD FAMILY PLANNING A positive attitude toward family planning is one of the prerequisites for the successful use of contraception. Data on respondents’ attitudes and their perceptions of their husband’s attitude toward family planning are shown in Table 4.18. Overall, the data indicate a high degree of approval of family planning among Vietnamese couples. According to women, in 92 percent of couples both the wife and her husband approve of family planning. In only 3 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 lit- tle room for variation by respondents’ background characteristics. Nevertheless, it is worth noting that there is a positive correlation between respondent’s education and approval of family planning by both spouses. Joint approval was reported by 79 percent of women with no education and by 96 percent of women who had completed higher secondary school. Fertility Regulation | 55 Table 4.18 Attitudes of couples toward family planning Percent distribution of currently married, nonsterilized women who know a method of family planning (FP) by approval of family planning and their perception of their husband’s attitude toward family planning,, according to background characteristics, Vietnam 2002 Respondent approves of family planning Respondent disapproves of family planning Background characteristic Both approve Husband dis- approves Husband’s attitude unknown Husband approves Husband’s attitude unknown Both disap- prove Respon- dent unsure Missing Total Percentage of respon- dents who approve of FP Percentage of hus- bands who approve of FP Number of women Age 15-19 83.9 0.0 3.5 0.0 0.9 1.0 10.7 0.0 100.0 87.4 86.0 63 20-24 89.5 0.5 5.0 0.0 0.3 0.1 4.5 0.0 100.0 95.0 90.5 530 25-29 93.1 0.5 1.7 0.5 1.5 0.1 2.7 0.0 100.0 95.3 94.1 965 30-34 93.2 0.6 1.8 0.4 1.3 0.3 2.2 0.1 100.0 95.7 94.1 1,022 35-39 93.5 0.4 1.5 0.5 1.5 0.1 2.3 0.1 100.0 95.5 94.9 936 40-44 92.0 1.0 1.9 0.5 1.0 0.6 2.9 0.2 100.0 95.1 92.6 858 45-49 87.8 0.8 3.7 1.5 1.2 0.6 4.5 0.0 100.0 92.3 90.1 601 Residence Urban 91.8 0.8 2.2 0.6 1.6 0.1 2.8 0.0 100.0 94.8 93.1 954 Rural 91.9 0.6 2.3 0.5 1.1 0.3 3.1 0.1 100.0 94.9 93.0 4,021 Project province No 91.8 0.6 2.3 0.4 1.2 0.3 3.3 0.1 100.0 94.8 93.0 3,369 Yes 91.9 0.7 2.4 0.7 1.2 0.3 2.7 0.0 100.0 95.1 93.1 1,607 Region Northern Uplands 96.3 0.1 1.5 0.1 0.1 0.1 1.8 0.0 100.0 97.9 96.7 1,012 Red River Delta 98.5 0.2 0.3 0.2 0.1 0.0 0.7 0.0 100.0 99.0 98.7 1,237 North Central 92.9 0.4 0.8 0.8 1.8 0.4 2.9 0.1 100.0 94.2 94.3 623 Central Coast 89.6 0.8 0.3 0.6 6.1 0.1 2.5 0.0 100.0 90.7 90.5 501 Central Highlands 84.3 1.1 2.2 2.1 7.5 1.0 1.9 0.0 100.0 87.5 86.3 147 Southeast 88.0 0.6 4.5 0.8 0.7 0.6 4.3 0.5 100.0 93.5 89.4 543 Mekong River Delta 82.0 1.9 6.8 0.8 0.2 0.7 7.5 0.1 100.0 90.7 85.1 913 Education No education 79.0 0.2 5.3 1.3 0.4 1.7 12.1 0.0 100.0 84.5 81.6 302 Some primary 84.8 1.1 5.4 1.0 1.6 0.4 5.4 0.3 100.0 91.5 87.3 804 Completed primary 93.0 0.6 2.2 0.4 0.9 0.3 2.6 0.0 100.0 95.8 93.8 1,391 Compl. lower secondary 94.8 0.6 1.1 0.4 1.2 0.1 1.7 0.1 100.0 96.5 95.6 1,577 Compl. higher secondary+ 95.7 0.4 0.9 0.3 1.6 0.1 1.0 0.0 100.0 97.0 96.3 901 Total 91.9 0.6 2.3 0.5 1.2 0.3 3.1 0.1 100.0 94.9 93.0 4,975 4.14 ABORTION AND MENSTRUAL REGULATION Childbearing can be regulated by deliberate pregnancy termination as well as by contraception. In Vietnam, pregnancy termination is legal and available at both public and private health facilities. Two procedures are used for pregnancy termination: menstrual regulation (vacuum aspiration) for pregnancies within five weeks of conception, and abortion (dilation and curettage) for pregnancies up to 12 weeks du- ration and sometimes longer. 56 | Fertility Regulation Information on pregnancy termination was collected in the reproductive section of the VNDHS 2002 questionnaire.1 A word of caution is in order concerning the completeness of the data. International experience with the collection of data on deliberate pregnancy termination in household surveys is poor. 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, a comparison of data from surveys and the Ministry of Health indicates that there can be serious underreporting in surveys (GSO, 1996b and NCPFP and GTZ, 1995). Neverthe- less, data from the VNDHS 2002 indicate that 22 percent of pregnancies in the three years prior to the survey were intentionally terminated either through menstrual regulation (17 percent) or induced abortion (5 percent) (data not shown). Rates of Pregnancy Termination Table 4.19 shows age-specific induced abortion rates for the five-year period preceding the sur- vey. The age-specific rates are all-woman 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 that compensates for never-married women. Overall, the data indicate that a Vietnamese woman will have an average of 0.6 induced abortions during her reproductive years. The total abortion rate for rural women (0.7) is higher than that of urban women (0.5). The rate is also slightly higher among women who live in the provinces that fall in the NCPFP project (0.7 versus 0.6). Table 4.19 Induced abortion rates Age-specific induced abortion rates and total abortion rates for all women for the five-year period preceding the survey, Vietnam 2002 Residence Project province Mother’s age Urban Rural No Yes Total 15-19 0.000 0.001 0.001 0.000 0.001 20-24 0.009 0.018 0.015 0.018 0.016 25-29 0.031 0.032 0.029 0.039 0.032 30-34 0.019 0.033 0.027 0.036 0.030 35-39 0.028 0.024 0.029 0.026 40-44 0.016 0.013 0.015 0.012 0.014 45-49 0.007 0.005 0.002 0.012 0.006 Total induced abortion rate TAR 15-49 0.495 0.650 0.564 0.730 0.617 TAR 15-44 0.461 0.625 0.553 0.670 0.589 0.017 1 Survey eligibility 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. Fertility Regulation | 57 Table 4.20 presents abortion rates for the five-year period preceding the survey by background characteristics. These are total abortion rates (TAR) and are based on reporting of both menstrual regula- tion 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.2 Table 4.20 also shows the mean number of abortions per woman age 40-49. Table 4.20 Abortion rates by background characteristics Total induced abortion rate for the five-year period preceding the survey and mean number of abortions among women age 40-49, by background characteristics, Vietnam 2002 Abortion rates Background characteristic Total induced abortion rate1 Mean number of abortions among women 40-49 Residence Urban 0.49 0.50 Rural 0.65 0.39 Project province No 0.56 0.39 Yes 0.73 0.46 Region Northern Uplands 1.35 0.66 Red River Delta 0.84 0.63 North Central 0.52 0.33 Central Coast 0.09 0.07 Central Highlands 0.27 0.31 Southeast 0.31 0.23 Mekong River Delta 0.27 0.25 Education No education 0.63 0.14 Some primary 0.52 0.25 Complete primary 0.58 0.35 Compl. lower secondary 0.72 0.54 Compl. higher secondary+ 0.59 0.57 Total 0.62 0.42 1 Women 15-49 years; includes both menstrual regulation and abortion Similar to the VNDHS 1997, the data show that abortion is reportedly higher among rural women, women who live in the project provinces, and women who live in the Northern Uplands. Unlike the 1997 survey, the VNDHS 2002 does not show a clear relationship between the TAR and education of women; however, the mean number of abortions per woman 40-49 does increase with education. Use of Contraception before Pregnancy Termination Additional questions were included in the VNDHS 2002 for pregnancy terminations occurring in the three years immediately preceding the survey. These questions concerned the desired status of the pregnancy at the time of conception, whether contraception was used at that time, whether there were any health problems following the termination and, if so, whether in-patient medical treatment was required. 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. 58 | Fertility Regulation Fertility Regulation | 59 Table 4.21 indicates that almost two-thirds (64 percent) of pregnancy terminations occurred among women who were using contraception at the time of becoming pregnant. The percentage is higher for terminations by menstrual regulation (67 percent) than by abortion (54 percent). Table 4.21 Use of contraceptive method prior to pregnancy termination Percent distribution of pregnancy terminations in the three years preceding the survey, by method of contraception used prior to the termination, according to type of termination, Vietnam 2002 Type of termination Method of contraception Menstrual regulation Induced abortion Total No contraceptive method 32.7 46.5 35.6 Any contraceptive method 67.3 53.5 64.4 Any modern method 13.7 20.7 15.2 Pill 4.0 4.7 4.1 IUD 6.5 10.3 7.3 Injections 0.2 0.0 0.2 Condom 3.0 5.7 3.6 Traditional method 53.5 32.7 49.1 Periodic abstinence 19.7 10.8 17.8 Withdrawal 33.9 22.0 31.4 Total 100.0 100.0 100.0 Number of women 327 88 415 Half of all pregnancy terminations occurred among women using traditional methods, especially withdrawal (31 percent). This is disconcerting, given the fact that withdrawal is one of the few methods whose use has increased since 1997. Greater diligence in the use of withdrawal and periodic abstinence, or the use of more reliable methods of contraception, would reduce the need for pregnancy termination. Complications and Treatment Table 4.22 indicates that about half of women reported having a health problem following a preg- nancy termination. Of these women, 69 percent sought medical advice or treatment. As expected, fewer complications were associated with menstrual regulation than with abortion, although differences are small. Table 4.22 Health problems and treatment seeking following pregnancy ter- mination Percentage of pregnancy terminations followed by health problems and the percentage for which medical treatment was sought, by type of pregnancy termination, Vietnam 2002 Type of pregnancy termination Health problem/treatment Menstrual regulation Induced abortion Total Health problem reported 47.0 51.4 48.0 Sought medical advice or treatment 70.6 63.4 69.0 Number of pregnancy terminations 344 92 437 PROXIMATE DETERMINANTS OF FERTILITY 5 As in many countries of the world, marriage in Vietnam indicates the start of women’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 im- portant for understanding fertility, since they determine the length and pace of reproductive activity. This chapter presents discussions on these proximate determinants of fertility. Questions pertaining to the above-mentioned proximate determinants of fertility were included in the Women’s Questionnaire, which was used to interview ever-married women age 15-49. In this chapter, a number of tables are based on all women, that is, they consist of both ever-married and never-married women. In producing these tables, the denominators have been expanded to represent all women by mul- tiplying 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 computed by single year of age, either for the population as a whole or, in cases where the results are presented by back- ground characteristics, separately for each category of the characteristic in question. 5.1 MARITAL STATUS Table 5.1 presents the distribution of all women age 15-49 by marital status. The data indicate that 32 percent of women of reproductive age have never been married, 64 percent are currently married, 2 percent are widowed, and over 2 percent are either divorced or separated (not living together). Com- pared to 1997, there has been a very slight increase in the overall proportion of women who are currently married, from 63 to 64 percent. Since in Vietnam births are largely confined to married couples, this would imply that changes in marriage are not the factors in explaining the steep decline in fertility over the recent past. Nevertheless, although the overall proportion of women who are currently married has increased very slightly between the two surveys, the proportion of women age 15-24 who are currently married has declined. For example, 52 percent of women age 20-24 were married in 1997, compared with 46 percent in 2002. Since the age-specific fertility rates are highest at ages 20-24 (see Table 3.1), reduc- tions in the proportions of women married in that age group would be expected to have a larger effect on the overall level of fertility. Changes in the proportion of women who have never married are shown in Table 5.2 by age group for several recent surveys. Table 5.1 Current marital status Percent distribution of women by current marital status, according to age, Vietnam 2002 Current marital status Age Never married Married Widowed Divorced Not living together Total Number of women 15-19 95.8 4.1 0.0 0.0 0.1 100.0 1,630 20-24 52.2 46.4 0.0 0.8 0.5 100.0 1,155 25-29 18.1 80.0 0.2 1.2 0.5 100.0 1,221 30-34 7.7 88.8 0.9 1.7 1.0 100.0 1,197 35-39 5.5 89.7 2.1 2.1 0.6 100.0 1,162 40-44 7.2 85.7 3.4 2.6 1.1 100.0 1,128 45-49 5.1 82.0 7.0 3.4 2.5 100.0 838 Total 32.0 64.1 1.6 1.5 0.8 100.0 8,330 Proximate Determinants of Fertility | 61 The proportion of women who are widowed increases steadily with age, from less than 1 percent among women under 35 years old to 7 percent among women age 45-49. The proportion divorced or separated also increases with age (Table 5.1). Table 5.2 Never-married women Percentage of women who have never married, by age, various sources, Vietnam 1988-2002 Age 1988 VNDHS 1989 Census 1994 ICDS 1997 VNDHS 2002 VNDHS 15-19 95.3 89.1 91.4 92.3 95.8 20-24 47.8 43.1 46.3 46.9 52.2 25-29 15.2 18.0 20.4 21.1 18.1 30-34 8.4 11.2 10.5 10.9 7.7 35-39 6.5 8.9 9.1 8.7 5.5 40-44 4.0 6.0 6.9 8.3 7.2 45-49 1.3 3.5 6.4 9.9 5.1 Source: NCPFP, 1999:66 5.2 AGE AT MARRIAGE In Vietnam, marriage generally indicates the earliest point at which a woman begins her child- bearing. Early age at marriage often results in early age at childbearing and high fertility since women who marry early will have, on average, longer exposure to the risk of pregnancy. In the VNDHS 2002, information on age at marriage was obtained by asking women the month and year (or age, if year was not known) when they started living together with their husband (or first husband, in the case of women who married more than once). Table 5.3 presents the percentage of women who were first married by exact ages and the median age at first marriage for different age groups. The latter indicates the exact age by which half of an entire cohort has married. Unlike the pattern observed in many countries, the median age at first marriage in Vietnam has not increased over the last 25 years. Instead, the median age has been stable at about 21 years for age cohorts 25-29 through 45-49. Table 5.3 Age at first marriage Percentage of women who were first married by specific exact ages and median age at first marriage, by cur- rent age, Vietnam 2002 First married by exact age Age 15 18 20 22 25 Never married Number of women Median age at first marriage 15-19 0.3 na na na na 95.8 1,630 a 20-24 0.7 11.1 27.6 na na 52.2 1,155 a 25-29 1.6 17.1 40.2 56.3 73.8 18.1 1,221 21.1 30-34 0.9 12.1 44.1 67.1 84.1 7.7 1,197 20.5 35-39 1.0 14.6 37.8 57.0 79.3 5.5 1,162 21.3 40-44 0.7 12.2 32.9 55.7 76.4 7.2 1,128 21.4 45-49 1.2 11.6 32.6 54.9 76.7 5.1 838 21.5 Median for women 20-49 1.0 13.2 36.1 55.6 72.9 16.5 6,700 a Median for women 25-49 1.1 13.7 37.9 58.4 78.1 9.0 5,545 21.1 na = Not applicable a = Omitted because less than 50 percent of the women were married for the first time before reaching the age group 62 | Proximate Determinants of Fertility Figure 5.1 provides data on the median age at first marriage by background characteristics. The difference in median age at first marriage by urban-rural residence is three years (24 years for urban women and 21 years for rural women). Women living in the highly urbanized region of Southeast are more likely to marry late—almost three years later than women living in the Northern Uplands. There is a close association between level of education and age at first marriage. The lowest me- dian age at marriage is found for women with no education (19.3 years), followed by women with some primary (19.9 years) and women with primary level completed (20.6 years). Women who have completed higher secondary education have the highest median age at first marriage (23.4 years). 23.6 20.6 20.0 21.5 20.9 21.6 21.0 22.8 20.9 19.3 19.9 20.6 21.0 23.4 RESIDENCE Urban Rural REGION Northern Uplands Red River Delta North Central Central Coast Central Highlands Southeast Mekong River Delta EDUCATION No education Some primary Completed primary Compl. lower secondary Compl. higher secondary+ 0.0 5.0 10.0 15.0 20.0 25.0 30.0 Years Figure 5.1 Median Age at Marriage by Background Characteristics Vietnam 2002 5.3 POSTPARTUM AMENORRHEA, ABSTINENCE AND INSUSCEPTIBILITY The risk of pregnancy is much lower during postpartum amenorrhea—the interval between child- birth and the return of menstruation. The duration and intensity of breastfeeding (which delays the re- sumption of menstruation) affects the length of this interval, as does the length of time sexual intercourse is delaye amenorrh on the d birth sinc T the moth birth. Th abstinenc nancy in abstinenc months. d following a birth. Women who are not exposed to the risk of pregnancy, either because they are eic or are still abstaining from sex are considered insusceptible. In the VNDHS 2002, questions uration of postpartum amenorrhea and sexual abstinence were asked of all women who had a e January 1999. able 5.4 shows the percentage of births occurring in the 36 months prior to the survey for which er was postpartum amenorrheic, abstaining and insusceptible, by the number of months since the e results indicate that postpartum amenorrhea is substantially longer than the period of sexual e and is, therefore, the principle determinant of the length of postpartum insusceptibility to preg- Vietnam. The median duration of amenorrhea is almost 8 months, while the median duration of e is 4 months. The median duration of postpartum insusceptibility to pregnancy is almost 9 Proximate Determinants of Fertility | 63 The table also shows that almost all women are insusceptible during the first two months after giving birth at which time, 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 10-11 months following birth, 39 percent of women are still amenorrheic, while only 7 percent are ab- staining. By 16-17 months after birth, 11 percent are amenorrheic, while only 4 percent are abstaining. Table 5.4 Postpartum amenorrhea, abstinence and insusceptibility Percentage of births in the three years preceding the survey for which mothers are postpartum amenorrheic, abstaining, and insusceptible, by number of months since birth, and median and mean durations, Vietnam 2002 Percentage of births for which the mother is: Months since birth Amenorrheic Abstaining Insusceptible Number of births < 2 98.5 89.3 100.0 50 2-3 79.8 72.2 91.1 78 4-5 71.5 39.3 76.2 65 6-7 47.5 14.5 53.4 65 8-9 47.2 13.0 52.3 64 10-11 38.7 6.6 43.7 65 12-13 23.7 4.0 24.8 87 14-15 9.0 1.6 9.9 78 16-17 10.5 3.5 12.1 83 18-19 6.4 3.5 8.9 77 20-21 7.7 0.0 7.7 61 22-23 0.0 2.9 2.9 73 24-25 1.1 1.2 2.3 90 26-27 3.5 2.7 6.2 67 28-29 1.4 0.8 2.2 75 30-31 0.0 0.7 0.7 73 32-33 0.0 4.5 4.5 78 34-35 0.0 1.2 1.2 83 Total 22.5 13.0 25.4 1,313 Median 7.5 3.9 8.5 na Mean 9.2 5.5 10.3 na Note: Estimates are based on status at the time of the survey. na = Not applicable Data in Table 5.5 show that postpartum insusceptibility varies only moderately by age of mother. Insusceptibility is slightly longer for rural than for urban women and for mothers residing in project prov- inces as opposed to those who do not. Some regional variation is apparent. The longest insusceptibility is found in the Central Highlands and the shortest in the Northern Uplands. A roughly inverse relationship between duration of insusceptibility and education is evident from Table 5.5. Mothers with some primary have a median duration of postpartum insusceptibility of 10 months, in contrast to 6 months for mothers who have completed higher secondary education. The small number of births occurring at specific peri- ods prior to the survey for some background characteristics makes it difficult to interpret the medians in Table 5.5 and caution is advised. 64 | Proximate Determinants of Fertility Table 5.5 Median duration of postpartum insusceptibility by background characteris- tics Median number of months of postpartum amenorrhea, postpartum abstinence, and postpartum insusceptibility, by background characteristics, Vietnam 2002 Postpartum Background characteristic Amenorrheic Abstaining Insusceptible Number of births Age <30 7.4 3.8 8.2 901 30+ 7.9 4.4 9.3 412 Residence Urban 6.6 4.4 7.5 225 Rural 7.6 3.8 8.8 1,088 Project province No 6.2 3.7 7.5 881 Yes 8.9 4.4 9.5 432 Region Northern Uplands 4.3 2.2 6.0 254 Red River Delta 10.5 3.0 10.7 272 North Central 6.2 6.0 7.2 161 Central Coast 10.3 5.6 10.3 196 Central Highlands 10.1 3.9 11.9 65 Southeast 4.7 5.3 6.3 132 Mekong River Delta 6.4 3.8 7.1 234 Education No education 3.1 3.1 3.6 108 Some primary 9.2 3.8 9.8 188 Completed primary 7.9 4.7 8.6 474 Compl. lower secondary 7.4 3.4 8.6 325 Compl. higher secondary+ 5.6 4.0 6.2 218 Total 7.5 3.9 8.5 1,313 Note: Medians are based on current status. Table 5.6 Menopause Percentage of currently married women age 30-49 who are meno- pausal, by age, Vietnam 2002 Age Percent menopausal1 Number of women 30-34 0.7 1,062 35-39 1.1 1,042 40-41 2.1 359 42-43 2.0 426 44-45 10.6 339 46-47 17.9 270 48-49 36.0 259 Total 5.7 3,758 1 Percentage of currently married women who are not pregnant and not postpartum amenorrheic whose last menstrual period occurred six or more months preceding the survey 5.4 TERMINATION OF EXPOSURE TO PREGNANCY The risk of pregnancy declines with age as women increasingly become infecund or subfecund. The age at which fecundity begins to de- cline is difficult to determine for an individual woman, but it can be esti- mated for a population. One indicator of the reduction of exposure to the risk of pregnancy is menopause. In the VNDHS 2002, a woman is considered menopausal if 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 reports as being menopausal. Table 5.6 shows that the proportion of currently married women who have reached menopause increases with age from 1 percent of women age 30-39 to 11 percent of women age 44-45 and 36 percent of women age 48-49. Proximate Determinants of Fertility | 65 FERTILITY PREFERENCES 6 This chapter addresses questions that allow an assessment of the extent of unwanted fertility in Vietnam, the degree of acceptance of the two-child family norm, and the level of need for contraceptive services. Respondents in the VNDHS 2002 were asked questions concerning whether they wanted more children, if so, how long they would prefer to wait before the next child, and if they could start afresh, how many children in all they would want. Since an underlying objective of the Vietnamese family planning program is to persuade couples to have only two children and to space them at least five years apart, it is important to understand to what extent these fertility preferences have been accepted. Two other issues are examined here as well—the extent to which unwanted or mistimed births occur and the effect that the prevention of such births would have on fertility rates. The inclusion of women who are currently pregnant complicates the measurement of views on future childbearing preferences. For these women, the question on desire for more children was rephrased to refer to desire for another child after the one that they were expecting. To take into account the way in which the preference variable is defined for pregnant women, the results have been classified by number of living children, including current pregnancies. In addition, the question on preferred waiting time before the next birth was rephrased for pregnant women to make clear that the information wanted is the preferred waiting time after the birth of the child the respondent was expecting. Data of women who have been sterilized for contraceptive purposes also require special analytic treatment. The general strategy in some tables in this chapter is to classify these women as wanting no more children. 6.1 DESIRE FOR MORE CHILDREN In order to obtain information on future childbearing intentions, currently married respondents were asked: “Would you like to have another child or would you prefer not to have any more children?” If they did indeed want another child, they were asked: “How long would you like to wait from now before the birth of another child?” If the woman had not yet had any children, these questions were appropriately rephrased, 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. Almost seven in ten currently married women (69 percent) do not want any more children, three percentage points more than in 1997. Another 6 percent have been sterilized or have husbands who have been sterilized. Among women who express a desire for another child, the majority want to delay the next birth by two or more years (15 percent); only 6 percent of currently married women want another child soon (within two years) (see Figure 6.1). 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. Only 1 percent of women who have not yet begun childbearing reported wanting no children; this increases to 15 percent among women with one living child and reaches a high of 88 percent among women with two children, four percentage points more than in 1997. Not surprisingly, the desire to have a child soon is most prevalent among women who have not yet begun childbearing; 81 percent of women Fertility Preferences | 67 Table 6.1 Fertility preferences Percent distribution of currently married women by desire for children, according to number of living children, Vietnam 2002 Number of living children1 Desire for more children 0 1 2 3 4 5 6+ Total Have another soon2 80.5 14.3 1.1 0.8 0.2 0.0 0.3 5.6 Have another later3 5.0 62.9 4.2 2.9 1.4 0.3 1.0 14.9 Wants, unsure timing 1.1 1.9 0.4 0.3 0.3 0.0 0.0 0.7 Undecided 1.3 3.9 1.3 1.5 0.1 0.0 0.8 1.7 Wants no more 1.1 14.8 87.9 85.0 81.0 76.4 76.5 69.0 Sterilized4 0.5 0.9 4.0 8.9 13.6 19.8 14.8 6.4 Declared infecund 10.2 1.3 1.0 0.5 3.4 3.5 6.7 1.8 Missing 0.3 0.0 0.0 0.

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