Despite growing access to contraception and strong family planning, Vietnam has one of the highest rates of abortion in the world. As public health officials work to bring down these numbers, Vietnam must face the unfinished business of reaching out to its young, unmarried citizens. By Dana Filek-Gibson, with additional reporting by Ruben Luong. Photos by Vinh Dao.

Despite growing access to contraception and strong family planning, Vietnam has one of the highest rates of abortion in the worldA World Health Organization report presented at the Franco-Vietnam Gynaecological and Obstetric Conference last May found that each year an estimated 40 percent of pregnancies in the country are terminated.

While access to reproductive health services and information is greater than ever, the doctors who authored the report agree that “abortion is indeed the biggest challenge facing Vietnam in the field of reproductive healthcare, although the rate of application of contraceptive methods has increased.”

Several decades ago, abortion was an integral part of the country’s efforts to harness population growth. Still recovering from the aftershocks of war and with a limited supply of safe and effective contraception in stock, abortion was used to ensure that married couples stuck to the two-child rule.

Today, while the majority of married Vietnamese women report using some form of contraception, abortion rates remain high. Beyond access to effective birth control, societal attitudes highlight the perplexing relationship this country has with abortion. Last year, when doctors surveyed women seeking to terminate their pregnancy at Hanoi’s Central Obstetrics Hospital, nearly three-quarters of those interviewed still considered abortion a method of family planning. Across the board, all of the participants had at least some knowledge of contraceptives as well as the health risks associated with undergoing the procedure. A considerable majority also viewed abortion as a last resort.

However, when it came to the reasons for terminating a pregnancy, almost 40 percent of the women cited “being busy at work” as a legitimate basis. Other justifications included the state of the economy and either the woman or her partner being unready for a child at the time.

The prevalence of the procedure is also cause for concern, with nearly two-thirds of the 384 women in the survey stating they had already had at least one abortion.

When Options Were Limited
When Phuong*, a 20-year-old vocational school student from Gia Lai, first learned she was pregnant, she knew abortion was her only choice. This was not the first time she and her long-term boyfriend had been in such a situation. Phuong, who lived in Hoi An, boarded a bus for Danang, where the region’s best medical facilities were at the time. Making the rounds of the city’s best hospitals, she filled out the necessary forms, using a false name in order to remain anonymous. Because Phuong’s predicament was understood – a young woman pregnant out of wedlock – no one asked for her identification or any personal details. However, given the late stage of her pregnancy, doctors were unable to perform an abortion. In 2002, Vietnam did not yet recognise second-trimester abortions as legal, making Phuong’s quest for help too little too late.

Desperate and running out of options, a friend of Phuong’s boyfriend called his girlfriend Thuy*, another Danang local, to ask for help. Over the course of an afternoon, Phuong and Thuy visited Hoan My Hospital, where the pair were also turned away, before arriving at a family healthcare and family planning clinic. Again, the doctors were unable to help, however this time a nurse mentioned to Thuy that she knew a doctor who would perform the abortion. After jotting down a phone number and address, the pair set up an appointment for later that day.

The house in which Phuong had her abortion was located in an ordinary residential neighbourhood and did not appear to be a clinic from the outside. When the two entered, Thuy says she heard a scream from down the corridor. Not long after, a young woman emerged from within the house, ashen-faced, and sank onto a waiting room chair. The doctor then came into the room and called Phuong to the back.

Within minutes, the doctor returned. Phuong did not have enough money on her own to cover the cost of the abortion. Though the two were more acquaintances than friends, Thuy still felt responsible. With the promise that she would be back soon, Thuy left to get some money. “I shouldn’t have taken her to the hospital,” she recalls. “But if no one helped her there would still be a problem.”

In the alley outside the house, Thuy came across a pawn shop vendor in the street and bartered one of her gold earrings for the remainder of Phuong’s abortion fee. All told, the procedure cost VND 600,000 and lasted no more than 15 minutes. When she reappeared from down the hall, Phuong was pale but well enough to insist that they get on a bus to Hoi An immediately. When the doctor protested, Phuong said that she would be fine, as this was her third abortion and so she knew what to expect.

Fast forward to the present, and now married, Phuong is a housewife and mother of two. She and Thuy, also married, haven’t spoken in years. If her story were to happen again today, the process would be much easier and safer than it was back then, thanks to her marital status. Phuong could go to a public hospital on her own, knowing with almost complete certainty that her needs would be met. Better still, contraception would be easily accessible, preventing the need for drastic measures before the situation even arose.

Facing the Reality
But 12 years after Phuong and Thuy’s experience, is the situation improving for single Vietnamese youths? Without a husband, young unmarried Vietnamese are not considered a suitable audience for sex education or access to reproductive health services, as premarital sex goes against the country’s cultural values. This leads to a lack of awareness when it comes to not only safe and legal means of abortion but also the contraceptive measures and other services which could prevent pregnancy in the first place.

“For us, the issue of unmarried young people is really the concern,” says Arthur Erken, United Nations Population Fund representative in Vietnam. “I think the government realises it but at the same time, of course, it’s also a very sensitive issue. For us, the biggest challenge is to convince people. Giving comprehensive sexuality education to young people actually delays the onset of sexual activity.”

In Phuong’s case, giving birth was certainly not an option. Without the familial safety net, many young unmarried women find themselves in a similarly precarious situation. Both the cost and social judgment of visiting a public hospital drive many into private clinics, where there is less quality control over the facilities or the expertise of the healthcare provider giving the abortion.

Though Thuy found her friend’s attitude toward abortion both frustrating and a little unnerving, there is no doubt in her mind what would have happened if their roles had been reversed.

“If I were in school, I would do it, too,” Thuy says. “I can’t get pregnant and then tell my parents. No one wants an abortion, but [it was] the best situation [at that time]. They can’t get married so young. Ten years ago, your parents don’t want to lose their face. She did not have any choice.”

Unfortunately, despite the number of years between Phuong’s abortion and the present, the number of minors who find themselves in this situation only seems to be rising. Last year, local news outlet Tuoi Tre reported that Vietnam led the region in abortions among minors, with roughly 300,000 pregnancies terminated a year.

While there has been evidence of a tentative push toward more proactive reproductive health education, there is still plenty of work to be done. Earlier this year, VietNamNet ran an article on sex education programs at high schools in Phu Yen province, where local officials were revising the class curriculum in an effort to create more effective dialogue between teachers and students. At the Museum of Ethnology in Hanoi, a small room on the ground floor holds a display on gender expression and sexuality, including a rundown of contraception options.

While the change will certainly not happen overnight, Erken is optimistic for the future. “I think Vietnam is pragmatic enough to start dealing with the issue of sex education for unmarried young people, and I hope and I expect that because of that the abortion rates will decrease,” he says. “What Vietnam has done very well is that they’ve worked on the quantity of services. What they now can do and will do is work on the quality of it.”