At a small Hanoi cemetery, Nguyen Van Thao opens a fridge and pulls out a bag of bloody fetuses to prepare for burial — a grim reminder that Vietnam has one of the highest abortion rates in the world.
About 40 percent of pregnancies in the country end in abortion, according to a report by doctors from Hanoi’s Central Obstetrics Hospital, double the rate given by official statistics.
A legacy of childbearing quotas, poor family-planning advice for the young and conflicting messages about sex have created a situation where some are relying on abortion as a form of contraception.
Photo: AFP
There are 83 abortions per 1,000 women of childbearing age in Vietnam, compared with between 10 and 23 abortions per 1,000 women in much of western Europe and the US, according to sexual health non-profit group the Alan Guttmacher Institute.
“On our busiest ever day, we received 30 fetuses,” said Thao, who for about a decade has led a team of mostly Catholic volunteers in collecting fetuses, normally disposed of as medical waste, from abortion clinics across the capital.
“It’s hard to count how many we’ve buried,” said volunteer Nguyen Thi Quy, 62, who helps Thao shroud the fetuses, before giving them a proper burial at the cemetery in Hanoi’s Soc Son district.
For decades, communist Vietnam enforced a two-child policy, using a mix of administrative penalties and subsidized family planning to limit population growth. The scheme has since been scrapped, but its effects linger.
Abortions have never been socially taboo and the official rate of about 500,000 per 2.4 million pregnancies — about one in five — only counts procedures at state-run clinics.
“Sexually active young people have a problem... the public health system is not catering to [them],” Hanoi-based UN Population Fund representative Arthur Erken said.
Sexual behavior among young Vietnamese has radically transformed in the past few decades — they have sex earlier and marry later — but the state’s old-fashioned family planning services offer little advice or suitable contraception to young, unmarried couples, experts say.
As a result they suspect that abortion — permitted up to 22 weeks and widely available, particularly at legal, but largely unregulated private clinics — is being used to prevent unwanted pregnancies more often than in other countries.
“There is no systematic checking on private clinics. There could be another half a million [officially unaccounted for] abortions,” Erken said.
He added this would put Vietnam’s abortion rate at about 1 million for 2.4 million pregnancies and warned this figure “will increase unless we do something.”
Abysmal sex education in the nation’s schools, a general lack of information on reproductive health and no free family-planning services mean that for many young Vietnamese unwanted pregnancies are a fact of life.
“I’ve done this three times,” said Hoa, a fashionable looking 20-year-old, speaking after her third abortion at a private clinic in Hanoi.
“I was a bit scared the first time, but now I’m used to it,” said Hoa, adding she did not understand why she kept becoming pregnant as she and her boyfriend had taken precautions.
Many young Vietnamese have no knowledge of contraception, said Le Ngoc Bao, country representative of family planning organization Pathfinder International.
While society has become more permissive, giving birth out of wedlock is still frowned upon.
“If they get [an] unwanted pregnancy... the only way [out] is to get an abortion,” he said.
As many young people do not “fully understand the negative consequences of abortion,” the immediate costs of buying condoms or pills might seem more significant than the abstract risks of not taking precautions, he said.
Moreover, Vietnam’s high abortion rate comes even though statistics show widespread use of contraception — a sign of poor family-planning advice and counseling, Bao added.
In both private clinics and state-run facilities, even post-abortion counseling is limited, so some young women end up having repeated abortions.
Vietnam urgently needs to improve its provision of sexual education and contraception to young, unmarried women, Tran Ninh of the Vietnam Family Planning Association said.
Vietnam’s two-child policy, while not as draconian as China’s notorious one-child limit, has long forced families to restrict the number of children.
“If they have three kids, it’s a big problem for their career, they will not get a promotion or a salary raise,” said Giang Dang, a development expert at the Center for Community Support and Development Studies.
Dang said that the idea of a two-child family became “ingrained” and suggested that although it has been officially scrapped, local officials may still tacitly encourage it as “for them what counts is population growth being controlled.”
Cultural preferences for male children have also led to high rates of sex-selective abortions in certain areas of the country.
In a bid to prevent this, Vietnam has made it illegal for medical staff to reveal the sex of a fetus before birth — although experts say the law is hard to enforce and widely flouted.
As a result of the high abortion rate and decades of family planning aimed at limiting family size, Vietnam has one of the fastest aging populations in the world, Erken said.
“The pressure that puts on society — for pension reform, for example — is phenomenal,” he said.
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