Countries Abortion Profile

Viet Nam

1. Law related to Abortion

The Constitution of Vietnam declares that men and women enjoy equal rights in all aspects and circumstances such as reproductive health: “The State, society, family and citizen have the responsibility to provide health care and protection to mother and children; and carry out the population and family planning program.”
                                       
In 1960s, the Vietnamese National Assembly adopted the Law on Marriage and Family which is based on four principles, namely: freedom of marriage; monogamy; gender equality; and protection of women’s and children’s rights.
 
By 1989, the Law on Protection of People’s Health was approved, affirming the people’s rights to choose contraceptive methods. Furthermore, it states that: “Women have the rights to have abortion; to receive gynecological diagnosis and treatment; and health check-up during pregnancy; and medical service when giving birth at health facilities.”

2. Policy

From the decades of 60s to 90s, the Ministry of Health - Department of Treatment defines that abortion services are provided to women upon request at public clinics by trained physicians/midwives.
 
In the 1980s, the government encouraged small-sized families, ideally with two children, spaced three to five year.
 
Government Decree No. 104/2003/ND-CP dated 16 September 2003 guiding the implementation of some articles of the Ordinance on Population strictly prohibits choosing the sex of the fetus (Art.10)
 
In 2003, the Minister of Health published the National Standards and Guidelines (NSGs) for Reproductive Health Services including a Chapter on Safe Abortion. It is stated in the NSGs that trained obstetricians, assistant doctors with obstetrics - pediatric specialist or trained midwives can legally perform abortions. It is also defined that abortion services are provided at three administrative levels of the health system: (1) abortion of 6-22 weeks gestation provided at central and provincial hospitals; (2) abortion of 6-12 weeks gestation is provided at district health stations; and (3) abortion up to 6 weeks gestation is provided at communal health centers. Private clinics in certain provinces are allowed to perform abortion up to 6 weeks gestation if they meet required criteria set out by the Provincial Health Services.
 
During 2007 – 2009 Vietnam Ministry of Health (MOH) work together with UN agencies and International NGOs to upgrade the National Standards and Guidelines for Reproductive Health Services. The new version of the NSGs will be published in 2009. In this new version the following techniques/issues are mentioned:

  • MVA
  • MA using combined Mifepristone and Misoprostol regiment for gestation up to 63 days (gestation limitation for district level: 49 days; provincial level: 56 days; and central level: 63 days).
  • D&E
  • Second trimester abortion by combined Mifepristone & Misoprostol and Misoprostol alone regiments for gestation 13 – 22 weeks.
  • Abortion counseling
  • Instrument processing
  • In this version of the NSGs, providers are advised to screen second trimester abortion cases to avoid sex-selected abortion.

3. Second Trimester Abortion

4. Practice

Since 2001, Vietnam MOH work together with Ipas Vietnam on developing Comprehensive Abortion Care (CAC) Model at two central hospital – National Obstetrics & Gynecology Hospital (NOGH) and Tu Du Hospital – and two provinces with their districts and communes. The CAC model aim to improve quality of abortion care through improving counseling, qualifying abortion procedures, standardizing infection prevention practices, and linking abortion service with contraceptive service. Since 2006, CAC model is scaled up in 5 other provinces as well as a strong team of Safe Abortion trainers have being developed in order to widen CAC model in the country. Many CAC training courses have been held by the MOH for providers from provincial level and NOGH & Tu Du Hospitals become two CAC training centers.

5. Reproductive Health Perspective

Vietnam has signed ICPD and CEDAW. The Government is trying its best to realize its commitment on ICPD and CEDAW.
 
Women’s rights is upheld and protected by the law: Female workers on maternity leave, no matter how many births they have given, are entitled to natal allowance. Single women are entitled to pregnancy supporting techniques at the instructions of specialized doctors.
 
Vietnam has a large number of sectoral documents stipulating ways to better protect mothers, including the Safe Motherhood Programme, tetanus vaccination and iron tablets for pregnant women programme, protection of pregnant women during floods and other natural disasters.

6. Abortion Statistics

Viet Nam is considered to have one of the highest abortion rates in the world − about 500,000 cases were reported from the public sector in 2006, and at least the same number have been provided in the private health sector as estimated by the public abortion providers. The ratio of abortions to live births in Vietnam is high. According to Vietnam Abortion Situations Country Report 2001, there are 45.1 abortions per 100 live births. There is no official statistics on adolescent abortion but it is estimated that about 20 – 30% of all abortion cases belong to young, unmarried women. There is no official statistics on unsafe abortion and complications.

7. Public sector

First trimester abortion by manual vacuum aspiration (MVA) is provided at central, provincial and district levels and commune health centers, while medication abortion (MA) is provided only at central and provincial levels. D&C and sharp curette check following MVA procedure are still applied at provincial and district levels. For second trimester abortion, dilatation and evacuation (D&E) has been introduced at two central and seven provincial hospitals, and medical abortion protocols have been included in the draft updated National Standards and Guidelines for Reproductive Health Services. However, outdated and unsafe techniques such as Kovac’s method are still used at many provincial hospitals.
Cost of abortion services vary by gestation, abortion method and service site. Approximately, an MVA case cost 4-7 USD, an MA case cost 20-25 USD and D&E case cost 80-100 USD.

8. Private sector

Policies allow trained private providers to provide MVA and MA services for gestation up to 6 weeks. There is no government system which manages the number and quality of abortion service at the private sector. Abortion complication treatments at public sector are often for cases come from private sector.
Cost for abortion services at private sector differ for gestations and specific clinics, ranged from 18 – 100 USD.

9. Methods used

Abortion techniques in Vietnam by Mai Nguyen et all - National Abortion Survey, 2002.

Note:

  • There is big percentage of abortion cases by MVA but the technique is not standardized for all cases. 
  • Now the percentage of abortion cases by MA is increased, estimably 5%.  
  • Others including EVA, D&E and Kovac’s.
  • Recently, second trimester abortion by combined Mefepristone & Misoprostol and Misoprostol alone regiments are practiced at some central and provincial hospitals.

10. Provider level allowed for surgical and medical abortion

It is stated in the recent NSGs: 

  • ­MVA providers include doctor, assistant doctor (Obstetric-Pediatric specialist), secondary and college-level Midwife who are trained in MVA.
  • ­MA providers include obstetric and gynecological doctors who are trained in medical abortion.
  • ­D&C providers include doctors, obstetric-pediatric assistant doctors who are trained in D&C.
  • ­D&E providers include obstetric & gynecology doctors who are skilled in first trimester D&C and trained in D&E.

11. Abortion related morbidity mortality statistics

Causes of Maternal Mortality in Vietnam by MOH, Reproductive Health Department, 2002.

In spite of the liberal law and availability of abortion service at public and private sectors unsafe abortion is still one of the common reasons for maternal death, estimated at 11.5% of direct causes of maternal mortality in Viet Nam in 2002.

12. Manufacture and/or availability through import of abortion equipment (MVA syringes, EVA equipment)

Ipas MVA instruments including Ipas Single Valve and Ipas MVA Plus are made in Taiwan and distributed through 4 local distributors.                         
Available EVA instrument produced by Doctor Friend and Sturdy in Taiwan, by Sharp/Shin-ei in Japan, and Gima in Italy.

13. Manufacture/ import of Mifepristone, Misoprostol

Mifepristone in Vietnam come from two companies. Nam Ha Pharmaceutical Company imports mifepristone from China. STADA, a Vietnam-Germany Joint Venture Company import mifepristone powder and make tablets in the country. Misoprostol is imported with brand name Alsoben.

14. Facility and provider certification norms in brief

15. Information available in national service delivery standards

16. Informal / illegal providers – if present who are they

At remote areas, untrained providers even quacks still provide unsafe abortion services but there is no official data on this issue. The problem of unsafe abortion and illegal providers some time discussed on newspaper while there is a serious abortion complication reported.

17. Population urban/ rural: Demography of the country, with an analysis of availability of abortion services ratio to population

Vietnam has population of 85.2 millions (by Bureau of East Asian and Pacific Affaires, December 2007) with 28.3% urban and 71.7% rural population (by Health Statistics Yearbook 2006). There is no official statistics on abortion services ratio to population but it is not too difficult to access abortion services in rural areas except remote areas.    

18. Role of government

As stated in laws and policies, Vietnam Government support abortion but there is very limited annual budget allocated for safe abortion training and equipment.

19. Role of religion/ religious leaders

Religion leaders in Vietnam do not officially against abortion but never support it.

20. Local Ob Gyn societies

Vietnam Obstetric and Gynecology Society supports abortion. 

21. Current status and potential of research

While quality of abortion services at project sites is high at many provinces there is still a lot of work to do in order to improve the quality of abortion care. The effort needs to be focused on: 

  • Improving abortion/contraceptive counseling
  • Standardizing abortion practice including infection prevention and instrument processing
  • Linking abortion service with contraceptive service
  • Simplifying administrative procedure for abortion clients.

22. Awareness amongst community members

Vietnam people are aware of abortion legality and availability of the service. Even though, Vietnam culture against pre-married sexual intercourse and therefore against pre-married abortion. Because of this culture barrier young unmarried women often delay to access safe abortion service or go to untrained private providers for abortion.

23. Role of member organization/ individual

  • WHO provides technical support to safe abortion in Vietnam.
  • Ipas Vietnam provides technical support and work together with Maternal & Child Health Department – Vietnam MOH in designing, facilitating, monitoring/evaluating and scaling up CAC model in Vietnam.
  • Pathfinder International, Path, Marie Stopes International (MSI), and Vietnam Family Planning Association (VINAFPA) design, facilitate and implement Reproductive Health Projects and Safe Abortion Projects.