Overcoming Barriers to Ensure Access to Reproductive Health Care in Vietnam

During the last three decades, Vietnam’s general public has achieved an all-time high in contraceptive prevalence rates. However, many still face barriers in accessing their choice of contraceptive methods or provider. Hang Nguyen, Country Director for Marie Stopes International (MSI) Reproductive Choices in Vietnam, sits down to talk with us about those who are most impacted by these obstacles and how MSI is working to overcome them.

MSI, a UK-based non-profit, specializes in and delivers sexual and reproductive health care and family planning in 37 countries. MSI’s Vietnam program began in 1989, and continues to deliver reproductive healthcare—including contraceptive, abortion, and diagnosis, prevention, and treatment services—to more than 200,000 patients a year, including ethnic-minorities, factory workers, and young people; MSI Vietnam’s factory program brings SRHR care and services to factory workers in more than 80 factories in the Ho Chi Minh area. 

Contraception is not yet covered by Vietnam’s national health service, and while anyone can technically access contraception from any pharmacy or health clinic, factory workers still see very low rates of usage. This is often attributed to factory worker’s schedule of long and demanding hours, costs of new contraceptive methods, and travel time for those in remote, mountainous areas. MSI has developed and launched a service voucher program to facilitate young women and girls, as well as factory workers, to access contraceptive services at a time convenient to them.

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Transcript

Jennie: Welcome to rePROs Fight Back, a podcast where we explore all things reproductive health, rights and justice. I'm your host, Jennie Wetter, and I'll be helping you stay informed around issues like birth control, abortion, sex education and LGBTQ issues and much, much more-- giving you the tools you need to take action and fight back. Okay, let's dive in.

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Jennie: Welcome to this week's episode of rePROs Fight Back. I'm your host, Jennie Wetter, and my pronouns are she/her. So y'all, I am coming to you refreshed, revived, revitalized. I just spent a week in Jamaica with my mom and had plenty of time to disconnect from all of the things, get off of social media, not be checking my emails, and really just get away from everything and lay on the beach. I did a ton of reading and read a bunch of fun, fluffy books and just had a really nice time to disconnect. You know, I've definitely talked about on here that this last six months has been really hard between health issues with both my parents and then my dad passing away. It was really nice to get away with my mom and just have some time together. We were gone over my dad's birthday, so it was really nice to be together for that, to just get away for a little while and it was really needed, I think, for both of us, and it was just a wonderful trip to get to spend time with my mom and relax and just come back a little bit more refreshed, which was delightful and much, much needed. Also, you know, it helps that there was good news while I was on vacation, right? I was in Jamaica when SCOTUS decided to extend the stay around the Texas case around mifepristone. So ensuring that mife would continue to be available in states where abortion is legal for medication abortion, you know, it doesn't solve all of the problems, but it doesn't make them worse at the moment, which honestly is very sad to be like, that's good news, but that is very good news. But that's where we're at right now, is not getting worse is a win, y'all. I'm tired already again, but fight goes on and I'm very glad that medication abortion is gonna continue to be available in states where abortion is legal and we'll keep fighting to make sure that it gets to be available everywhere. I, I feel like I don't have a ton to add. I really feel like I'm still just back from vacation, although I've been back this week, but I, I feel like my brain is still a little bit on vacation, you know, digging out from under that mountain of email that came in while I was gone. All of the fun parts of coming back from vacation and facing the real world again. My poor little kitties have been utter monsters since I have been back and have just been really, really, really wanting attention, which is fine, but sometimes a little frustrating as I'm trying to work and they both feel they need to lay on my desk right in front of my computer and make it hard to work around them.

Jennie: Yeah. Okay, so let's turn to this week's episode. I'm really excited to have with me today Hang Nguyen, who is the Country Director for MSI Vietnam, on to talk about MSI's work in Vietnam and some of the special projects they have going on to extend access to family planning, but also reproductive healthcare at large in Vietnam. It was a wonderful conversation, so I hope you enjoyed my conversation with Hang.

Jennie: Hi Hang. Thank you so much for being here today.

Hang: My pleasure. Thank you. Jennie: Before we get started, do you wanna do a quick introduce yourself and tell us your pronouns?

Hang: Hello, my name is Hang Nguyen I'm the, uh, Country Director for MSI Reproductive Choices in Vietnam. I have been with the organization for, uh, more than 25 years, and it's, uh, it's a great honor for me to be here on this podcast.

Jennie: I'm very excited to talk to you today about MSI's work in Vietnam. It was really interesting to learn more about it and I can't wait for my audience to learn more. So can you tell us a little bit about the work MSI does in Vietnam?

Hang: Yes. MSI is a UK based NGO and the organization, uh, is very specialized in in sexual and reproductive health and, and family planning and, and we're expanding into women's health as well. MSI is working in 37 countries, including Vietnam and MSI started it’s, uh, very first reproductive health program in Vietnam in 1989. We currently deliver essential reproductive healthcare, including contraceptive services to more than 200,000 women a year through a network of 11 women's health clinics, a well-established and Expanding Women's Health at Workplace program, and a dedicated public sector strengthening program targeting ethnic minority women and poor women living in remote rural areas. MSI in Vietnam provides contraception, abortion, diagnosis and treatment of sexually transmitted diseases and reproductive tract infections, including cervical cancer screening and preventive treatment. We focus on serving the underserved communities such as factory workers, ethnic minority women, and young people.

Jennie: I, I really, what was really interesting to me, I mean, all of it is really interesting, but I haven't had a, a guest on talking about programs targeting factory workers before, and I found that really an interesting approach. Can you talk a little more about that program?

Hang: Yes, of course. We, MSI Vietnam, started our factory program in collaboration with supplier factories in Ho Chi Minh city in 2005. And, uh, with the very first success, our collaboration, the program has been standard into other companies, including global brands as well as the supplier factories in Vietnam. And to date, we are working with more than 80 factories across the country, bringing sexual reproductive health education as well as supporting services to the factory workers.

Jennie: So I think the next big bucket of things to talk about is contraception in Vietnam and how readily available is contraception for people to get, or are there any major barriers to accessing it?

Hang: Yeah, thank you for, for your question. Vietnam has, uh, during the last three decades, Vietnam has achieved a high overall contraceptive prevalence rate among, you know, the general communities of women of reproductive age. The total fertility rates in Vietnam is already at or lower than the replacement level. However, some population groups still face, uh, real barriers in their choice of methods and choice of provider; contraception is not yet covered by our National Health Service. While technically every woman in Vietnam can access contraception from pharmacies and health facilities, the rate of contraception usage is still the lowest among factory workers, uh, which is around 45% to 47% in comparison to the general contraceptive prevalent rates in Vietnam which are 79%. Women from ethnic minorities and young people also face the, the barriers in accessing contraceptives and, um, that's why that lead to the low rate of access among this group. Uh, the biggest barriers are the accessibilities and affordability to effective long-acting contraception methods among factory workers and women from ethnic minorities. Factory workers normally work long hours from Monday to Saturday, and they hardly have time to go for services. The cost of new contraceptive methods like implants is still high in comparison to their average monthly income. Ethnic minority women live in, uh, remote mountainous areas and normally it spans a half day to a day to walk to nearest community health clinics for contraception, uh, basically four times a year if they use the contraceptive injectable-- three months-- in many mountainous commutes, many women have to take their young kids with them, walk for four to five hours on a small path around the mountains to a nearest health facility for contraception service, like an intrauterine device, and there they have a small meal provided by the health facility, rest for a while, and have the IUD inserted, rest for the while and then take all the kids back home. Many women suffer from the fear of getting pregnant as their husband or partner do not want to use a condom. Many men could also intervene with, uh, which contraceptive methods that they want their, their wives or their partner to use and basically put more burdens on women, as well. And youth in Vietnam are still faced with social taboos when it comes to accessing contraceptives at health facilities. Although the situation has improved in recent years, the rates of unintended pregnancy leading to abortion was still as high as 30% among adolescent and youth as, uh, reported by the Ministry of Health and other international organization.

Jennie: Yeah. How are youth finding access to services, like you hear often in, in countries where they're finding maybe hostile environments when they tried to access services? You said some of that is changing, is that, is the attitude at the clinics changing as well?

Hang: I think there are definitely changes in the provision as well, the demand for, for family planning of, for contraceptive services in Vietnam during like the last five years. I'm, I'm sure that, uh, with the digital developments and social media, the general awareness of, uh, young people, women's and girl’s [needs], the availabilities of, of contraceptives is significantly improved and so is you know, other groups as well, but it's still disparities and inequalities in, in accessing to contraceptive services in reality. I think the main reason is, I mean, I already mentioned about the barriers in terms of the affordability and availability, like effective long-acting contraceptive methods, but it's, I also think that, women have to, many women actually have to choose the short term methods like condom. Condom is very difficult because their husband and their partner do not want to use, most of them do not want to use condom, but other short term methods, there is a lot of complaints among women about the fact that they miss the pill, they forget to take the pill, things like that, and how it, you know, it is resulted in unwanted pregnancies and, and many, in many women, especially in married women as well unwanted birth. I think in terms of the supply side in Vietnam, I guess that, uh, with our achievement in population development and, and, you know, population control now, contraceptive probably this is not very, uh, priority for the population in general. So rather the governments actually focus or encourage other players to focus on those population groups with high unmet needs, like women in the ethnic minorities or factory workers, or young adolescent and young people. And I think, uh, that's how MSI Vietnam also focus on them and serving them in, in different ways. MSI works very closely with the public and the private health sectors to expand the coverage of contraceptive services to the women. So, uh, we work with the public health facilities in rural and remote areas. We train public service providers, and we utilize them and to bring contraceptives services and of course other, other reproductive health services like cervical cancer screening to the community, to women living in the community. We also work with the corporate sector with the global brands. Now we are working with some global brand like Apple, Levi’s and Samsung as well to, uh, really bring reproductive health and family planning education and services to, to the factory floor. And that's how we target and we reach out to this, um, this group with high unmet needs. We also work with young people. We partner with the business and companies to leverage their resources and their infrastructure to integrate to the either integrate, uh, SRHR education into their existing program, but also like develop and launch service voucher program to facilitate young women and girls and, and also, you know, factory workers as well to use, intercept these vouchers to access services at their time, kind of convenient time because, you know, time is an issue to factory workers and to many women. That's what we have been doing, so far, uh, as, as a solution to help, uh, addressing the unmet needs in the country.

Jennie: Great. There's one other thing that I wanted to unpack that you said earlier, and it was talking about maybe not being able to get the method they would like. Is it a function of the method not being available or were you talked about that it could be too expensive? Is it a price function or lack of availability?

Hang: I think it is both. As a lack of the availabilities, because the IUD has been the most popular long-acting family planning method in Vietnam so far. It was provided free of charge by the public health sector to women for, for a long time. But I, I guess women, not every woman actually can’t use IUD because they experience all these kind of symptoms and, and the discontinuation rates is quite high among IUD methods; for the contraceptive implants, I think at the moment, the commercial products available on the market is still very, very expensive and, you know, it's, it's hardly affordable by, by, uh, women. And so MSI in Vietnam work with development donors and corporate companies and we also work with other private partners in order to bring kind of subsidized, family planning services to factory workers and to women living in the rural areas. I think so far it has been an effective way for us to leverage the resources as well as the infrastructures and expertise of different partners to bring the services closer and closer and more to targeted groups at a much lower, lower cost for them.

Jennie: Yeah, that's so important. I mean, thinking of, you know, not having the method you want or being able to afford it after you've walked five hours to get there, like.. it just makes people not come back for services that they want or…

Hang: Yeah. Yeah, very true, very true. I mean, like, uh, the factory workers have a very, very busy day, you know, starting like five or six o'clock in the morning preparing for their families and their kids to go to school and also rush to work and work there and come, you know, leave there, the factories at about like, you know, six or seven and there is a lot of work waiting for her at home, like a preparing dinner, kind of, taking care of their kids. Sometimes they actually have to spend time studying together with their kids. And, uh, you know, we, we interview many, uh, factory workers, and so they said that they probably have about 30 minutes to one hour of their time in a day, which is after nine o'clock. So they spend this time to kind of, to search information online or to kind of visit their, their friends on Facebook, you know, and all this kind of thing, and then go to bed and ready for another day, like every other day. So it's, it's, it's really tough for them and we got these insights and that's why we… and we also work with the, the company as well to, and to advocate the top management to allow these women to go to the, the factory health clinic at different time during the years when we, uh, bring our services there. We also train the health staff of the, uh, of the factories in order for them to provide like the initial counseling, as well as a referral of the factory workers to, to selected health clinics for our services using our vouchers scheme.

Jennie: So I feel like we've already talked about some of the challenges accessing services and the need. So maybe let's touch a little bit on why reproductive healthcare is so vital to women in Vietnam?

Hang: I think maybe, let me tell you a story about contraception and reproductive healthcare can change lives of many people in Vietnam. When I attended a mobile contraceptive service provision in a poor province in 2019, I met with two ladies. One was 37 years old who came to the event for a contraceptive implant service. She had a two-month old baby with her, and when I talked to her, she told me her newborn, who is the fifth child in her family, the fifth one, and she was only 37. When I asked her the reason why she choose to have a, you know, so many kids, she just said, “oh, I did not choose to have five kids. I would rather have a one or two only.” Then, uh, she started opening up and told me how failure in contraception led her to, uh, to the five, to having five kids--20, 18, 17, 14, and two months. She did not have a stable income, and her husband, who was a, a carpenter earned, uh, average 210 US dollar a month, and that is for seven people in the family. Therefore, the young kids of 20, 18, and 17 had to drop out of the, their schools to join their father and work to support the family. Then I met with another woman. She was 45 and she looked healthy and happy. She was there for a gynecological examination. She told me she had one child of 23 and he just graduated from a banking college, got a job in a big city and started sending money home to support her and her husband. That woman had time and money to enjoy life, traveling, visiting their parents, and sibling-- life is good for her. So I just asked, uh, myself, would the life of that young woman with five kids and the lives of her family be much better if she had a better choice of contraceptives and like the elder woman? Could reproductive healthcare save the lives of women if they have better knowledge and access to cancer screening and preventive treatment in, in time? So we are not too late for them when cancer is detected. Would the lives of women and girls be better if they have access to contraceptives that help them to continue their education or just stay in the, in their job? 40% of the factory workers have to quit their job after giving birth. They just don't have anyone around to help them to take care of the baby. Yeah, so I believe the answers is obvious. Their reproductive healthcare and contraception empowers women. It has a huge impact on the lives of, of women and girls. I also believe that it definitely lays a, a solid foundation for a better future for women, their children, and you know, eventually for a better country and for the whole world. Don't you think?

Jennie: Yeah. I mean everyone should be able to decide if, when and how to have children. And their timing it, you can plan your life around it then; it makes huge difference.

Hang: Yeah.

Jennie: Okay. So we always like to wrap up the podcast by thinking about what can the audience do? So what can the audience do to help?

Hang: Before appealing the support, calling for the support of the audience, I just want to say that MSI Vietnam are extremely, extremely grateful to the Australian government, the European Union, the government of Canada, the government of New Zealand, the Atlantic Philanthropies, and many generous donors and supporter for their generous support to MSI Vietnam, you know, endeavor to further MSI's mission to ensure the fundamental rights of individuals to have children by choice, not chance during the last three decades. For the listener of this podcast, one way to help is to donate to MSI to help keep this work going. People in the United States can, uh, donate at msiunitedstates.org, and if you are elsewhere in the world, Googling MSI Reproductive Choices should get you to our global homepage or the country program closest to you. Thank you very much and have a good day.

Jennie: Hang, thank you so much for being here. I really enjoyed talking to you.

Hang: So do I. Likewise. Thank you very much.

Jennie: Okay, y'all, I hope you enjoyed my conversation with Hang. It was great to learn more about their important work in Vietnam. I really enjoyed learning more about the outreach they were doing to factory workers. It was an area that we haven't talked about on the podcast before, right? We've talked about, you know, extending access to rural communities and stuff, but this was really interesting for me to learn more about the work they're specifically doing with factory workers to ensure that they are getting access to the care they want. I found it really interesting.

Jennie: Thanks for listening everyone. And we'll see you on our next episode of RePROS Fight Back. For more information, including show notes from this episode and previous episodes, please visit our website at reprosfightback.com. You can also find us on Facebook and Twitter at RePROS Fight Back, or on Instagram at reprosfb. If you like our show, please help others find it by sharing it with your friends and subscribing, rating and reviewing us on iTunes. Thanks for listening.