The pioneers of Vietnam’s epidemiological transition: an ethnographic study of pregnant women’s experiences of gestational diabetes

ABSTRACT

Background

Gestational diabetes mellitus (GDM) is an abnormal glucose metabolism diagnosed during pregnancy that can have serious adverse consequences for mother and child. GDM is an exceptional health condition, as its management serves not only as treatment but also as prevention, reducing the risk of future diabetes in mother and child.

Objectives

This qualitative study aimed to explore how pregnant women experience and respond to GDM, focusing particularly on the role of the family environment in shaping women’s experiences.

Methods

The research was carried out in Vietnam’s Thái Bình province in April–May 2023. We conducted in-depth ethnographic interviews with 21 women with GDM, visiting them in their homes. Our theoretical starting point was phenomenological anthropology, and the data were analysed using a thematic analysis approach.

Results

At the centre of women’s experiences was the contrast between GDM as a biomedical and a social condition. Whereas GDM was biomedically diagnosed and managed in the healthcare system, it was often deemed insignificant or non-existent by family members. This made GDM a biomedically present but socially absent health condition. This paradox posed challenges to women’s GDM self-care, placing them in pioneering social positions.

Conclusions

The biomedical presence yet social absence of GDM turned women into pioneers at biomedical, digital, epidemiological, and family frontiers. This article calls for appreciation of pregnant women’s pioneering roles and for health systems action to involve women and families in the development of GDM policies and programmes at a time of sweeping global health changes.

PAPER CONTEXT

Main findings: Vietnamese women’s experiences of gestational diabetes were affected by social splits between clinic and home; between biomedical and family worlds.

Added knowledge: Gestational diabetes places pregnant women in Northern Vietnam in pioneering roles on biomedical, digital, epidemiological, and family frontiers.

Global health impact for policy and action: Pregnant women should be involved in the development of policies and programmes addressing gestational diabetes, with particular attention to the connections between clinical and family worlds.

KEYWORDS:

• Digital health
• family environment
• health services
• phenomenological anthropology
• pregnancy
• self-care

Responsible Editor Maria Emmelin

Responsible Editor Maria Emmelin

Acknowledgments

This research was conducted under the auspices of the Vietnamese-Danish VALID project (Living Together with Chronic Disease: Informal Support for Diabetes Management in Vietnam). The research forms part of the VALID project’s second phase, titled ’Gestational Diabetes in Vietnam.’ We are grateful to VALID colleagues in Vietnam and Denmark for fruitful collaboration and to Thái Bình health authorities and healthcare workers for supporting our work. Last but not least, we thank the pregnant women and their family members for participating in the study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributions

All authors took part in the conception of the ethnographic study. Fieldwork was conducted by TG, TAN, TKDV, NATD, TMPN, and VTN. Transcriptions were coded by TAN, TKDV, NATD, TMPN, and VTN, and thematic analysis was conducted by TG, TAN, TKDV, NATD, TMPN, and VTN. TG took the lead in drafting the manuscript and all authors contributed to all stages of the writing. All authors have approved the final version for submission to Global Health Action and hold accountability for the work.

Ethics and consent

The research followed ethical guidelines developed by CIOMS (Council for International Organization of Medical Sciences). All pregnant women were informed of the purposes of the research and gave written informed consent. The women were informed that they could withdraw at any time and that withdrawal would not affect their access to health care. Throughout the research process, confidentiality of participant information was ensured, and all personal names in this article are pseudonyms. Ethical approval of the project was granted by the Ethics Council for Biomedical Research of Thai Binh University of Medicine and Pharmacy on 1 December 2022 (IRB – VN01.009).

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

The research was funded by the Ministry of Foreign Affairs of Denmark [project no. 21-M03-KU: ‘Gestational Diabetes in Vietnam’].