Deconstructing ‘barriers’ to access: Minority ethnic women and medicalised maternal health services in Vietnam

Abstract

Low maternal health service utilisation amongst minority ethnic women in Vietnam is often attributed to ‘traditional customs’. Drawing on secondary data and original, qualitative research amongst Hmong and Thai communities, this paper analyses minority behaviour related to childbirth. The informed selectivity in service attendance identified can be considered, in part, a rejection of current medicalised approaches at health facilities, where supine delivery is compulsory and family members are prohibited from attending women in labour. The paper reveals how conventional analyses of barriers to minority maternal health service utilisation inhibit scrutiny of the ways services fail to engage with or accommodate local preferences. Participatory identification of mutually acceptable delivery methods by maternal health staff and local women is recommended to enable the development of culturally inclusive services.

Keywords:

• minority ethnic groups
• childbirth
• Vietnam
• culture
• medicalisation

Acknowledgements

The authors thank the villagers who participated in the study, the health staff in Dien Bien and Ha Giang, Medical Committee Netherlands Vietnam (MCNV), and the main donor of the programme under which the study was conducted, the Royal Netherlands Embassy in Hanoi.

Notes

1. Document No 692/CN-SYT on Ethical Clearance, Dien Bien; Document No 725/UBND-VX on Ethical Clearance, Ha Giang.

2. Compared to around 10% amongst the Kinh.

3. This woman subsequently became a traditional midwife.

4. Food traditionally prepared to restore a parturient's strength following delivery.

5. It is possible that interviewees were uncomfortable stating simply they preferred home birth to delivering at a health facility. However, this does not invalidate the subsequent analysis.

6. Behaviour should be considered in historical perspective given that the local CHC was only established in 2000. Still, of all respondents who delivered in 2001 or after, less than half (20/42; just under 48%) gave birth at a health post.