Women's health and health care in Vietnam

Women made up more than half of the Vietnam's population (nearly 47 million or 50.7% of the total population in 2016). The number of female employees in Vietnam in 2016 was 26.4 million accounting for 48.4% of the country's workforce (Vietnam General Statistics Office, 2017). Women's health and health care in Vietnam have been significantly improved over time. Maternal mortality in Vietnam has decreased from 233 per 100,000 live births in 1990 to 69 per 100,000 live births in 2009, and then again to approximately 50 per 100,000 live births in 2015 (Inter-Agency Group, 2015). Life expectancy at birth of Vietnamese women reached 76.1 years in 2016, higher than that of men (70.8 years) (Vietnam General Statistics Office, 2017). The improvement in health indicators for women has been impressive, but there still exist inequities in women's health and health care in Vietnam (United Nations Development Programme). To tackle the inequity problems, a deep understanding of the current situation of women's health and health care in Vietnam is needed by policy makers, social and health practitioners as well as by the public. The findings from this set of authors provide further insights into today's women and health care issues in Vietnam.

Chuong et al., based on the analyses of data from the Vietnam Multiple Indicator Cluster Survey 2000, 2006, 2011, and 2014, found that the coverage of antenatal and skilled birth attendance both increased over time in Vietnam. However, improvements in antenatal care and skilled birth attendance in Vietnam have been uneven across different segments of the population, and the degrees of inequity are likely to increase (Chuong et al., 2018). Inequity in health service utilization was also discovered from a study by Hanh et al., which showed that about 28.2% of the migrants having sex had not used any contraceptive method. Contraceptive use was significantly associated with age, education, private companies, and income (Hanh, Tuan, Anh, Ha, & Anh, 2018).

Many women in Vietnam are still suffering from communicable diseases, especially reproductive tract problems and HIV/AIDS. Le et al. revealed that about 32% of female migrant's workers in Hanoi, Danang, Ho Chi Minh City and Binhduong reported having reproductive tract infections. Factors associated with the problems were low level of education, economic status and numbers of migration (Le, Tran, Duong, Nguyen, & Bui, 2018). Vinh et al., conducted a mixed method study among 148 women who were regular sexual partners (SPs) of male injecting drug users in Tien Du, Bac Ninh province, found that HIV infection rate among SPs was high, 11.5%. Sexual violence was prevalent, 63.5% among SPs; 94.1% (16/17) among SPs with HIV. SPs suffering from sexual violence caused by their regular sexual partners faced 9.24 times higher HIV risk than those who did not have sexual violence (Vinh, Hien, Tri, & Huynh, 2018). Similarly, Dinh et al. conducted interviews with 12 HIV-positive women and discovered that women's decision-making about disclosure was significantly affected by dependence on or independence of parents-in-law and their own parents. The complex interplay of stigma and disclosure within Vietnamese families, highlighting the need for specific social measures which promote self-disclosure combined with family support for female PLWHA (Dinh, White, Hipwell, Nguyen, & Pharris, 2018).

Early linkage to HIV care is associated significantly with improved patient outcomes and reduced the risk of HIV transmission. However, delays between HIV diagnosis and registering for care have prevailed in Vietnam. Chau et al. found that women accounted for one-third of newly diagnosed cases (42/125), but initiate HIV treatment at an earlier stage of HIV disease than men (65% women at stage 1, 2 versus 31% in men). Stigma and discrimination was greater among women while inadequate awareness of treatment was greater for men. Dissatisfaction with HIV testing and counselling and no or passive referral to treatment were other barriers for both gender for enrolling in care services after diagnosis (Chau et al., 2018).

Non-communicable diseases are becoming more and more prevalent among Vietnamese women. Cervical cancer has been shown to be the second most common cancer amongst female aged 15 to 44 years old in Vietnam (Anh, Parkin, Hanh, & Duc, 1993; Domingo et al., 2008; Q. M. Nguyen, Nguyen, & Parkin, 1998). Nguyen et al. showed that medical costs for the treatment of cervical cancer patients were considerable, especially those at latter stages (Nguyen, Hoang, & Nguyen, 2018). Women in Vietnam should be projected from cervical cancer by getting HPV vaccination. However, Dinh Thu et al., based on their study on willingness to pay for HPV vaccine, showed that only 53.1% of women stated their willingness to pay (WTP) for HPV vaccine for their daughters and their affordability levels for the vaccine have been limited, ranged from under $23 to $46 (Dinh Thu et al., 2018).

In this special issue, some other important issues of women's health and health care are also addressed. Recurrent pregnancy loss is a physical and mental burden for women. Le et al. determined causation for (11.29%) patients who had positive scores on an antiphospholipid antibody test and who were subsequently successfully treated for their problem (Le, Nguyen, Ta, & Hoang, 2018). Amniocentesis test uptake for congenital defects is an important decision of pregnant women in Vietnam. Nguyen et al., based on a cross-sectional survey among 481 participants in 2016, concluded that women with higher educational attainment, higher income level, having a baby with congenital defects, and women with better knowledge and/or attitude about amniocentesis test were more likely to accept the test (C. C. Nguyen et al., 2018).

In summary, the authors from this special issue have shown that, even though good progress toward better health and health care for women has been made in Vietnam, a number of issues related to women's health and health care in Vietnam still exist. These imply that women's health in Vietnam and health care need much further attention. The evidence from this research is expected to be used by policy makers in Vietnam and in other similar contexts.

Footnote from the Managing Editor

As the Editor-in-Chief and our guest editors noted progress toward better health and health care for women in Vietnam has been made. However, there is still work to be done related to women's health and health care in Vietnam as there is in other countries. If the population pyramid is revisited, other countries with similar gender and age make up have similar needs and concerns. If we revisit the special issue related to Women's Health in Africa from 2015 you will note that many of the topics are similar. In both the African and Vietnamese women's health issues there is a heavy focus on HIV related conflict and care and issues surrounding birth and reproduction. Both issues feature work of authors related to cancer and the role of economics in making health care decisions. These are universal issues that go beyond African and Vietnamese women. It is our hope that doing these special issues will not shine a spot light on women's health in these particular regions but also provide an outlet for the sharing of research and inform and inspire policy makers and practitioners in across the globe to meet the current needs related to health care access, reproductive issues, and HIV as well as future needs of these aging populations.