The impacts of NGOs and SHGs on learning reproductive health information of Vietnamese women with physical disabilities

Abstract

Researchers have drawn attention to people’s perceptions of reproductive health in Vietnam. Disabled people in Vietnam have been shown to have particularly low awareness and knowledge of reproductive health, in particular, women with disabilities have varied reproductive health knowledge because some of them have access to better reproductive health information than others. In this situation, non-government organizations (NGOs) and self-help groups (SHGs) contributed great value and provided a great resource for people with disabilities. This article explores the important roles of NGOs and SHGs, as they provide reproductive health information to people with disabilities. This article is concluded with some recommendations and directions for future research.

Keywords:

• People with disabilities
• women with physical disabilities
• reproductive health
• NGOs/SHGs
• Vietnam

Introduction

This is a current issue because it is calling for a new strategy to solve current problems in providing sexual and reproductive health information for people with disabilities in Vietnam. This call for this strategy arose from my PhD findings focussing on access to reproductive healthcare for women with physical disabilities in Vietnam.

Over the past 20 years, researchers have drawn attention to people’s perceptions of reproductive health in Vietnam. The majority of studies have explored the perceptions and experiences of reproductive healthcare among Vietnamese women in rural and urban areas (Gammeltoft 1999), while other researchers have focused on reproductive healthcare of Vietnamese youth and ethnic minority women. Literature of sexual and reproductive health on marginalized people is not well-documented.

Disabled people in Vietnam have been shown to have particularly low awareness and knowledge of reproductive health due to the limitation of access to such information. Access to health information resources is determined not only by education but also by poverty and disability. In my previous research, I examined the sexual and reproductive health issues of people living with physical disabilities in Ho Chi Minh City, Vietnam. The findings showed that people with physical disabilities lacked knowledge of sexual and reproductive health, indeed many of them could not give a definition of sexual and reproductive health. Participants complained that sexual and reproductive health information resources were limited. This was compounded because their family and community members did not discuss this issue with them, and little or no sexual and reproductive health education was received in schools. In this case, education was influential, as those from a poor family background did not have any chances to learn such information (Nguyen et al. 2017).

Although the Vietnamese government and International Non-Governmental Organisations (INGOs) have implemented healthcare programs/projects which have provided sexual and reproductive health information and services, many questions remain on what needs to be addressed to ensure that those with disabilities have equal access to their sexual and reproductive rights.

Roles of INGOs in improving sexual and reproductive health knowledge of Vietnamese people

INGOs played a crucial role in enhancing reproductive health knowledge of Vietnamese people. Their projects focused on improving the quality of sexual and reproductive healthcare services for Vietnamese people rather than on increasing the awareness of Vietnamese people about sexual and reproductive health. They developed healthcare training courses for healthcare providers at healthcare services. Topics in relation to family planning, safe abortion, contraception, sexually transmitted infections, maternal and child health were included in their programs and health promotion (Pathfinder 2008). Following the projects, trained doctors, nurses and staff members at healthcare services were reported to be more sensitive and had better communication with patients, which encouraged people to come to the healthcare services (Pathfinder 2008).

These projects were more successful than expected. For instance, if the figures are accurate, the proportion of married women who accessed healthcare services in the implementation areas of these projects increased from a low of 13% to 100%. Pathfinder (2008) suggested that this increase was related to raising the awareness and knowledge of healthcare providers in these areas. Although these projects occurred over 10 years ago, they have been key to improving the quality of healthcare services in Vietnam as well as providing authorized sexual and reproductive healthcare information for Vietnamese people in these implementation cities and provinces. However, the extent to which they have impacted on the sexual and reproductive health rights of people with disabilities is unclear.

How NGOs and SHGs impact on the reproductive health knowledge of women with physical disabilities?

The study participants I talked to stated that NGOs and SHGs played a crucial role in enhancing sexual and reproductive health knowledge because they held by some sexual and reproductive health training courses for people with disabilities. However, they created advantages for those with the resources to attend, but socioeconomically disadvantaged people could not attend due to time poverty and financial pressures.

Pros for people with socioeconomical advantages

Key informants who worked within NGOs and SHGs in this study stated that they held many SRH training courses for people with disabilities. The participants in these training courses were varied in terms of types of impairments. They included people with hearing impairments, physical impairments, vision impairments, and intellectual disabilities. The key informants stated that their organisations would like to provide comprehensive sexuality education for people with disabilities in Ho Chi Minh city. Key informants had opportunities to participate in several reproductive health training courses. In these training courses, as health professionals they were invited to be trainers. These training courses provided general information about menstruation hygiene, contraceptive methods, safe sex, and sexually transmitted infections. The number of participants in each training course was about 10 – 20 people.

For example, one of the courses invited a female doctor who came and provided scientific knowledge about the human body, contraception, and sexually transmitted infections. The participants assessed these courses as very useful. Nhu (pseudonym), a participant, shared:

DRD (an NGO) held a training course about reproductive health years ago. I was a participant and I felt like they provided sufficient information. In this course, they guided us on how to use condoms, and hygiene. The session included theory and practice. They taught us how to put condoms on bananas. Recently, the Women with Disabilities Club held a reproductive health seminar. The participants in this seminar had a chance to receive information regarding hygiene, safe sex, and also a quick chat about childbearing (Nhu).

As a consequence of her higher socioeconomic status, Nhu had access to more resources and free time than other disabled people with socioeconomical disadvantages. Consequently, she obtained a better understanding of disability and reproductive health.

Cons for people with socioeconomical disadvantages

The constrained life circumstances of disabled women on low incomes contributed to them receiving little reproductive health information or training. Some participants complained that they did not have information related to these workshops as no one told them about that.

Moreover, NGOs and SHGs inadvertently increased the gap in reproductive health knowledge between people with socioeconomical advantages and people with socioeconomical disadvantages whenever they organised these training courses. These NGOs/SHGs acknowledged this problem but they seemed unable to address it. For example, Dieu (pseudonym) revealed that some members in her disabled women’s club were hidden at home. They rarely went out due to many obstacles such as no accompaniment and unaffordable travelling costs. Dieu noted:

Every time I rang them and invited them for a meeting. They always said, “I am sorry. I do not have time. I am so busy. I have to work.” Actually, I understand that they have to work, have to earn money, or have to do their house chores. And travelling cost is the main reason. You know, disabled people find it very hard to go somewhere. For example, a wheelchair user, if she goes out, she needs a taxi and a personal assistant. If she is poor, how can she afford it, who will pay for her, who will assist her? And other built environments are inaccessible (Dieu).

Dieu’s statement highlighted the numerous obstacles that challenged disabled women in everyday life. Specifically, economic status was a core factor, which led to reducing access to reproductive health information. Due to poorer economic background, disabled women could not have spare time to go to SRH training courses. They also could not afford assistance or buy assistive technologies to access social activities. Thus, they gave up their learning opportunities while interacting with the built environment and financial burden. Consequently, they hesitated to leave their home. Participants with socioeconomic disadvantages accepted their situations as fate (Nguyen 2021). Their constrained life situations restricted their agency.

Discussion and conclusion

Lower socioeconomic background increased the numerous barriers for disabled people. In Vietnam, the majority of people with disabilities lived in poverty (GSO 2016) and, because of this, many participants lost their chances to obtain higher education levels and consequently lost their access to authorized reproductive health information. Furthermore, disabled people with lower incomes lacked opportunities to participate in social activities. Due to time poverty, they were unable to participate in reproductive health training courses held by NGOs/SHGs. Meanwhile, they spent most of their time to earn money for sustaining their life.

The NGOs/SHGs importantly provided authoritative reproductive health information to people with disabilities. Many women in this research thanked the NGO, Disability Research Capacity and Development (DRD), because of its significant contribution to improving the participants’ knowledge. But it also became clear that such organizations need to consider the means to improve the knowledge and educational level of the participants on low incomes, who currently miss out on training opportunities.

The first implication of this research suggests that a comprehensive sexual and reproductive health education should be applied in schools, starting at younger ages with age-appropriate materials and ensuring coverage for all students, regardless of whether they complete high school or study biology. Teachers should be given training in teaching about sexual and reproductive health and developed educational materials so they can feel confident in teaching this subject.

There is a need for the government, NGOs/INGOs/SHGs, and the Ministry of Education and Training to work together to provide more authoritative sexual and reproductive health documents or workplace training for all people with disabilities. Most participants had access to the internet via their phones and thus these stakeholders could cost-effectively use the internet to convey Vietnamese language sexual and reproductive health information catering to people with disabilities, as well as the general public in Vietnam.

To conclude, I hope that further research will be conducted soon to enhance people with disabilities in Vietnam address their challenges in daily life.

Ethics approval

This project has received ethics approval from the Human Research Ethics Committee at Monash University, Clayton, Melbourne, Australia (Project ID: 18096).

Acknowledgment

This article is extracted from my PhD thesis. I received a full PhD scholarship from the Australian Government and Monash University for two grants: Monash Graduate Scholarship (MGS) and Monash International Postgraduate Research Scholarship (MIPRS).

Disclosure statement

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