Sex ratio at birth in Viet Nam at the beginning of the twenty-first century: Situation, Determinants and Policy Implications

Nguyen-Bang Pham (2010). Sex ratio at birth in Viet Nam at the beginning of the twenty-first century: Situation, Determinants and Policy Implications PhD Thesis, School of Population Health, The University of Queensland.

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Author Nguyen-Bang Pham
Thesis Title Sex ratio at birth in Viet Nam at the beginning of the twenty-first century: Situation, Determinants and Policy Implications
School, Centre or Institute School of Population Health
Institution The University of Queensland
Publication date 2010-09
Thesis type PhD Thesis
Supervisor Associate Professor Peter S. Hill
Dr. Chalapati Rao
Dr. Timothy Adair
Total pages 224
Total colour pages 10
Total black and white pages 214
Subjects 11 Medical and Health Sciences
Abstract/Summary Abstract A shortage of over 100 million women and girls in Asia has been reported as a result of the high sex ratio at birth (SRB) in parts of this continent over the last three decades. This high SRB has raised concerns of its implications for population health at the global level. High SRB also poses a threat to achieving international development goals such as reproductive health and reproductive rights. The debate on the SRB situation in Viet Nam began in 1999 and was further heightened in 2006. The dominant concern is that contemporary Vietnamese society is similar to that of China in the 1990s and therefore facilitates the widespread practice of prenatal sex selection (PSS) in favour of male offspring, leading to a high SRB. Fuelling the debate is a paucity of reliable and adequate data which are needed to provide an authoritative basis for designing an effective population policy. This study first reviewed all data sources available in Viet Nam to estimate SRB, and subsequently applied a data quality assessment framework to assess the quality of three national-scale datasets. The assessment concluded that none of these datasets is perfect in all dimensions, and therefore Viet Nam lacks a longitudinal high quality data series to track SRB trends. However, triangulation of data identified a cluster of six provinces in the North with consistently high SRB across three datasets. These provinces also have a spatial association with the Red River Delta, where son preference is stronger than anywhere else in the country. The data quality assessment undertaken also identified that the dataset from the Population Change Survey of 2006 had sufficient explanatory variables for in-depth analyses of the determinants of SRB, such as maternal, socio-economic and demographic factors. Multivariate analysis indicates that high SRB is most likely to be observed among women aged 30-39 years, residing in rural areas of the Red River Delta, with unpaid employment, and only primary or secondary education. Further, logistic regression analysis showed that among variables included in the statistical models, high SR of most recent births is only associated with the number of previous female births. This significant association is consistent across all socio-economic and demographic groups of women, reaffirming that son preference is the most important determinant of the high SRB in Viet Nam. The study also explored the influence of the ‘stopping rule’, which acts as a postnatal sex selection method by continuing childbearing until the birth of a son. A measure of sex-specific Parity Stop Ratios was developed to measure the impact of the rule on the sex ratio of last births (SRLB). The analysis identified that the stopping rule is an important mechanism that influences fertility decisions of Vietnamese couples, leading to a high SRLB of 130 in Viet Nam in the past three decades. PSS practices are illegal so monitoring its occurrence is a challenge. To overcome this difficulty, the analysis examined associations between high SRB and variables that predict an increased opportunity to engage in these practices, such as, the use of ultrasound for foetal sex determination in the first 22 weeks of pregnancy, and access to abortion services. The significant associations between these variables and the high SRB, particularly at first births, provide indirect evidence that PSS is the direct cause of the recent high SRB of 110. To demonstrate the complex interactions between son preference and fertility behaviour in a broader context of cultural, socio-political and health practices, the study developed a framework for contextual analysis of SRB. Contemporary Viet Nam brings together a number of factors: the clash between the traditional preference for son and the social norm of small family size, the combination of ready access to prenatal ultrasound and legal provision of abortion, and particularly the recent reinforcement of the one-to-two child policy. The links among those factors have facilitated the recent spread of sex selection in the Vietnamese population. Recognising these negative synergic effects between culture, technology, society and policy in producing the high SRB, the study also undertook a policy analysis and developed a framework for stakeholder analysis. The evolution of the population policy over the past 50 years has been successful in shaping the small family norm and in contributing to the country’s socio-economic development. Continued birth control will increase the SRB with negative implications for an ageing population in Viet Nam. Such changes will impose heavier socio-economic burdens on future generations. Other concerns are that an emphasis on declining fertility tends to ignore broader new population and development issues such as contraceptive security, gender equality, rural-urban migration, and the current ‘golden age’ structure of the population. The findings of this thesis provide comprehensive and authoritative evidence which can form the basis for developing a new population policy for Viet Nam that responds effectively to these challenges to facilitate the country’s socio-economic development in the next decades.
Keyword sex ratio at birth
Viet Nam
son preference
total fertility rate
prenatal sex selection
stopping rule
sex selective abortion
population policy
population and development
gender equality
Additional Notes Page numbers to be printed in colour: 32, 52, 56, 64, 84, 105, 112, 119, 146, 173

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Created: Tue, 08 Mar 2011, 10:37:03 EST by Mr Nguyen Pham on behalf of Library - Information Access Service