Reproductive outcomes in rural Vietnam.
Perspectives and experiences by pregnant women and health care professionals on
pregnancy promotion and maternal health care
Sophie Graner Reproductive outcomes in rural Vietnam. Perspectives by pregnant women and health care professionals
Sophie Graner
Department of Clinical Sciences, Obstetrics and Gynecology Umeå University, 2010
Department of Clinical Sciences Obstetrics and Gynecology Umeå University
SE-901 87 Umeå, Sweden ISBN 978-91-7459-082-1
ISSN 0346-6612
Umeå University Medical Dissertations New Series No 1373
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Department of Clinical Sciences, Obstetrics and Gynecology Umeå University, SE-901 87 Umeå, Sweden
Responsible publisher under swedish law: the Dean of the Medical Faculty This work is protected by the Swedish Copyright Legislation (Act 1960:729) ISBN: 978-91-7459-082-1
ISSN: 0346-6612 Omslag: Ida Holmgren
Elektronisk version tillgänglig på http://umu.diva-portal.org/
Printed by: Print och Media, Umeå University Umeå, Sweden 2010
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Abstract
Background
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Aims
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Methods
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Main findings
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Contents
Abstract... 5
Background... 5
Aims... 5
Methods... 5
Main findings... 5
Conclusions... 6
Sammanfattning på svenska... 7
Bakgrund ... 7
Syfte ... 7
Metod... 7
Resultat... 7
Sammanfattning... 8
List of publications... 9
Abbreviations and definitions... 15
Introduction... 17
Reproductive health... 17
Historical and contemporary review... 17
Millennium development goals... 17
Maternal health care... 18
Antenatal care... 18
Delivery care... 18
Postpartum care... 19
Family planning... 19
Vietnam - the setting... 20
History of Vietnam- a brief summary... 20
The Doi Moi... 21
Education... 21
Demographic surveillance... 22
Maternal mortality... 22
Reproductive health policy... 22
The health care system in Vietnam... 23
Access and quality of health care in Vietnam... 24
National insurances in Vietnam... 24
Antenatal care in Vietnam... 25
Medical doctors, assistant physicians and midwives... 25
Induced abortion and family planning in Vietnam... 26
HIV epidemic in Vietnam... 27
The role of Vietnamese women... 27
Traditions related to pregnancy and childbearing in Vietnam... 28
The significance of a son... 28
Quality in health care services... 29
Conceptual framework... 29
User fees within health care... 29
Health care professionals and patient interaction... 30
Quantitative and qualitative research in public health... 30
The quantitative paradigm... 30
The qualitative paradigm... 31
Contrasting Positivistic and Naturalistic axioms... 31
Choice of research method... 31
Epidemiology and biostatistical methods... 32
Cohort study... 32
Cross-sectional study... 32
Causality in epidemiology... 33
Demographic surveillance sites... 33
Focus group discussions... 34
Content analysis... 35
Are the findings plausible?... 35
Quantitative studies and validity... 36
Qualitative studies and trustworthiness... 36
Variables in reproductive health research... 37
Birth weight... 37
Foetal growth standards... 37
Small for gestational age... 38
Intrauterine growth restriction... 38
Low birth weight... 39
Gestational age... 39
Preterm birth... 40
Induced abortion... 40
Aims... 42
General aims... 42
Specific aims... 42
Subjects and methods... 43
Study setting... 43
Ethical considerations... 43
Methods studies I and II... 46
The FilaBavi epidemiological field laboratory... 46
Baseline surveys and follow-up surveyss... 46
Surveyors and supervisorss... 46
Data quality controll... 47
Participants - studies I and II ... 47
Data analysis - studies I and II ... 48
Sources of bias ... 48
Selection biass... 48
Recall biass... 48
Classification of birth weight in study III... 49
Methods studies III and IV ... 52
My pre-understanding ... 52
Participants - studies III and IV... 53
Data collection - studies III and IV ... 53
Data analysis - studies III and IV ... 54
External validity studies I, II, III and IV ... 54
Results ... 56
Results studies I and II ... 58
Mortality rates ... 59
Induced abortion ... 60
Place of birth and assistance at birth ... 61
Farming women ... 61
Ethnic minority ... 61
Sex of the infant ... 62
Results studies III and IV ... 63
Rationale to attend ANC ... 63
Relation between midwife and pregnant woman ... 64
The cultural context ... 64
Medication during pregnancy ... 65
Ultrasound examination during pregnancy ... 65
Role of husbands ... 65
Health care professionals’ work environment ... 66
Discussion... 67
The research team ... 77
Methodological considerations ... 78
Conclusions ... 80
Implications ... 81
Clinical implications... 81
Implications for further research ... 81
Acknowledgements ... 82
Preface ... 84
References ... 85
Appendices ... 95
Guidelines study III: midwives ... 95
Guidelines study III: medical doctors and assistant physicians ... 97
Guidelines study IV: Kinh women... 99
Guidelines study IV: Muong women ... 100
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Gross national income per capita (PPP international $) 2,310
Life expectancy at birth male/female (years) 69/75
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(per 1 000 population) 194/116
Total expenditure on health per capita (Intl $, 2006) 264
Total expenditure on health as % of GDP (2006) 6.6
Table 1: Statistical information on Vietnam 2008 (www.who.org) History of Vietnam – a brief summary
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Table 2: Contrasting Positivistic and Naturalistic axioms Choice of research method
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