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Reproductive outcomes in rural Vietnam. Perspectives and experiences by pregnant women and health care professionals on pregnancy promotion and maternal health care.
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background Reproductive health and health events associated with pregnancy including induced abortions are among the most important factors for the health of fertile women. Adverse outcomes have an impact on women’s reproductive health and their overall health as well as the health of their offspring. Pregnancy and child bearing take place within a cultural context. Risk factors for adverse pregnancy outcomes depend on factors both associated with the individual woman as well as contextual factors.

Aims This thesis investigates reproductive health indicators and their determinants for women in a rural district in Vietnam with special focus on adverse pregnancy outcomes and their determinants. In addition, this thesis explores the perspectives and experiences among pregnant women and health care professionals on maternal health care in Vietnam and risks during pregnancy and delivery.

Methods The studies used quantitative and qualitative methods.  In the quantitative studies a total of 4,396 women reporting 5,838 pregnancies, and 5,521 infants were included. Parametric and non parametric tests and univariate and multivariate logistic regression analysis was performed.   For the estimation of small for gestational age a population-specific reference curve was constructed based on the mean birth weight at term in the study population. In the qualitative studies data were collected from eight focus group discussions, four with pregnant women and four with health care professionals. Manifest and latent content analysis was applied. 

Main findings Women belonging to an ethnic minority or women giving birth at home were at increased risk of stillbirth.  The risk of induced abortion increased with maternal age. Neonatal mortality was estimated to 11.6 per 1000 live births and perinatal mortality to 25.0 per 1000 births. The prevalence of small for gestational age was estimated to 6.4%. Risk factors for small for gestational age included women in farming occupations and post-term birth. There was a marked decrease in perinatal mortality after 33 weeks of gestation.

Contextual conditions influenced both pregnant women’s use of maternal health care and the performance of the health care professionals. The use of maternal health care was influenced by economical conditions as well as cultural norms that impeded women’s autonomy. Structural constraints included inadequate financing of the health system, including lack of staff, insufficient professional re-training, and inadequate equipment. Pregnant women in rural Vietnam created a strategy to promote a healthy pregnancy through lifestyle adjustments, gathering of information, and seeking timely medical care. Insights in pregnancy-related conditions were sought from various sources and were influenced both by Vietnamese traditions and modern medical knowledge.

Conclusions Knowledge about pregnancy complications and their related signs and symptoms, and a high confidence in the maternal health care probably contribute to the relatively good maternal health status and pregnancy outcomes in Vietnam. To improve perinatal and neonatal outcomes there is a need to ensure access for all pregnant women to delivery units with surgical capacity in case of an obstetrical emergency. Also, a higher proportion of premature infants need to be born at units with access to neonatal care. This may be achieved by an improved system for referral including capacity of medical care during transportation. Other desirable improvements include antenatal identification of small for gestational age foetuses. In our study the induced abortion rate increased with maternal age and was highest among married women, indicating that induced abortions may be used as a method for family planning.

The cultural norms in Vietnam limit women’s autonomy and reduce their possibility to make independent decisions about their reproductive health. Our studies emphasize the importance of adequate access for all women to maternal health care adjusted for their individual needs. A better understanding is needed of context-specific factors that influence couples’ choice of family planning methods, place of birth, and maternal health care. The communication between pregnant women and health care professionals needs further investigation. This knowledge is essential in order to develop reproductive health services that are accessible, acceptable and affordable to all.  

Place, publisher, year, edition, pages
Umeå: Umeå university , 2010. , 101 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1373
Keyword [en]
Maternal health services, Maternal health care, Antenatal care, Reproductive health, Pregnancy outcome, Pregnancy complications, Perinatal mortality, Neonatal mortality, Birth weight, Small for gestational age, Epidemiology, Cohort study, Qualitative research, Content analysis, Vietnam
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
URN: urn:nbn:se:umu:diva-37266ISBN: 978-91-7459-082-1 (print)OAI: oai:DiVA.org:umu-37266DiVA: diva2:358995
Public defence
2010-11-17, Bergasalen, Byggnad 27, Norrlands Universitetssjukhus, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2010-10-28 Created: 2010-10-24 Last updated: 2010-10-28Bibliographically approved
List of papers
1. The panorama and outcomes of pregnancies within a well-defined population in rural Vietnam 1999-2004
Open this publication in new window or tab >>The panorama and outcomes of pregnancies within a well-defined population in rural Vietnam 1999-2004
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2009 (English)In: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 16, no 3, 269-277 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Pregnancy outcomes in the general population are important public health indicators. PURPOSE: The overall aim of this study was to investigate the outcomes of reported pregnancies within a well-defined population, to identify risk groups for adverse pregnancy outcomes, and to suggest preventive measures. METHOD: A prospective population-based cohort study of pregnant women in Bavi district, Vietnam between 1 January 1999 and 30 June 2004. RESULTS: Pregnancy outcome was reported for 5,259 cases; 4,152 (79%) resulted in a live birth, 67 (1.3%) in a stillbirth, 733 (14%) in an induced abortion, and 282 (5.4%) in a spontaneous abortion. There was an increased risk of home delivery for women from ethnic minorities (OR = 1.85; 95%CI = 1.06-3.24) or with less than 6 years of schooling (OR = 7.36; 95%CI = 3.54-15.30). The risk of stillbirth was increased for ethnic minorities (OR = 6.34; 95%CI = 1.33-30.29) and women delivering at home (OR = 6.81; 95%CI = 2.40-19.30). The risk of induced abortion increased with maternal age. CONCLUSION: Our findings emphasize the public health significance of access to adequate family planning, counselling, and maternal health care for all women. Policies should specifically target women from high-risk groups.

Keyword
Pregnancy outcome, Cohort, Vietnam, Demographic surveillance systems, Population-based, Prospective
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
urn:nbn:se:umu:diva-36871 (URN)10.1007/s12529-008-9026-0 (DOI)19225895 (PubMedID)
Available from: 2010-10-12 Created: 2010-10-12 Last updated: 2017-12-12Bibliographically approved
2. Adverse perinatal and neonatal outcomes and their determinants in rural Vietnam 1999-2005
Open this publication in new window or tab >>Adverse perinatal and neonatal outcomes and their determinants in rural Vietnam 1999-2005
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2010 (English)In: Paediatric and Perinatal Epidemiology, ISSN 0269-5022, E-ISSN 1365-3016, Vol. 24, no 6, 535-545 p.Article in journal (Refereed) Published
Abstract [en]

Population-based estimations of perinatal and neonatal outcomes are sparse in Vietnam. There are no previously published data on small for gestational age (SGA) infants. A rural population in northern Vietnam was investigated from 1999 to 2005 (n = 5521). Based on the birthweight distributions within the population under study, reference curves for intrauterine growth for Vietnamese infants were constructed and the prevalence and distribution of SGA was calculated for each sex. Neonatal mortality was estimated as 11.6 per 1000 live births and the perinatal mortality as 25.0 per 1000 births during the study period. The mean birthweight was 3112 g and the prevalence of low birthweight was 5.0%. The overall prevalence of SGA was 6.4%. SGA increased with gestational age and was 2.2%, 4.5% and 27.1% for preterm, term and post-term infants, respectively. Risk factors for SGA were post-term birth: adjusted odds ratio (AOR) 7.75 [95% CI 6.02, 9.98], mothers in farming occupations AOR 1.72 [95% CI 1.21, 2.45] and female infant AOR 1.61 [95% CI 1.27, 2.03]. There was a pronounced decrease in neonatal mortality after 33 weeks of gestation. Suggested interventions are improved prenatal identification of SGA infants by ultrasound investigation for fetal growth among infants who do not follow their expected clinical growth curve at the antenatal clinic. Other suggestions include allocating a higher proportion of preterm deliveries to health facilities with surgical capacity and neonatal care.

Keyword
perinatal mortality, neonatal mortality, gestation, birthweight, SGA, maternal occupation
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
urn:nbn:se:umu:diva-37264 (URN)10.1111/j.1365-3016.2010.01135.x (DOI)000283167100003 ()20955231 (PubMedID)
Available from: 2010-10-25 Created: 2010-10-24 Last updated: 2017-12-12Bibliographically approved
3. Maternal health care professionals' perspectives on the provision and use of antenatal and delivery care: a qualitative descriptive study in rural Vietnam
Open this publication in new window or tab >>Maternal health care professionals' perspectives on the provision and use of antenatal and delivery care: a qualitative descriptive study in rural Vietnam
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2010 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 10, no 1, 608- p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: High quality maternal health care is an important tool to reduce maternal and neonatal mortality. Services offered should be evidence based and adapted to the local setting. This qualitative descriptive study explored the perspectives and experiences of midwives, assistant physicians and medical doctors on the content and quality of maternal health care in rural Vietnam. METHOD: The study was performed in a rural district in northern Vietnam. Four focus group discussions with health care professionals at primary health care level were conducted. The data was analysed using qualitative manifest and latent content analysis. Result Two main themes emerged: "Contextual conditions for maternal health care" and "Balancing between possibilities and constraints". Contextual conditions influenced both pregnant women's use of maternal health care and health care professionals' performance. The study participants stated that women's uses of maternal health care were influenced by economical constraints and cultural norms that impeded their autonomy in relation to childbearing. Structural constraints within the health care system included inadequate financing of the primary health care, resulting in lack of human resources, professional re-training and adequate equipment. CONCLUSION: Contextual conditions strongly influenced the performance and interaction between pregnant women and health care professionals within antenatal care and delivery care in a rural district of Vietnam. Although Vietnam is performing comparatively well in terms of low maternal and child mortality figures, this study revealed midwives' and other health care professionals' perceived difficulties in their daily work. It seemed maternal health care was under-resourced in terms of staff, equipment and continuing education activities. The cultural setting in Vietnam constituting a strong patriarchal society and prevailing Confucian norms limits women's autonomy and reduce their possibility to make independent decisions about their own reproductive health. This issue should be further addressed by policy-makers. Strategies to reduce inequities in maternal health care for pregnant women are needed. The quality of client-provider interaction and management of pregnancy may be strengthened by education, human resources, re-training and provision of essential equipment.

National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
urn:nbn:se:umu:diva-37058 (URN)10.1186/1471-2458-10-608 (DOI)000283315000001 ()20946681 (PubMedID)
Available from: 2010-10-19 Created: 2010-10-19 Last updated: 2017-12-12Bibliographically approved
4. 'Normal foetal movements make me happy': a qualitative study on pregnant women's perception on signs and symtoms during pregnancy and maternal helath care in rural Vietnam
Open this publication in new window or tab >>'Normal foetal movements make me happy': a qualitative study on pregnant women's perception on signs and symtoms during pregnancy and maternal helath care in rural Vietnam
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

Background: Women's understanding of pregnancy and antenatal care is influneced by their cultural context. In low income settings women may have limited influence over their reproductive health including when to seek health care. Awareness of signs of pregnancy complications is essential to seek timely care. The use of antenatal care services in Vietnam has been studied with quantatative methods but there are few qualitative studies on the perception of pregnancy and maternal health care among Vietnamse women.

Method: The study was conducted in a rural district in northern Vietnam. Four focus group discussions with pregnant women were performed. The data was analysed using manifest and latent content analysis.

Result: The latent theme 'Securing pregnancy during normal course and at deviation' consisting of the main categories 'Ensuring a healthy pregnancy' and 'Seperating the normal from the abnormal' emerged.

Conclusion: This qualitative study of pregnant women in rural Vietnam indicates how women create a stategy to promote a healthy pregnancy through lifestyle adjustments, gathering of information, and seeking timely medical care. Insight in pregnancy-related conditions were sought from various sources and influenced both by Vietnamese traditions and modern medical knowledge. Public knowledge about deviating symtoms during pregnancy and high confidence in maternal health care are most likely contributing factors to the relative good maternal health status in Vietnam.

Keyword
Pregnancy, Maternal health care, Vietnam, Qualitative study
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
urn:nbn:se:umu:diva-37265 (URN)
Available from: 2010-10-25 Created: 2010-10-24 Last updated: 2011-04-12Bibliographically approved

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