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Paper for the conference "Expanding Access: Advancing the Roles of Midlevel Providers in Menstrual Regulation and Elective Abortion Care" South Africa 2 - 6 December 2001. The paper in pdf-format Vietnam Abortion Situations Country Report Dang Thi Nghia Nguyen Duy Khe Table of contents Section 1. Country profile on abortion services 1. Reproductive health and abortion statistics 2. Laws and policies 3. Provider profile 4. Organization of abortion care 5. Knowledge and perception of abortion services Section 2. Midwives’ role in abortion services 1. Description of Midlevel Providers 2. History of Midlevel Providers offering abortion service 3. Scope of abortion service provided by midlevel provider 4. Incentives and barriers 5. Professional organization 6. Advocating abortion services Section 3. Lessons learned Section 4. Questions and concerns Section 1. Country profile on abortion services Background The Socialist Republic of Vietnam is located in South East Asia. Vietnam is the second most populous nation in Southeast Asia after Indonesia and the thirteenth most populous in the world. At the first census after reunion in 1979, the population of Vietnam was 52.7 million. After ten years, the population increased to 64.4 million in 1989 (Census 1989). The population was 77.7 million in 2000 (MOH, 2000). The speed of population growth will have a seriously effect on the socioeconomic development of the country, a concern which has led the government to carry out a family planning programs in order to reduce the population growth rate. The young dependency ratio in Vietnam was high at 42.5 per cent in 1989. It was estimated that between 500.000 and 600.000 women would enter the reproductive period every year for a long time in the future, producing a high momentum of population growth. According to the Health Statistics Yearbook of the year 2000, the infant mortality rate is 36.7 per thousand live births, the maternal mortality rate is 95 per 100,000 live births. Life expectancy at birth is 67.8 years. All of which indicate that there is a better health care in Vietnam compared to other countries of the same income level (World Bank. 1992.). Most Vietnamese, approximately 80 per cent of the population live in rural areas. According to the 1989 census, Vietnam had six cities where 13.6 per cent of the urban population lived. Although, Vietnam is a low-income country, the literacy level of its population is high compared to the other developing countries of the region. Ninety six per cent of males and 84 per cent of females are literate and the average number of years of schooling for the total of population is 9.5 years. However the overall educational attainment is still low, only 1.6 per cent were graduated from university and it was different among the regions, namely the urban and the rural areas and the North and the South (1989 Census). Women occupy 52 per cent of the jobs in the national economic sectors. Notably Vietnamese women have played an important role in the nation’s history and economy. In addition, compared with other developing countries in the region. Vietnamese women have high status. Despite the high status, the traditional society and the hierarchical and patriarchal family institutions exert a strong pressure on women’s thinking in the traditional culture. A network of health services is well developed in Vietnam as a result of a strong commitment of the socialist policies. Commune Health Centers (CHC) were established at each commune of the whole country with almost 100 percent coverage. This is the basic level of health care services in which there is a staff in charge of pediatrics and gynecology/obstetrics, who is expected to implement the national programs on health such as maternal and child care and family planning services at the community level. Information from MOH shows that in 2000 there were 51 per cent of the commune health centers were headed by a doctor and the remaining are equipped with assistant doctors. In 1989, the Council of Ministers promulgated a new decree liberalizing the operation of the health sector, allowing health workers to engage in private practice. The privatization of the health sector reduced temporarily the burden of health care on the Ministry of Health (World Bank, 1992). This also reduced the responsibility of the Ministry for reporting and recording with the result that the records of health services as well as of induced abortion became inadequate. Undoubtedly, abortions have tended to go under reported and are performed in less hygienic conditions (Quoc Anh et al,1997). 1. Summary of reproductive health and abortion statistics These tables below present the most current statistics on reproductive health and abortion in Vietnam from the health statistic yearbook of health statistics and information division, Planning Department, the Ministry of Health.

Table 1.1 Vietnam basic reproductive health indicators Indicators   1999 2000 Total National Population 73,962,400 (1995) 76,327,900 77,685,500 Women of Reproductive Age 19,218,000 (1996) 20,665,000 24,523,000 (estimated for the year 2007) Maternal Mortality Overall 137/100,000 (1997)   95/100,000 Maternal Mortality (Abortion Related) 5% Not available Not available Life expectancy M: 64.2, F: 69 M: 65, F: 70 67.8 (both M,F)

Table 1.2. Number of Abortion

Indicators 1994 1995 1996 1997 1998 1999 2000 Number of Induced abortion 1,112,285 1.133.009 1,217,979 1,123,620 934,293 786,677 688,029 Number of miscarriage 22.200 66.249 39.755 43.730 35.161 33,552 30,865 Abortion ratio (%)     64.4 59.8 51.9 51.8 45 Number of pregnancy 3.282.485 2.575.000 2.259.266 2.060.508 2.000.853 - -

Abortion Ratio is the number of abortion per 100 live births. Source: Health Statistics Yearbook in 1994, 1995, 1996, 1997, 1998, 1999, and 2000. The estimated percentage of all abortions by MVA Single valve (before 6 weeks) is 60% of total abortion compared to 40% from 7 to 12 week and late abortions after 12thweek (Hieu, 1997). Table 1.3. Percentage of currently married women who had ever had induced abortion and abortion during 1994 and 1997

Ever abortion Abortion during 1994-1997 Repeat abortion during 1994-1997 Number of living children No child 1.20 1.20   1-2 children 20.17 8.13 2.21 3-4 children 29.34 9.33 - ³ 5 19.01 7.04 - Education No education 6.23 2.62 0.66 Incomplete primary 13.57 4.49 1.80 Complete primary 18.76 8.74 4.92 Incomplete secondary 23.48 8.47 4.15 Complete secondary 30.45 11.84 3.72 Higher 48.72 10.26 1.71 Respondent’s occupation Group 1 39.62 8.89 0.54 Group 2 23.13 7.27 2.72 Group 3 19.07 8.30 4.33 Group 4 18.75 3.13 0.00 Partner’s occupation Group 1 31.27 8.17 2.79 Group 2 25.59 8.02 2.55 Group 3 18.02 7.96 4.06 Group 4 25.78 7.32 4.18 Sub-region Northern Uplands 39.38 16.94 8.13 Red River Delta 35.48 12.87 4.89 North Central 10.61 4.79 2.64 Central Coast 1.81 0.18 0.00 Central Highlands 9.13 1.37 0.00 Southeast 17.08 4.15 0.58 Mekong River Delta 14.64 4.30 1.91 Total 21.79 7.96 3.51 Source: Nguyen Quoc Anh et al, 1997

Table 1.4. Percentage of ever married women who sought induced abortion by religion

Religion Ever induced abortion Induced abortion since 1994 Repeat abortion Number of women No religion 56.5 21.6 9.6 4268 Buddhist 28.6 7.0 2.4 944 Christian (Cath.) 31.2 11.0 6.7 271 Protestant 34.3 0.0 0.0 20 Cao Dai 35.6 14.8 5.9 77 Hoa Hao 28.6 0.0 0.0 48 Other 19.0 0.0 0.0 36 Total 49.8 18.2 8.0 5664

Sourse: Nguyen Quoc Anh et al , 1997 Roughly, 600.000 to 800.000 Vietnamese women undergo abortions every year. This estimate includes a large number of repeat abortions. Excluded, however, are those abortions performed in private medical clinics. Counseling and provision of information on contraception is still limited. This is the main reason for the high number of unwanted pregnancies. Post-abortion counseling is inadequate, resulting in repeat abortions (WHO, 1999) 2. Laws and policies Abortion has been legal and available on request in Vietnam since 1960 (WHO, 1999). The Law of Protection People’s Health 1989 has attached special importance to the right of anyone in choosing health services and access to services. Article 44 of the 1989 Law of Protection of People’s Health guarantees Vietnamese women the right to an abortion "if they so desire". Abortion is provided to both single and married women. In the past menstrual regulation was performed routinely without conducting a pregnancy test. Since 1995, The Ministry of Health requested pregnancy test to be conducted prior to all menstrual regulations. In order to increase access to family planning services in general and abortion care in particular, MOH issued the Decision number 220/QD-BYT on February 22, 1993 and lately the Decision number 385/QD-BYT issued on February 13, 2001 clearly defined tasks for each level’s of health care in the field of reproductive health including abortion services. According to the Decision, midlevel providers are allowed to perform abortion services at commune health centers. Until recently, early abortions-prior to 6 weeks was performed with manual vacuum aspiration (MVA) and abortions from 7-12 weeks were performed by dilation and curettage (D&C). From 1998, MCH/FP Dept. MOH recommended the use of vacuum aspiration for all first-trimester abortions. Both contraception and abortion services are widely available as an integrated part of the basic health care services provided by public health sectors. And trained midlevel providers are permitted to perform MVA. Some policies which subsidized for abortion (drugs and procedure cost subsidize for women who failed in using contraceptive methods). Another policy provides incentive for health workers who perform the service. Those policies may lead to increase number of abortion. It also needs to consider about the cost of abortion service. Increase the cost of abortion will contribute to enhance the qualification of abortion procedure because health facility will have more money to invest in equipment, providers will have more incentive. This will help to reduce morbidity and mortality of mothers. At the moment the cost for an abortion is low even lower than the cost of a contraceptive method such as pill or condom, therefore many women use abortion as complement to contraceptive methods when they have complications (WHO, 1999). On the other hand, high cost of abortion may reduce access to health care by group of low-income women. The cost for MR in public sector is around 1 to 2 USD. However, it is free for women who failed in using modern contraceptive methods. This cost in private sectors varies a lot from 5 to 20 USD, depending on the location of the clinic and the provider’s qualification. 3. Provider profile After graduation from high school and passing entry examination, schoolboys and schoolgirls can be admitted to Medical schools if he/she wants to become a doctor, admitted to Secondary Medical school if he/she wants to be a nurse or a midwife. It takes 6 years to become a general medical doctor and 3 years to become a nurse or midwife. If a general medical doctor wants to become an obstetrician and gynecologist, he/she has to spend up to 3 more years for specialization. At Secondary Medical School, students both midwifery and nursing have to complete 3 years education. In the past, secondary medical schools also trained assistant doctors. This kind of training lasted also 3 years. There is no formal curriculum for abortion training both clinical and counseling. After graduation from schools, Health care providers have to pass at least two months training courses on abortion care and then they are certified to provide abortion services. Providers of reproductive health services The main caregivers of reproductive health services are medical doctors and registered nurse/midwives or assistant doctors. Al most all of them are provided with specialization training. Abortion care is a part of this specialization training in both theoretical and clinical matters. Doctors and midwives have the same on job training on abortion but it is different

Table 3.1 Providers of abortion services Type of provider Total year pre-professional education Duration professional medical training Duration of pre-service training in abortion services Duration of apprenticeship / on job training Training in clinical abortion procedure Training in abortion counseling Training in clinical abortion procedure Training in abortion counseling Ob/Gyn Doctors 12 years 6 years general + 3 years specific 3 weeks 1 weeks 6 weeks 2 weeks Assistant doctors 12 years 3 years     6 weeks 2 weeks Midwives 12 years 3 years     6 weeks 2 weeks

4. Organization of abortion care a. Abortion services Midwives working in primary health care (Commune Health Center) are responsible for a wide range of reproductive health services, including antenatal and postpartum care, contraceptive services, abortion services including technical procedure as well as counseling, and normal deliveries. Counseling service is not well implemented by this group of providers. In all these activities midwives are working independently if there is no Ob/Gyn specialist in the site. Likewise midwives at maternity hospitals attend normal deliveries, while the obstetricians take care of complicated cases. Midwife who works in an Ob/Gyn hospital or in an Ob/Gyn wards of a general hospital is working under the supervision of Ob/Gyn doctors. The table below describes organization of abortion care as defined by Decision number 385/QD-BYT issued by MOH:

Table 4.1. The Organization of abortion care Methods Age of gestation Provider Level of health care system MVA Single valve < 6 weeks with test HCG (+) Ob/Gyn doctors, Midlevel providers All levels MVA Double valves More than 6 weeks and < 12 weeks O/Gyn doctors District and Provincial level D&C More than 6 weeks and < 12 weeks O/Gyn doctors District and Provincial level EVA < 12 weeks O/Gyn doctors Provincial level Medical abortion < 8 weeks O/Gyn doctors In experimental process at central and provincial level D&E 13 –16 weeks O/Gyn doctors Provincial level Kovac 16 – 24 weeks O/Gyn doctors Provincial level

According to the decision physicians and midlevel providers who accomplished abortion training are allowed to perform abortion. Actually in many public health facilities where Ob/Gyn doctors are available, registered nurses or nurse-midwives or assistant doctors are only assisting the doctor in the care of surgical abortion, and treatment of complications or evacuation of incomplete abortion. b. Systematic records keep According need assessments of abortion services done recently by IPAS and MOH in two Ob-Gyn hospitals (one in Hanoi, one in HCM city), a detailed medical record form is requested although they were not always completed. And when women presents for an abortion, clinicians often do not have access to previous medical records of the client. A new chart has to be made up for every abortion-related visit, even for women who have had a previous abortion at the same health care facility.

Table 4.2. Availability of abortion service delivery records Level of Health care   Number of abortion providers Number of abortion provided Number of complications Monetary cost of specific services provided Total By type of provider By methods By gestation To individual To H.care system Primary Yes Yes Yes Yes Yes Yes Yes No District Yes Yes Yes Yes Yes Yes Yes No Province Yes Yes Yes Yes Yes Yes Yes No Nation Yes Yes Yes Yes Yes Yes Yes No

The validity of the records: The validity of the records is rather questionable (JOICEF, 2000). Numbers of pregnancy termination are collected only from public health care sectors. It is easy to understand that there are quite a lot of missing numbers of abortion from private sectors. c. Referral plan In rural areas: Woman is referred to her commune health center by her village health worker (VHW) if the abortion services are available at this site. Normally, the woman does not consult with her VHW before going to the center. In the commune where abortion services are not performed by commune health center staff, a family planning team will be sent every week or two weeks from district hospital to perform these services. Normally the family planning team and staff at commune health center only perform MR at CHC. Other abortion services or treatment of complication will be performed in the higher levels where the emergency facilities are available. In urban areas: Since the district and MCH/FP centers or provincial hospitals are normally close to urban area therefore women in these areas can go directly to this level to get abortion services. d. The differences between private and public sectors Since 1989 private health sectors have been allowed to perform MR with the permission from MOH. According to the decision number 15/1999/TT-BYT of MOH, private sectors are only allowed to performed MR (for less than 6 weeks of gestation) by a trained health care provider who has the permission from MOH to do this service. Recently, abortion services provided by haft-private health care providers are common. Those providers are working at public hospitals (especially in provincial and district hospital) and they also have their own clinics at home. Numbers of private health staff who are providing abortion service are not well documented (WHO, 1999). Regarding the quality of services provided by private sectors, women who has money are more likely to get the service from private sectors. According to them there are several benefit of seeking private service: (1) more convenience in term of time (no waiting time), (2) more method of pain management (3) more privacy. (WHO, 1999). On the other hand, reports from local health authorities also indicate that they are often in substandard conditions in term of counseling and infection prevention as well as not properly trained. e. Integration with other service Abortion services in Vietnam are widely available and considered to be an integrated part of reproductive health care. These services are provided through networks of health facilities from central to communal levels. Induced abortions play an important role in fertility equation. It is estimated that over 40 percent of pregnancies terminated each year (UNFPA, 1994). This may be related to the fact that many women who use contraception experience contraceptive failure, e.g. expulsion of IUD, and that adolescents and unmarried women are not targeted for contraceptive service delivery. Both married and unmarried women use termination of pregnancy as a complement to contraception. At health care facility including both private and public sectors, doctors, midwife and assistant doctors who are working for reproductive health services provide both abortion service and other sexual and reproductive health services such as family planning service and counseling, provide Ob/gyn examination and treatment. f. Policy on young, adolescent people Regarding MOH regulations, adolescent under 18 year old is requested to have permission or consent from parents in order to seek abortion at the second trimester. They can have the first trimester abortion without consent from their parents or husband. 5. Knowledge and perception of abortion services Pregnancy termination were considered to be a sin in traditional Vietnamese society but has become more widely accepted among younger women in recent times (Johansson et al., 1996). Many women, however, continue to make a moral differentiation between early menstrual regulation when the fetus is not yet formed and considered to be a "blood clot" or a "been seed", and later abortion which destroy a fetus. Thus, many women attempt to go for a menstrual regulation as early as possible when they considered themselves to be pregnant. Whether the abortion is early or late, many women consider that it is better to have an abortion than to have a child for which family resource are inadequate to proper care (Gammeltoft, 1996). Abortion services are now available and the services are well known in both rural and urban areas. Women know where to go for this kind of service. Section 2. Midlevel providers and abortion services 1. Description of Midlevel Providers: According to existing data from the year 2000 from Personnel Department, the Ministry of Health, there were 9,362 commune health centers (CHC) which have midlevel providers (including trained midwives and assistant doctors). This represents 89 % of the total of 10,505 CHC in Vietnam. The numbers of midlevel providers are different among areas. Over the country there were 38% (23/61) provinces that have 100% CHC covered by midlevel providers. The table below describes the number of CHC which are covered by midlevel providers.

Table 2.1. Numbers of midlevel providers by regions Areas Total CHC Number of CHC have mid. Provider Percentage Per area West-northern (3 provinces) 572 431 75% East-northern (11 provinces) 2,092 1,857 88% Red River delta (11 provinces) 2,235 2,073 92% North of Central (6 provinces) 1,797 1,483 82% Coastal Central (7 provinces) 888 806 90% West highland* (3 provinces) 458 314 68% East-southern (8 provinces) 1,433 1,011 98% Mekong Delta (12 provinces) 1,433 1,387 96% Whole country (61 provinces) 10,505 9,362 89%

Source: MOH, 2000 The National Strategy on Reproductive Health Care for the period of 2001 – 2010 clearly states that "Try to cover all commune health centers by Secondary midwives by the year 2010". (MOH, 2000). 2. History of midlevel providers offering abortion services Vietnam history has undergone many difficulties. Passed two long and hard wars, it seems dried almost human and property. During the wartime, men, youth were encouraged to go to battles. Remaining was old person, middle-age women, teenagers and children. Middle-age women and teenagers had to carry out most of work that men did before. Both sides, battle and behind battle needed health care staff therefore short nursing training courses were opened. These courses lasted 9 months, 12 months, or 18 months depended on requirement. Midwives are the same duration with training for nurses. In the past, courses for assistant doctors were also established to fill the need for health care. Finishing this course, students became Ob/gyn and child-care assistant doctors. This training has been stopped in many secondary medical schools but many assistant doctors are still working in health care services over the country. Since 1960s, midwives, ob/gyn assistant doctors have been permitted by law to perform abortion. However, Midlevel providers are facing difficulties such as insufficient knowledge (working long time without retraining/refresh training), inadequate or old equipment, insufficient counseling skills. 3. Scope of abortion practice of midlevel providers

Table 3.1. Scope of abortion practice of midlevel providers Type of procedure Offered of level provider Method of pain management Type of supervision required when performing procedure On-site Remote or CHC MR up to 6 wks Midlevel and Obstetricians – MVA Local     Medical abortion < 8 weeks Doctor       1st trimester -<12 wks , use MVA 2 valves - <12wks , use D&C Doctors   -Local -Local - Local       2nd trimester Medical abortion 13-16 wks: D&E 16-24 wks: Kovac Doctors -Local and general -Local     Treatment of abortion complications Uterine evacuation -Midlevel (< 6wks) -Obstetricians(> 6wks) - local Management of spontaneous Abortion Uterine evacuation -Midlevel (< 6wks) -Obstetricians (> 6wks) -Local - local Postabortion contraception Counseling -Midlevel/obstetricians     Services -Midlevel/obstetricians

4. Incentives and barriers to midlevel provision of abortion services Vietnam’s Law, Regulations and Policies encourage midlevel providers to learn more so that they can perform abortion service properly and they can improve technical and counseling skills. The Government tries to increase the income of health care providers, to upgrade infrastructure, supply adequate equipment in order to help midlevel providers pay more their attention to their work. The Government also provides incentive to midlevel providers who are working well. In some cases, especially at commune health centers, health staff have been trained to provide abortion services. However, they can not perform the service at their clinics because the health facility does not meet the requirement to perform the service. 5. Professional Organization for midlevel providers Vietnam Association of Midwives (VAM) is a professional organization of midwives of the Socialist Republic of Vietnam, which was established with the following objectives: To unite its members in building up the midwifery branches. To help midwives in achieving progress with a view to contribute to the protection and improvement of public health, especially that of mothers and newborn. To preserve members’ legitimate interest. (VAM) is a young and dynamic organization. Since 1995, the organization has grown to 3,000 members in the whole country. VAM has an approved constitution and VAM is close to completing formalities to be accepted as a member of the International Confederation of midwives. VAM is ready to take its place in the international community of midwives. 6. Advocating abortion services provision by midlevel providers The role of midlevel providers in providing abortion services are advocated by law, accepted by clients and supported by policy makers. In order to maintain these factors, midlevel providers have to learn and practice continuously, to increase knowledge, improve skills. However, knowledge and practice skills are not enough, they should know how to do counseling properly. Section 3. Lessons learned related to access to safe abortion services There are several factors that contribute to good access to safe abortion services for women in Vietnam: The well developed network of health care down to communal level - it is estimated that half of commune health centers can provide abortion services. Abortion is accepted by law in Vietnam. Abortion can be performed to anyone who wishes to do. The cost for one abortion is low even lower than the costs of some contraceptive methods for example, pill or condom. Therefore accessibility to abortion and utilization of abortion services to terminate an unwanted pregnancy seem to be easy and convenient. However, there are also some factors which limit access to safe abortion care: Equipment for abortion services are not available in every health facility, especially at the communal level. The conditions of many commune health centers are not good enough to provide the services (in term of hygiene). Many health staff have been trained on abortion but they can not perform the procedure due to lack of equipment or substandard hygienic conditions. Even though opening abortion services at private sectors can improve the accessibility to abortion for women. The quality of abortion services in private sectors is not well controlled. Many private providers are doing the service without permission from MOH. The qualification of those providers does not meet requirements. In many cases, abortion services are still performed by untrained providers The complication of abortion is still high , particularly in rural area. Attention needs to be paid on training for midlevel provider especially for those who are working in rural, and remote areas where midlevel providers play an important role in reproductive health care and proving abortion services. The opportunity for midlevel provider at Ob/Gyn and provincial hospitals (where Ob/Gyn doctors are available) to provide abortion services is limited. Midlevel providers at these health facilities only have responsibility to assist Ob/Gyn doctors in abortion services. Section 4. Questions and concerns regarding midlevel provision of abortion services More attention needs to be paid on the quality of abortion training for midlevel providers (including complication management).(AND PAIN RELIEF?) The role of midwife in providing abortion services in health facilities where Ob/Gyn doctors available is rather limited. How to advocate the role of midlevel providers in this facilities is still a question for policy-makers to answer. Post abortion care and counseling seem to be neglected in health care and family planing services. This weakness needs more attention to reduce the abortion rate and promote women health. References Goodkind D. Abortion in Vietnam: Measurement, Puzzles, and concerns. Studies in Family Planning, 1996, 25(6):342-352. Hong, K.T., Study on Sexuality in Vietnam: The Known and Unknown Issues. 1998, The Population Council: Hanoi, Vietnam. Kadoi, N., Assessment on Abortion in Nghe An Province. 2000, JOICEF: Nghe An. MCH/FP department, M.O.H., Summing up the MCH/FP activities of the year 2000 and planning for the year 2001. 2001, MCH/FP department: Hanoi. Mai, T.T.P. Providing Abortion Service in Vietnam. Reproductive Health Workshop. 2001. Ho Chi Minh City: MCH/FP department. Midterm Demographic Survey 1994, Major Results of Midterm Demographic Survey. 1995, Hanoi, Vietnam: Statistic Publisher. MOH, Health Statistic Year Report. 1999, 2000, Planning Department, Ministry of Health: Hanoi. Health, National Strategy on Reproductive Health Care for the 2001 - 2010 Period. 2001, Hanoi, Vietnam. NCPFP, Center for Population Study and Information, Analysis of the result from need assessment of Vietnam population project management, Hanoi, Vietnam 1996. NCPFP, UNFPA, The fact about the organization and personnel of Population and Family Planning committee at different levels and the way to enhance, Statistic Publishing House, Hanoi, Vietnam 1996. NCPFP, Vietnam Policies and Strategy on Population and Family Planning, Hanoi, Vietnam, June 1993. NCPFP, Selected Data of some Censuses and General Surveys Servicing Population - Family Planning Activities. 1998, National Committee for Population and Family Planning: Center for Population Studies and Information: Hanoi, Vietnam. NCPFP, Health and Demographic Survey 1997. 1999, National Committee for Population and Family Planning: Population and Health Project: Hanoi, Vietnam. NCPFP, Report on Population and Family Planning Activities during the year 2000 and Planning, Activities for the Year 2001. 2000, National Committee for Population and Family Planning: Hanoi, Vietnam. Quoc Anh N., Hoang Kim Dung, Induced abortion: Present situation, the affecting factors and solutions, Vietnam Demographic and Health Survey, 1997. Suzy Van Laere, Nguyen Thi Van Anh, Ralf Eckhard Ulrich, Promotion of Family Heath in Five Provinces of Vietnam - Reproductive Health Survey 1995. 1996, NCPFP, GTZ: Hanoi. January 1996. The 1999 population and household census, Statistical Publishing House, May 2000, General Statistical Office. United Nations, 1994, "Abortion Policy: A Global Review", Volume III Oman to Zimbabwe, Department for Economic and Social Information and Policy Analysis, New York Vach H.T., Bishop A., The potential impact of introducing pre-testing in to MR service in Vietnam, International Family Planning Perspective, 1998, 24(4) 165-169. World Bank, 1992, "Vietnam, Population, Nutrition, and Health, Division of Policy", Washington DC, Report No, 10289-VN. World Health Organization (WHO). Abortion in Vietnam: an assessment of policy, program and research issues, Geneva, World Health Organization, 1999 (document number WHO/RHR/HRP/ITT/99.2.

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Updated 19 June 2002