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Introduction Rapid population growth has shown its adverse effects at the national as well as at the family level. At the national level, it is the cause of poverty, low level of living, malnutrition, ill health, environmental degradation, and many other social problems. At the family level, big-sized families usually find it difficult to support their children, potentially leading to malnutrition, poor health and inability to afford education for their children. Therefore, rapid population growth has been the concern of several countries, especially LDCs including Vietnam. The government of Vietnam has formally introduced and implemented population and family planning (PFP) programs since the early 1960s. However, up to the year 1992, the implementation of PFP programs in Vietnam had shown to be ineffective. In addition, the pressure of population growth on the economy necessitated appropriate population policies. For those reasons, two important documents related to PFP policies were introduced: Resolution No. 4 on Population Policies, Population and Family Planning Strategy to the year 2000. These two documents marked the turn in the enactment of Vietnam population policies. Recently, the introduction of the two documents -Vietnam Population Strategy in the stage 2001-2010, and National Target Program on Population and Family Planning to the year 2005- has emphasized the increasing concern on PFP problems by the government. Up to now, PFP programs in Vietnam has achieved certain results. Total fertility rate declined rapidly from 4.0 in 1988 to 3.2 in 1994 and 2.3 in 1997. The crude birth rates go down from 28.5%o in 1993 to 21.9%o in 1997 and 19.9%o in 1999. However, fertility decline is unstable. Fertility level continues to decline in high-fertility provinces. However, fertility level begins to rise again in provinces where fertility has declined to replacement level or lower. Although population growth rate has declined, it is still high. In addition, the age structure is very youthful in Vietnam where 33.5 percent of the population is less than 15 years old in the year 1999. This age structure will create very large number of people in the reproductive age in the near future - a main source for rapid population growth. To achieve the decline in fertility is difficult. It is more difficult to maintain this declining trend. Therefore, population with the goal of birth control is still a problem of the leading worthwhile concern in Vietnam. Contraceptive use plays an important role among affecting factors on fertility. The current situation of contraceptive use in Vietnam shows that overall contraceptive prevalence rate is rather high of 75.82 percent. However, the prevalence of modern methods only accounts for 54.56 percent. The traditional methods still make up 28.04 % of contraceptive use. The large extent of the use of traditional methods means that many women who would like to plan their families are not using the most effective methods to do so and are likely to continue to have unwanted children. Therefore, it will be especially important to ensure that household accept the use of the modern methods so that the goal of maintaining the declining trend in fertility, and above all the goal of attaining population stability will be achieved. To clarify what policies should be implemented to increase the use of modern contraception, it is necessary to understand the factors behind modern contraceptive use. The main purpose of the research, therefore, is to answer the crucial question: "What are the determinants of modern contraceptive use in Vietnam?" To date, there have been some researches considering contraceptive use in Vietnam including Pham Thanh Nhiem (1999), Nguyen Minh Thang et al. (1992), and NCPFP (2000d). However, most of the previous studies were not carried out in a comprehensive and systematic way on this topic. Moreover, these studies use data that are either old (Pham Thanh Nhiem using data from VLSS1992-93) or coming from other source like DHS (Nguyen Minh Thang et al. using data from DHS1988 and NCPFP using data from DHS1997). Therefore, together with trying to answer the above central question using data from VLSS1997-98, the author will make comparison where possible. In the thesis an overview about contraceptive choice in Vietnam will be examined. Then the focus will be on the factors explaining modern contraceptive use. Empirical studies often divide determinants of modern contraceptive use into individual characteristics (women’s socioeconomic background) and community characteristics (family planning efforts). However, in the thesis the author concentrates only on individual characteristics. The reasons are: firstly, previous studies showed insignificant effects of community variables on modern contraceptive use; secondly, in some instances, family planning programs appear to work best where people are motivated to reduce family size by using contraception; finally, the author would like to narrow the scope of study to concentrate more on individual or women’s socioeconomic background. The research hypothesis coming from the above research question is that the variation in modern contraceptive use should be explained by the variation in individual characteristics. In addressing the research question, qualitative method is used, including review of historical trends, descriptive, analytical and comparative methods. Besides, quantitative method (econometric modeling or logistic model) is extensively used. The maximum likelihood method available in STATA software package is used to estimate the parameters of logistic model. STATA software package is also used to process the necessary data to examine the current contraceptive choice in Vietnam. Data used in the analysis are secondary data extracted from the VLSS97-98. This survey was implemented by General Statistical Office under the financial support of the UNDP and the SIDA and the technical assistance from the World Bank and several independent consultants. Moreover, tertiary data from the National Committee for Population and Family Planning (NCPFP), Demographic and Health Survey (DHS), Vietnam Living Standards Survey 1992-93, the 1989 and 1999 Census and previous studies of other authors are also used. The thesis consists of three chapters. Chapter I is the theoretical frameworks. Chapter II mentions the PFP and presents a descriptive analysis of the use of contraception in Vietnam. Chapter III uses logistic regression model to examine the factors affecting modern contraceptive use in Vietnam. Drawing some conclusions and suggesting some policy recommendations concludes the thesis. Chapter 1: Theoretical frameworks In this chapter, first of all, concepts used in the thesis will be clarified. Then theoretical and empirical approach to factors affecting modern contraceptive use will be examined. Finally, the role of contraceptive use will be presented. 1/ Major concepts Contraceptive prevalence rate is the percentage of married women currently using contraception. The crude birthrate is the yearly number of live births per thousand of population. Total fertility rate is the average number of children a woman would have assuming that current age-specific birthrates remain constant throughout her childbearing years, 15-49 years of age. Replacement level of fertility indicates two children per family. Modern contraceptive method: modern methods are generally categorized as "clinic" and "supply" methods. Supply methods are available from both clinic and non-clinic sources, and thus do not necessarily require a clinic visit. The main supply methods are pills, condoms and vaginal barrier methods. These are temporary (or short-acting) contraceptives that require the user to obtain a regular supply or re-supply. Clinic methods, on the contrary, require a clinic visit or a medical intervention. The main clinic methods are the longer-acting methods such as injections, IUDs, implants or methods intended to provide "permanent" protection against the risk of pregnancy such as female and male surgical sterilization. All methods except permanent methods are reversible methods. In general, clinic methods are far more effective at preventing pregnancy than the supply methods. However, the effectiveness of any reversible methods depends to a large extent on appropriate and consistent use. Traditional contraceptive methods: the methods classified as "traditional" are also called "non-supply" methods, under the assumption that these methods do not require access to supply sources. Among the traditional methods, the most widely used ones are periodic abstinence and withdrawal. Periodic abstinence refers principally to the rhythm (or "calendar rhythm") method. In general, and on average, these traditional methods are much less effective at preventing pregnancy than modern methods. However, their effectiveness depends to a large extent on correct and consistent use. Other traditional methods include post-coital douching for contraceptive purposes and a variety of folk methods that are for the most part unique to a specific culture or location such as herbs, amulets, charms or spells to prevent conception. The contraceptive efficacy of this group remains largely unproven. Although postnatal sexual abstinence, breast-feeding, morning after pill and abortion may result in lower fertility, most demographic analyses do not consider them contraceptive methods. The terms "modern" and "traditional" methods used in this thesis are classified based on the above-mentioned concepts and the questionnaires in VLSS. Specifically, modern methods include IUD; condoms; female sterilization; male sterilization; pill; injection and diaphragm/jelly/foam. Traditional methods consist of rhythm, withdrawal and herbal medicine. As far as specific contraceptive methods are concerned, condom is the only method that can prevent both pregnancy and STDs, HIV/AIDS. To some extent, vaginal barrier methods reduce the risk of STD transmission. However, these methods are less effective for preventing pregnancy than other modern methods. All contraceptive methods except sterilization are reversible. Most methods related to mechanical devices or hormones more or less result in side effects. Most contraceptive methods are for women. All of these features affect contraceptive choice in Vietnam that will be discussed in chapter 2. 2/ Factors affecting modern contraceptive use Fertility decline results from the increase in contraceptive use or the rise in abortion rate. The invention of modern birth control methods has led people to use contraception to avoid unwanted pregnancy instead of undergoing abortion. Therefore, the decline in fertility mainly comes from the increase in contraception. Basing on this argument, the author assumes that factors affecting fertility also have an influence on contraception. Therefore, theories of fertility are studied to be the theoretical framework for examining contraception. Specifically, those theories are the Malthusian Population Trap; the microeconomic household theory of fertility; modern theories of fertility. It should be noted here that all these theories don't specify all factors affecting modern contraceptive use. However, the theories explain to certain extent the effects of some factors such as income and lay the foundation for examining the effects of other factors such as education, income, area of residence, son preference on modern contraceptive use. The Malthusian population trap hypothesized that the relationship between income and fertility is positive. The microeconomic household theory of fertility looks at fertility behavior at micro-level using the traditional neoclassical theory of consumer choice to explain family size decisions. In this theory, children are considered as a special kind of consumption good costing time and money and providing benefits to parents. Fertility behavior is seen as the result of rational choice of maximizing utility of the household under the constraint of price, time and income. Parents make rational choice between having their own children or other consumption goods to maximize their satisfaction. Fertility decline is explained by the changes in household income and the cost of children. Specifically, other factors are held constant, the higher household income, the higher desired number of children, the higher the cost of children, the lower desired number of children. The cost of children includes the direct cost and opportunity cost. The increase in direct cost is due to the market demand for higher quality of children, which leads to higher demand for education and health expenditure on children. The increase in opportunity cost relates to the value of parents’ time in the market, especially mother’s time. Here, the positive relationship between fertility and household income in not strong. It depends on the sources of increased income. For example, if income rise results from an increase in women’s employment opportunity in the market, and if the effect of opportunity cost of women’s time on fertility outweigh the effect of income, there will be a fall in fertility. Obviously, the relationship is now negative. Modern theories of fertility: Modern theories of fertility try to explain how people use the available mechanisms for determining the number of births. One of the positions about making decision on births is to use a cost-benefit calculus. Children impose certain costs on their parents and confer certain benefits. It follows that to reduce the birth rate, it will be necessary to raise the ratio of costs to benefits. Another position about determinants of fertility is based on the idea of rational choice. John Caldwell argues that the main reason why large families are rational in traditional societies is that extended family relationships cause net intergenerational wealth transfers to flow from younger to older generations. As nuclear families become more common and the emotional and economic ties between generations weaken in the course of modernization, the direction of the intergenerational flow of wealth reverses. Since parents must now transfer net wealth to their children, rather than receiving net wealth from them, they opt to have fewer children. The success of efforts to promote greater modern contraceptive use will depend on an understanding of the importance of factors affecting the use of modern contraception, which consists of individual characteristics, community characteristics and government’s population policies. As pointed out in the introduction section, the author focuses only on individual characteristics. That is the reason why individual characteristics are examined in more details in this chapter. The theoretical basis as well as empirical studies has shown that women’s individual characteristics affecting modern contraceptive use include the followings: - Household’s income: the effect of household income on modern contraceptive use is ambiguous. Some demographers hold that an increase in household income will result in a fall in contraceptive use. The others support the positive relationship (This line of argument has received substantial support from empirical studies in Nigeria (Feyisetan and Ainsworth, 1996), Zimbabwe (Thomas and Maluccio, 1996)). - Women’s schooling: women’s schooling is posited to result in lower fertility and, by inference, higher contraceptive use, through four main channels: income effects, higher demand for child schooling, lower child mortality, more effective use of contraception. Most studies (Ainsworth, Beeegle and Nyamete, 1996; Feyisetan and Ainsworth, 1996; Thomas and Maluccio, 1996) find that women’s schooling has a consistently strong positive relation with contraceptive use. - Son preference: couples with a son are more likely to use contraception than those without him. - Number of living children: for parents, the number of living children or surviving children is the desired number of children. In developing countries where infant mortality rates are usually high, living children are an important consideration. It is expected that the relationship between number of living children and modern contraceptive use is nonlinear. Specifically, as the number of living children rises, the use of modern contraception also increases. However, when the number of living children continues to increase to a certain extent, there is a tendency of falling use of modern contraception. - Women’s religion and ethnic group: we expect an impact of women’s religion and ethnic group on modern contraceptive use in the dimension that women with religion and women in minority group are less likely to use modern contraception. - Women’s area and region of residence: contraceptive use is expected to be higher among urban than rural women. Regional variation is expected to affect contraceptive use also. This might reflect different socioeconomic circumstances across regions. 3/ The role of contraceptive use The final part of this chapter focus on the in-depth analysis of the relationship between population and development and of the role of contraceptive use in fertility reduction, protecting maternal and child health, improving women’s status and above all in promoting economic development. Chapter 2: Population and family planning in Vietnam
In this chapter, an overview about population policies and family planning in Vietnam and some typical results will be examined. Then more details will be focused on current contraceptive choice in Vietnam. 1/ Population policies and family planning programs in Vietnam and some typical results Rapid population growth has shown its adverse effects on socio-economic development. Therefore, since the early 1960s, Vietnamese government has formally enacted population policies addressing to birth control. During the 1961-1975 stage, population policies were only carried out in Northern Vietnam with the name “guided birth campaign” and then “planned birth campaign”. The target of the campaign was 3-child family. The campaign focused on women in reproductive age that already had large number of children, specifically female civil servants, women in army forces and women in populous plains. The program focused mainly on IUD insertion. Contraceptive choice was determined by managers of planned birth programs, not by users. As a result, the crude birth rate declined by 10.7%o from 43.9%o in the early 1960s to 33.2%o in 1975. Total fertility rate also went down from 6.39 to 5.25. In Southern Vietnam, the government in Saigon did not begin to implement a family planning program until it was advocated by the U.S. Agency for International Development in 1971. Due to fierce war, family planning program was not commonly implemented. After reunification in the year 1975, population policies and family planning programs were extended to all over the nation. The program was the expanded to include all women in the reproductive age and men who had wives in reproductive age. On June 30, 1989, the National Assembly passed the National Health Law. This law established a legal basis for a policy of the people's freedom to choose whatever contraceptive means they desired to implement family planning. The tendency of population increase to offset the deaths in the war in the south, then the Southwest and the North border wars hindered the implementation of family planning program nationwide. Consequently, after 17 years from 1975 to 1992, the crude birth rate was reduced only by 3.16%o from 33.2%o in 1975 to 30.04%o in 1992. Total fertility rate (TFR) declined from 5.25 to 3.8 respectively. In short, till the year 1992, family planning-population policies had shown to be unsuccessful and ineffective. Birthrate and TFR were high at 30.04%o and 3.8 respectively. Moreover, the target of reducing population growth rate to 1.7% by 1990 wasn’t attained. Rapid population growth was in fact a hindrance to Vietnam economy where people’s living standards were still very low compared to the world. Vietnam faced the danger of lagging behind if birthrates and population growth rate were not restrained. For that reason, two important documents related to PFP policies were introduced: Resolution No. 4 on Population Policies, Population and Family Planning Strategy to the year 2000. The general goal of Resolution No. 4 is "Obtaining families with few children who are healthy to allow a good living conditions". The specific goal is “Every husband and wife should have only one or two children so that each family (each couple) will have two children on social average by 2015, leading to a stabilization in the size of the population in the middle of the 21st century. All efforts should be made to have a clear change right in the 1990s.” In order to implement the goal, viewpoints and measures of Resolution No. 4, the Prime Minister signed Decision 270/TTg on 03/06/1993 approving Population and Family Planning Strategy to 2000, institutionalizing guideline, policies, measures and developing effectively Resolution No. 4 in the stage 1993-2000. The Strategy set the goals for the stage 1993-2000: “Quickly reducing the 3rd birth rate so that TFR will be 2.9 or lower and population size will be less than 82 million people by the year 2000”. Resolution No. 4 and Population and Family Planning Strategy to the year 2000 were successfully implemented. By the 1st July, 2000, Vietnam’s population size was 77.68 million people, which was less than the set goal of 82 million people in Population and Family Planning Strategy to 2000 by 4.32 million people. This substantial reduction contributes much to socio-economic development. The average population growth rate between the 1989 census and the 1999 census was 1.7%, which was the lowest in the past 45 years since independence in 1954 in the North. Total fertility rate declined rapidly from 4.0 in 1988 to 3.2 in 1994 and 2.3 in 1997. This indicator shows once again the big success in the implementation of the Strategy to the year 2000, where the set goal of TFR by 2000 is 2.9. The crude birth rates go down from 28.5%o in 1993 to 21.9%o in 1997 and 19.9%o in 1999. Recently, the introduction of the two documents- Vietnam Population Strategy in the stage 2001-2010, and National Target Program on Population and Family Planning to the year 20050- show that the focus of the population program has changed from a strong focus on fertility control to more concern about quality of the family planning program and improving the quality of the population. This is consistent with the direction that was raised at the Cairo Conference on Population and Development in 1994. 2/ Current contraceptive choice in Vietnam: Knowledge of at least one contraceptive method had increased continuously since 1988 from 94 percent to 97 percent by 1994 and to 99.48% by 1997-1998. Up to 1998, knowledge of at least one method had become almost universal. As far as specific methods are concerned, there were marked increases in familiarity with each method between the three surveys- DHS 1988, ICDS 1994 and VLSS97-98. For the IUD, there is relatively little difference in levels of knowledge between the three surveys. The high level of familiarity with the IUD reflects the historical dominance of that method in the government family planning program. Contraceptive awareness were rather equal by 1997-1998. More than 90% of women surveyed indicated awareness of IUD, condoms, male and female sterilization. Knowledge of traditional methods were also high, approximately 85%. Even vaginal methods (Diaphragm, jelly), that are not yet widely available in Vietnam, are familiar to nearly 15% of ever-married women. Knowledge of contraceptive methods of ever married women improved greatly during the period 1992-1993 and 1997-1998 by all characteristics. According to VLSS 1992-1993, there were obvious variations in contraceptive awareness by characteristics. Specifically, contraceptive awareness was obviously higher among urban women, women living in the Red River Delta, women with higher educational level, and women with 3-5 children. However, there were relatively small differences in level of contraception knowledge by all characteristics in 1997-1998. In term of source of information supply on contraceptive methods, family planning clinic played the most important role, then mass media, other medical facility and mass organization. This is in compliance with the general guideline of government programs, which underline information – education – communication (IEC) as the main tools. For traditional methods such as rhythm method, withdrawal and herbal medicine, relative or husband or friend also accounted for an important part in providing information on these methods.Surprisingly, school played very little role in supplying information on contraception. This shows that sexual education was still not introduced into school. Overall contraceptive prevalence in Vietnam is high compared to LDCs’ rate (75.82 percent as compared to 67 percent) and has increased in the period 1992-93 and 1997-98. However, the use of modern methods is much lower than that of LDCs. In Vietnam, 71.96 percent of currently married contraceptive users were practicing modern contraception whereas modern methods accounted for 91 percent of total contraceptive use in LDCs. As far as specific contraceptive methods are concerned, IUD was still the most widely used method of contraception by 1997-98. The second most commonly used method was traditional methods such as withdrawal and rhythm. The high proportion of Vietnam women using traditional methods means that there is considerable demand for family planning services among the Vietnamese population, which has not been fully met by the current family planning programs. Use of condoms, pill and sterilization, had increased between 1993 and 1998 but was still low, which was 6.08 percent, 3.69 percent and 6.6 percent respectively in VLSS97-98. Use of injection was extremely low, only 0.18 percent. The use of most methods increased in 1997-1998 as compared to 1992-1993 only in absolute terms. However, their use declined in relative terms. This reflects a more diverse use of contraception. The reasons for this method-mix inVietnam are considered in detail in the final part of this chapter. There existed gender inequality in contraceptive use. Men still had very little responsibility in the use of contraception. The vast majority of married contraceptive users were women, which was shown in very high rate of use of IUD, pill and female sterilization. These three main "female" methods accounted for nearly two thirds of all contraceptive practice in Vietnam, whereas "male" methods took a very small rate. Although sterilization procedures are available for both men and women and male sterilization is simpler, safer and usually less expensive procedure than female sterilization, female sterilization procedures far outnumbered their male counterparts by 7.93 percent to 0.8 percent. Contraceptive use was almost put on the shoulder of women. Chapter 3: Determinants of modern contraceptive use in VietnamThe main focus in this chapter is to study factors affecting whether a married woman aged 15-49 has access and desire to use a modern method of contraception. Firstly, the empirical model for the analysis will be presented; Then bivariate and multivariate analysis of modern contraceptive use will be examined. 1/ Empirical model: In the study on “The Impact of women’s Schooling on Fertility and Contraceptive Use: A Study of Fourteen Sub-Saharan African Countries”, Ainsworth, Beegle and Nyamete used the following reduced-form model for analyzing determinants of modern contraceptive use: y = b0 + b1x1+b2x2 +b3x3 +b4x4 +b5x5 +b6x6+ m where y is a dichotomous dependent variable that takes on the value zero or one, indicating current use of modern contraception; b0 is an intercept; x1 is the woman’s schooling; x2 indicates urban residence; x3 is the woman’s ethnic group; x4 is the woman’s region of residence; x5 is the woman’s religion; and x6 is a group of variables proxying the household’s income or wealth. Basing on theoretical studies presented in chapter I, the above-mentioned model, the particular purpose of the research and the specific characteristics in Vietnam, the author suggests the following model for analyzing the current use of modern contraception in Vietnam: FC = FC(x1, x2, x3, x4, x5, x6, x7, x72, x8) (3.1). Where FC is the current use of modern contraception; x1 indicates urban residence; x2 is woman’s region of residence; x3 is household’s income; x4 is the woman’s religion; x5 is the woman’s ethnic group; x6 is the woman’s education; x7 is the total living children the woman has, entered in quadratic form; x8 indicates whether the woman has a son. Since the dependent variable is dichotomous, taking a value of one or zero depending on whether a married woman aged 15-49 is currently using a modern method of contraception or not. Logistic model is used to estimate parameters of equation (3.1). As mentioned in the introduction part, the data the author has at hand at individual level cannot be used to estimate the logistic regression model by the standard OLS. Therefore, the author uses the maximum likelihood method to estimate the parameters. To examine in more detail the nonlinearity of the effect of number of living children on modern contraceptive use, specifically, to account for the fact that the use of modern contraception rises with the total living children the woman has, peaks, and then declines, the author controls for variables "Total living children" and "number of living children squared" in the model. In model (3.1), the dependent variable is "Is a currently married woman in the reproductive age (15-49 years of age) using a modern method of contraception". The dummy dependent variable takes on the value 1 if the woman is using a modern method of contraception and 0 if she is not. In VLSS 1997-1998, 4411 ever-married women aged 15-49 were asked about their contraceptive use. However, only a sample of 4104 currently married women was asked about their current use of contraception. That is the reason why only currently married women aged 15-49 are included to study the situation of current contraceptive use in Vietnam. All the necessary independent variables have been specified in model (3.1). The independent variables’ definitions as well as characteristics are shown in table 3.1. It should be mentioned that: - In the thesis the author use expenditure quintiles as a proxy for income although data on income can be collected in VLSS97-98. The reason is: "First, consumption expenditure data are likely to be more accurate than income data, because questions on expenditure are often easier to answer (in particular, the self-employed have difficulty answering questions on income) and because some households are reluctant to reveal their true income. Second, income raises living standards only if it is consumed, and past income (savings) or borrowing can be used for consumption purposes. Thus consumption data are likely to reflect household’s welfare levels more accurately than would income data." (Glewwe, Zaman and Gragnolati, 1999, p.3)
Table 3.1: Variables’ definitions and characteristics
Source: Author’s calculation based on Vietnam Living Standards Survey 1997-98
- In the model, family size is represented by the total living children a couple has. Here, the total living children not the total number of children is considered. This is because for parents the number of living children is their desired number of children. And it is this number of living children that affects their decision making on whether to have more children and whether to use contraception or not. “Number of children squared” is included in the model to explain its predicted nonlinear effect on modern contraceptive practice. 2/ Bivariate analysis of modern contraceptive use Table 3.2 shows the effect of individual characteristics on the use of modern contraception. This is of interest to test the expectations discussed in chapter I about factors affecting modern contraceptive use. As shown in the table, the prevalence of modern contraception is higher among urban than rural women. However, the difference is not large. One possible reason is that urban women have higher use of traditional methods. The other possible reason is that rural household finds the participation of children in the household economy less important. This is attributable to increasingly limited amount of agricultural land. Therefore, the demand for children to guarantee labor supply for farming decreases and the demand for contraceptive use increases in rural area. Better knowledge on contraception of rural women between VLSS92-93 and VLSS97-98 is another reason for high use rate of modern contraception in rural area. Substantial regional variation in current use of modern contraception is evident. Use of modern contraception ranges from 30.6 percent of women in Central Highlands to 67.54 percent of currently married women in Red River Delta. In general, use of modern methods is noticeably lower in the three southernmost regions. It may be because use of traditional methods is higher in these three regions. Another reason for higher use of modern methods in the north than in the south is that family planning has been implemented in the north in the early 1960s while it didn’t begin in the south until it was advocated by the U.S. Agency for International Development in 1971. The distinctly lower level of modern method in the Central Highlands may result from socio-economic, geographic and cultural characteristics of this region. In developed region, women are generally characterized by lower demand for children and hence higher demand for modern contraception and vice verse in the less developed regions. The higher use rate in North Mountain and Midlands can be explained by the early implementation of family planning programs in the North in the early 1960s. The low level of modern contraception in Mekong Delta region may reflect better agricultural opportunities in this region, which can be seen from table 3.3. The table shows that the land area per capita under annual crop, one of the main sources of farming households’ income, in the Mekong River Delta is nearly three times as large as that in the Red River Delta and The North Central Coast. Therefore, the demand for children to guarantee an adequate labor supply for farming may be high, and hence modern contraceptive use are low. Modern contraceptive use is higher for Chinese and Kinh group than for the minority. This is what we expected. On the one hand, Chinese and Kinh group may have better access to family planning. On the other hand, socioeconomic characteristics, customs of marriage and reproductive practices lead to lower use of contraception in minority group. As far as religion is concerned, Buddhist and Catholic women have lower level of modern contraceptive use.
Table 3.2: Current use of a Modern Method of Contraception by Selected Individual Characteristics by Currently Married Women Aged 15-49
Source: Author’s calculation based on Vietnam Living Standards Survey1997-98
Table 3.3: Agricultural and forestry land area per capita by type of land (m2)
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