Pregnant adolescents in Vietnam : social context and health care needs
Author: Klingberg-Allvin, Marie
Date: 2007-05-04
Location: Rockefellersalen, Karolinska Instituitet, Nobels väg 11
Time: 09.30
Department: Institutionen för folkhälsovetenskap / Department of Public Health Sciences
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thesis.pdf (445.6Kb)
Abstract
Background: Childbearing among adolescents in Vietnam is relatively rare
but they are more prone to experience adverse outcome than adult women.
Reports of increasing rates of abortion and prevalence of STIs including
HIV among unmarried youth indicate a need to improve services and
counselling for these groups. Midwives should be key persons in the
promotion of young people's sexual and reproductive health in Vietnam.
Aim: The overall aim of this thesis is to describe the prevalence and outcome of adolescent pregnancies in Vietnam (I), to explore the social context and health care seeking behavior of pregnant adolescents (II), as well as to explore the perspectives of health care providers and midwifery students regarding adolescent sexuality and reproductive health service needs (III, IV).
Methods: The studies were conducted from 2002 to 2005, combining qualitative and quantitative research methods. A population based prospective survey was used to estimate rates and outcomes of adolescent pregnancies (I). Pregnant and newly delivered adolescents' experiences of childbearing and their encounters with health care providers were studied using qualitative interviews (II). Health care providers' perspective on adolescent sexual and reproductive health (ASRH) and views on how to improve the quality of abortion care were studied in focus group discussions (FGD). The values and attitudes of midwifery students about ASRH were investigated using questionnaires and interviews (IV). Descriptive statistics was used to analyse quantitative data (I, IV) and content analysis were applied for qualitative data (II, III, and IV).
Findings: Adolescent birth rate was similar to previously reported in Vietnam but lower when compared to other Asian countries. The incidence of stillborn among adolescents was higher than for women in higher reproductive ages. The proportion of preterm deliveries was 20% of all births, higher than previous findings from Vietnam. About 2% of the deliveries were home deliveries, more common among women with low education, belonging to ethnic minority and/or living in mountainous areas (I). Ambivalence facing motherhood, pride and happiness but also worries and lack of selfconfidence emerged as themes from the interviews; and experience of 'being in the hands of others' in a positive, caring sense but also in a sense of subordination in relation to husband, family and health care providers (II). Health care providers at abortion clinics and midwifery students generally disapproved of pre-marital sex, but had a pragmatic view on the need for contraceptive services and counselling to reduce the burden of unwanted pregnancies and abortions for young women. Providers and midwifery students expressed a need for training on ASRH issues (III, IV).
Conclusion: Cultural norms and gender inequity make pregnant adolescent women vulnerable to sexual and reproductive health risks. Health care providers experience ethical dilemmas when counselling unmarried adolescents who come for abortion, with impact on the quality of care. Integrating ASRH in education and training programmes for health care providers, including midwives, as well as continued in-service training on these issues are suggested to improve reproductive health care services for adolescents in Vietnam.
Aim: The overall aim of this thesis is to describe the prevalence and outcome of adolescent pregnancies in Vietnam (I), to explore the social context and health care seeking behavior of pregnant adolescents (II), as well as to explore the perspectives of health care providers and midwifery students regarding adolescent sexuality and reproductive health service needs (III, IV).
Methods: The studies were conducted from 2002 to 2005, combining qualitative and quantitative research methods. A population based prospective survey was used to estimate rates and outcomes of adolescent pregnancies (I). Pregnant and newly delivered adolescents' experiences of childbearing and their encounters with health care providers were studied using qualitative interviews (II). Health care providers' perspective on adolescent sexual and reproductive health (ASRH) and views on how to improve the quality of abortion care were studied in focus group discussions (FGD). The values and attitudes of midwifery students about ASRH were investigated using questionnaires and interviews (IV). Descriptive statistics was used to analyse quantitative data (I, IV) and content analysis were applied for qualitative data (II, III, and IV).
Findings: Adolescent birth rate was similar to previously reported in Vietnam but lower when compared to other Asian countries. The incidence of stillborn among adolescents was higher than for women in higher reproductive ages. The proportion of preterm deliveries was 20% of all births, higher than previous findings from Vietnam. About 2% of the deliveries were home deliveries, more common among women with low education, belonging to ethnic minority and/or living in mountainous areas (I). Ambivalence facing motherhood, pride and happiness but also worries and lack of selfconfidence emerged as themes from the interviews; and experience of 'being in the hands of others' in a positive, caring sense but also in a sense of subordination in relation to husband, family and health care providers (II). Health care providers at abortion clinics and midwifery students generally disapproved of pre-marital sex, but had a pragmatic view on the need for contraceptive services and counselling to reduce the burden of unwanted pregnancies and abortions for young women. Providers and midwifery students expressed a need for training on ASRH issues (III, IV).
Conclusion: Cultural norms and gender inequity make pregnant adolescent women vulnerable to sexual and reproductive health risks. Health care providers experience ethical dilemmas when counselling unmarried adolescents who come for abortion, with impact on the quality of care. Integrating ASRH in education and training programmes for health care providers, including midwives, as well as continued in-service training on these issues are suggested to improve reproductive health care services for adolescents in Vietnam.
List of papers:
I. Klingberg-Allvin M, Graner S, Ho Dang Puc, Hojer B, Johansson A (2007). "Pregnancies and births among adolescents. A population based prospective study in rural Vietnam." (Manuscript)
II. Klingberg-Allvin M, Nguyen Thanh Binh, Johansson A, Berggren V (2007). "One foot wet and one foot dry. Transitition into motherhood among married adolescents women in rural Vietnam." (Submitted)
III. Klingberg-Allvin M, Nga NT, Ransjo-Arvidson AB, Johansson A (2006). "Perspectives of midwives and doctors on adolescent sexuality and abortion care in Vietnam." Scand J Public Health 34(4): 414-21
Pubmed
IV. Klingberg-Allvin M, Van Tam V, Nga NT, Ransjo-Arvidson AB, Johansson A (2007). "Ethics of justice and ethics of care. Values and attitudes among midwifery students on adolescent sexuality and abortion in Vietnam and their implications for midwifery education: a survey by questionnaire and interview." Int J Nurs Stud 44(1): 37-46. Epub 2006 Jan 18
Pubmed
I. Klingberg-Allvin M, Graner S, Ho Dang Puc, Hojer B, Johansson A (2007). "Pregnancies and births among adolescents. A population based prospective study in rural Vietnam." (Manuscript)
II. Klingberg-Allvin M, Nguyen Thanh Binh, Johansson A, Berggren V (2007). "One foot wet and one foot dry. Transitition into motherhood among married adolescents women in rural Vietnam." (Submitted)
III. Klingberg-Allvin M, Nga NT, Ransjo-Arvidson AB, Johansson A (2006). "Perspectives of midwives and doctors on adolescent sexuality and abortion care in Vietnam." Scand J Public Health 34(4): 414-21
Pubmed
IV. Klingberg-Allvin M, Van Tam V, Nga NT, Ransjo-Arvidson AB, Johansson A (2007). "Ethics of justice and ethics of care. Values and attitudes among midwifery students on adolescent sexuality and abortion in Vietnam and their implications for midwifery education: a survey by questionnaire and interview." Int J Nurs Stud 44(1): 37-46. Epub 2006 Jan 18
Pubmed
Issue date: 2007-04-13
Rights:
Publication year: 2007
ISBN: 978-91-7357-128-9
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