Sex ratio imbalance worsens in Vietnam

Toward sustainable development goals in gender inequality: an analysis of gender preferences among urban pregnant women in a Southeast Asian country

BACKGROUND

Gender-biased discrimination and preferences are global phenomena, particularly son preferences. However, updated evidence about this issue in Vietnam has not yet been provided. Therefore, this study aimed to examine the gender preferences among pregnant women and identify associated factors of such preferences.

METHODS

A cross-sectional survey was conducted in two hospitals in Vietnam with 732 pregnant women. Gender preferences for their child were asked, along with socio-demographic (e.g., education, occupation) and pregnancy characteristics (e.g., pressure to have a son, gender of first child, the importance to have a son of family members, and information sources on pregnancy care) by using face-to-face interviews and a structured questionnaire. Multinomial logistic regression was performed to determine factors associated with gender preferences.

RESULTS

About 51.9% of the participants had no gender preference, while, among those who had a gender preference, 26.5% preferred sons, and 21.6% preferred daughters. Only 6.2% had pressure to have a son. Having the first child who was female (OR = 4.16, 95%CI = 1.54-11.25), having the pressure to have a son (OR = 6.77, 95%CI = 2.06-22.26), and higher self-perceived importance to have a son (OR = 3.05, 95%CI = 1.85-5.02) were positively associated with son preference. Otherwise, women having partners with high school education or above (OR = 2.04, 95%CI = 1.06-3.91), living with parents-in-law (OR = 2.33; 95%CI = 1.25-4.34), the higher number of pregnancies, and a higher degree of importance in having a son regarding parents-in-law (OR = 2.15, 95%CI = 1.38-3.35) associated with higher odds of preferring daughter.

CONCLUSION

This study showed that gender preference was common among pregnant women, but the pressure to have a son was low. Further education programs and legal institutions should be implemented to improve gender inequality and gender preference in society.

Sex ratios at birth after induced abortion

BACKGROUND

Skewed male:female ratios at birth have been observed among certain immigrant groups. Data on abortion practices that might help to explain these findings are lacking.

METHODS

We examined 1 220 933 births to women with up to 3 consecutive singleton live births between 1993 and 2012 in Ontario. Records of live births, and induced and spontaneous abortions were linked to Canadian immigration records. We determined associations of male:female infant ratios with maternal birthplace, sex of the previous living sibling(s) and prior spontaneous or induced abortions.

RESULTS

Male:female infant ratios did not appreciably depart from the normal range among Canadian-born women and most women born outside of Canada, irrespective of the sex of previous children or the characteristics of prior abortions. However, among infants of women who immigrated from India and had previously given birth to 2 girls, the overall male:female ratio was 1.96 (95% confidence interval [CI] 1.75-2.21) for the third live birth. The male:female infant ratio after 2 girls was 1.77 (95% CI 1.26-2.47) times higher if the current birth was preceded by 1 induced abortion, 2.38 (95% CI 1.44-3.94) times higher if preceded by 2 or more induced abortions and 3.88 (95% CI 2.02-7.50) times higher if the induced abortion was performed at 15 weeks or more gestation relative to no preceding abortion. Spontaneous abortions were not associated with male-biased sex ratios in subsequent births.

INTERPRETATION

High male:female ratios observed among infants born to women who immigrated from India are associated with induced abortions, especially in the second trimester of pregnancy.

Variations in male-female infant ratios among births to Canadian- and Indian-born mothers, 1990-2011: a population-based register study

BACKGROUND

We assessed variations in the male-female infant ratios among births to Canadian-born and Indian-born mothers according to year of birth, province and country of birth of each parent.

METHODS

In this population-based register study, we analyzed birth certificates of 5 853 970 singleton live births to Canadian-born and 177 990 singleton live births to Indian-born mothers giving birth in Canada from 1990 to 2011. Male-female ratios were stratified by live birth order and plotted by year of birth. Logistic regression was used to assess whether ratios varied between Canadian provinces and according to the birthplace of each parent. The deficit in the number of girls was estimated using bootstrap methods.

RESULTS

Among Canadian-born mothers, male-female ratios were about 1.05, with negligible fluctuations by birth order, year and province. Among Indian-born mothers, the overall male-female ratio at the third birth was 1.38 (95% confidence interval [CI] 1.34-1.41) and was 1.66 (95% CI 1.56-1.76) at the fourth or higher-order births. There was little variability in the ratios between provinces. Couples involving at least 1 Indian-born parent had higher than expected male-female ratios at the second and higher-order births, particularly when the father was Indian-born. The deficit in the expected number of girls among Indian immigrants to Canada in the study period was estimated to be 4472 (95% CI 3211-5921).

INTERPRETATION

Fewer than expected girls at the third and higher-order births have been born to Indian immigrants across Canada since 1990. This trend was also seen among couples of mixed nativity, including those involving a Canadian-born mother and an Indian-born father. Fathers should be considered when investigating sex ratios at birth.

Risk factors for repeat abortion and implications for addressing unintended pregnancy in Vietnam

OBJECTIVE

To determine predictors of repeat abortion in 3 provinces in Vietnam.

METHODS

In a cross-sectional study between August and December 2011, women who underwent abortion were interviewed after the procedure in 62 public health facilities in Hanoi, Khanh Hoa, and Ho Chi Minh City (HCMC). Information on sociodemographic factors, contraceptive and reproductive history and intentions, and opinions and experience of abortion services was collected. The primary outcome was repeat (≥2) abortions.

RESULTS

Overall, 1224 women were interviewed: 534 from Hanoi, 163 from Khanh Hoa, and 527 from HCMC. The mean age and parity of the respondents were 29 years and 1.8, respectively, and 79.6% were married. Approximately half of the respondents were not using contraception before pregnancy. The prevalence of repeat abortion was 31.7%. In multivariate models, significant predictors of repeat abortion included living in Hanoi, higher parity, age 35 years or older, and having 2 or more daughters (versus 1) or no sons (versus 1) after controlling for parity (all P < 0.05).

CONCLUSION

Repeat abortion remains high in Vietnam, fueled partly by inadequate contraceptive use. Son preference seems to be an important predictor of repeat abortion. Strengthening post-abortion contraceptive counseling and promoting long-acting contraceptive methods are essential to reduce repeat abortion.

Sex of newborns associated with place and mode of delivery: a population-based study in northern Vietnam

BACKGROUND

There is increasing evidence of an elevated sex ratio at birth (SRB) in many Asian countries, including Vietnam, and that this prenatal gender inequity is related to sex-selective abortion. However, few studies have investigated the relation between the sex of offspring and delivery care utilization.

OBJECTIVE

The aim of the present study was to relate sex of newborns to place and mode of delivery in a province in northern Vietnam.

METHODS

A population-based surveillance system within the Neonatal Health-Knowledge Into Practice (NeoKIP) project (ISRCTN44599712) recorded all births within eight districts of Quang Ninh province in northern Vietnam from July 2008 to June 2011.

RESULTS

In total, there were 22,377 live births within the study area. SRB was 108 boys per 100 girls. There was a large difference in SRB depending on place of delivery, with 94 boys per 100 girls being delivered at home, whereas 113 boys per 100 girls were delivered at a district-level hospital. Cesarean section (CS) rate was 17%, and within the CS group, the SRB was 135:100.

CONCLUSIONS

We demonstrated an elevated SRB, especially at district hospital level, and that sex of offspring influenced place and mode of delivery. Although mothers to boys were more likely to receive more qualified delivery care, they were at the same time more likely to undergo unnecessary surgery. Correct information to women and family members about CS and stricter implementation of the medical indications for CS are urgently called for.