Exploring barriers to accessing maternal health and family planning services in ethnic minority communities in Viet Nam.

This study draws on a mixed methods design to explore the perspectives of ethnic minority women in six provinces in the Central Highlands and Northern Midlands and Mountains regions of Viet Nam answering the overarching research questions: According to the data available what is the status of ethnic minority women’s access to and utilization of maternal health and family planning services? What is the extent of inequalities in access to maternal health care and family planning services compared to national estimates and what is the extent of inequalities within the ethnic minority population? What are the reasons for women not having access (or having inadequate access) to maternal health care services? The primary objective of this report is to enhance understanding of childbirth practices maternal health-seeking behaviour and the extent to which existing health services meet the needs and preferences of ethnic minority communities. The specific aims outlined in the Terms of Reference (ToR) for this study include to: Measure maternal health care utilization and family planning indicators of ethnic minority women in 60 communes selected from six provinces; Determine trends and disparities in maternal health care and family planning service utilization among women in ethnic minority communities; Identify determinants of maternal health care and family planning service utilization and non-utilization; Explore traditional customs cultural beliefs and practices that shape the environment for service delivery and influence women’s health-seeking behaviours utilization and non-utilization of maternal health care and family planning services; Explore opportunities for the primary health care system to provide culturally appropriate services adaptive to the local contexts and responsive to the needs of local people and provide recommendations that support the provision of culturally appropriate maternal health and family planning services for women in ethnic minority and remote communes. The report is based on original survey data from 4609 ethnic minority women focus group discussions (FGDs) with more than 100 ethnic minority women and interviews with health care providers and village leaders. The report covers key reproductive maternal newborn and child health (RMNCH) indicators related to health care access disaggregated by four dimensions of inequality (place of residence education level economic status and ethnicity). The report summarizes both strengths and weaknesses of the current systems and practices with respect to ethnic minority women’s access to and utilization of maternal health and family planning services. The situation is better with respect to some indicators and subgroups of the population. For example minimal differences were found in the use of modern contraceptives amongst ethnic minority participants compared to national estimates; coverage for community-based maternal health services is relatively high in Bac Kan Province with more than 75% of women receiving antenatal care from commune health centres (CHCs); and more than 85% of women from the Tay and Gia Lai minority groups having their last birth attended by skilled health personnel. On the other hand inequalities still persist for most indicators related to health care utilization compared to national estimates. The inequalities within the ethnic minority population in this study were most prominent among women in disadvantaged subgroups; that is the poorest the least educated those residing in specific regions and those from certain ethnic groups. There is still much progress to be made in improving RMNCH indicators and reducing inequalities related to maternal health care access.