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International Journal of Management (IJM) Volume 11, Issue 6, June 2020, pp. 1698-1709, Article ID: IJM_11_06_156

Available online at http://www.iaeme.com/IJM/issues.asp?JType=IJM&VType=11&IType=6

ISSN Print: 0976-6502 and ISSN Online: 0976-6510

DOI: 10.34218/IJM.11.6.2020.156

© IAEME Publication Scopus Indexed

FACTORS AFFECTING ACCESS TO

REPRODUCTIVE HEALTHCARE SERVICES OF

ETHNIC MINORITY WOMEN: EVIDENCE IN

VIETNAM

Pham Thi Phuong Thai

Associate Professor Ph.D, Thai Nguyen University of Science, Vietnam

Ta Thi Thao

Ph.D, Thai Nguyen University of Science, Vietnam

Nguyen Phu Truong

Ph.D, Central Propaganda Committee, Vietnam

Le Thu Hien

Ph.D, Vietnam Youth Academy, Vietnam

Doan Van Truong

Ph.D, Thanh Hoa University of Culture, Sports and Tourism, Vietnam

ABSTRACT

Research has identified factors affecting access to reproductive health care

services for ethnic minority women in the Northern mountainous region of Vietnam.

To achieve the goal, in this study we surveyed 450 ethnic minority women. The results

of the correlation analysis have identified three factors that have a significant

influence on the access to reproductive health care services of ethnic minority women

in Vietnam, including: (i) Family economic conditions, (ii) Culture - customs, (iii)

individual characteristics. In which, factors of family economic condition and

geographical distance have the greatest influence on reproductive health care access

behavior. On this basis, the study proposes several positive solutions to raise the

awareness of ethnic minority women in accessing reproductive health care services.

Key words: Women, ethnic minorities, health care, access to health services, Vietnam

Cite this Article: Pham Thi Phuong Thai, Ta Thi Thao, Nguyen Phu Truong, Le Thu

Hien and Doan Van Truong, Factors Affecting Access to Reproductive Healthcare

Services of Ethnic Minority Women: Evidence in Vietnam, International Journal of

Management, 11(6), 2020, pp. 1698-1709.

http://www.iaeme.com/IJM/issues.asp?JType=IJM&VType=11&IType=6

Pham Thi Phuong Thai, Ta Thi Thao, Nguyen Phu Truong, Le Thu Hien and Doan Van Truong


1. INTRODUCTION

Human development is an expansion of human choices, not only limited to economic

prosperity but also focused on improving the quality of human life, in which health choice is

also one of the important choices. The Northern Uplands is home to the majority of ethnic

minority groups in Vietnam, where the economy is underdeveloped. These are areas with high

slopes, the main form of cultivation is shifting cultivation and forest exploitation; Food

production capacity is very limited, mainly self-sufficient at a minimum. Each ethnic minority

woman surveyed gave an average of 4-5 children, with a high crude birth rate and a high

crude death rate (IrishAid, 2017). Reproductive health care is an important part of health

policy for ethnic minorities because it is closely related to child health and poverty reduction

effectiveness, which are two of the 17 development goals in the period 2015 - 2030 of the

United Nations. Many previous studies show that the rate of antenatal care visits at health

facilities of ethnic minority women is not high, the form of giving birth at home accounts for

a large proportion, the rate of using contraception is low,... So what are the factors leading to

the above situation? This paper will focus on analysing how factors including: family

economy condition, individual characteristics of ethnic minority women, and culture –

customs, tradition-folk knowledge affect to reproductive health care services of ethnic

minority women.

2. LITERATURE REVIEW AND HYPOTHESIS DEVELOPMENT

A number of studies in the world point out the factors affecting the reproductive health care of

women with specific conditions. Research by Zelalem Birhanu Mengesha, Tinashe Dune and

Janette Perz (2016) conducted a systematic review of scientific articles and grey literature

published in English from 1990 to 2015 to identify barriers and facilitators in accessing sexual

and reproductive health care with a group of women of cultural and linguistic diversity in

Australia. The results show that the main barriers and facilitators are identified in three major

themes, including: personal level experiences of accessing health care, women’s interaction

with the healthcare system and women’s experience with healthcare providers (Zelalem

Birhanu Mengesha, 2016).

Amanda Harris, Yun Zhou, Hua Liao, Lesley Barclay, Weiyue Zeng, Yu Gao, (2010)

conducted a descriptive study on maternal health care use among ethnic minority women in a

remote region of China. Research has identified factors that influence women obtaining care

and their decision-making. The results show that the utilization of maternal health care is

related to a range of social, economic, cultural and geographical factors, as well as the

policies of the state. Only a small number of women in this area receive prenatal and postnatal

care (Amanda Harris, 2010). Women give birth at home because the cost of giving birth at a

hospital is beyond their ability to pay, the quality of commune hospital is poor and there is a

lack of supportive services such as pain relief (Binh, 2004); (Dien, 1996).

In Vietnam, women make up over 50% of the country's population. They participate in

economy, politics, culture, society, security and national defense and increasingly prove their

role in society. In the cause of national renewal, women always uphold and promote the spirit

of patriotism, solidarity, dynamism and creativity (Doan Van Truong, 2020). Vietnam's health

system is divided into central, provincial and communal levels, including public and private

health. The commune health station is the first unit to reach out to people in the state health

system. The use of health care services by the people depends on their needs and affordability.

Some studies have shown that factors such as economic characteristics, geographical distance,

quality of health services, and socio-cultural characteristics are factors that influence the

behavior of access to health services citizen.

Factors Affecting Access to Reproductive Healthcare Services of Ethnic Minority Women:

Evidence in Vietnam


McKinn, S., Duong, TL, Foster, K. et al. (2017) also point out that ethnic minority women

face challenges including differences in language and gender with health experts, time

constraints and reluctance to ask questions (McKinn, 2017). Hoang Van Minh, Bui Thi Thu

Ha, Nguyen Canh Chuong and Nguyen Duy Anh (2018) using data from the MICS Survey in

Vietnam between 2000, 2006, 2011 and 2014 show that: the percentage of women received

Reproductive and health care services by skilled medical staff are mostly from highly

educated people, Kinh ethnicity, have good economy and live in urban areas (Hoang Van

Minh, 2018). Goland, E., Hoa, D.T.P. & Malqvist, M (2012), analyzing data from the MICS

survey conducted in Vietnam in 2006, showed that ethnicity, household wealth and education

were all significantly associated with antenatal care coverage and skilled birth attendance,

individually and in synergy. Within the group of mothers from poor households ethnic

minority mothers were at a three-fold risk of not attending any antenatal care and six times

more likely not to deliver with skilled birth attendance (Goland, 2012).

In the indigenous knowledge system of ethnic minorities in general, traditional knowledge

and experience on women's and children's health care play an important role. The author Vu

Truong Giang's research provides social perceptions about the practices of reproductive health

care for women and children. The author lists the abstinence practices during pregnancy,

childbirth, some traditional remedies, the practices of postnatal care, offerings to newborn

babies, the duration of stay, medical treatment by rituals.

Most of the studies mentioned above consider the practices as a key point for ethnic

minorities' access to health services. Each project has its own approach and view. From a

medical perspective, the authors pay attention to cross-sectional investigations, analyzing

quantitative data to make general figures related to medical indicators. From an ethnological

perspective, considering ethnic factors, residence areas, ethnic traditions to consider health

care behaviors of ethnic minorities ... However, these are all considered scientific bases. value

for later research.

3. RESEARCH METHODS

3.1. Model Research

Figure 1 Research model

(Source: Synthesis of author)

- Characteristics of ethnic

minority women (Age,

literacy, occupation)

- Cultural characteristics

+ Spiritual culture

+ Folk knowledge

- Socio-economic

conditions of the locality:

Facilities; Health

resources

Behavioral access to reproductive health services of

ethnic minority women

Prenatal

care Postpartum

care

Family

planning



3.2. Sampling Method

3.2.1. For in-Depth Interviews and Focused Discussions

We used qualitative research, interviewed local health workers (n = 10), in-depth interviews

and focused discussions with ethnic minority women (n = 40), in-depth interviews with local

officials (n = 5). In addition, we use secondary data from a national study on the current status

of socio-economic development of 53 ethnic minorities in Vietnam (2017).

20 health workers interviewed were selected from 10 commune health stations in 4

districts of 2 provinces. 40 ethnic minority women participating in the survey were also

deliberately selected including: pregnant women, women raising children under 5 years old.

This group of women was also deliberately selected according to the criteria: ethnicity, level

of access to health services (using family planning methods, giving birth at health stations,

periodic antenatal care). Table 1 Structure of survey sample

Grassroots health workers n = 20 Ethnic women n = 40

Gender Age

Male 6 < 20 8

Female 14 20 – 24 20

Age (22 – 60) 25 – 30 7

< 25 2 31 – 35 5

25 – 34 4 Folk

35 – 44 11 Cong 10

> 45 3 Si La 10

Qualification La Hu 10

Doctor 4 Mang 10

Nurses / Doctors 3 Academic level

Midwives 13 Unlettered 14

Local officials Primary school (1-5) 19

Male 3 Junior high school (6-9) 6

Female 2 10 + 1

(Source: The survey data of the study)

3.2.2. For Semi Structured Interview

The sample structure is as follows: Table 2 Sample structure

Folk The scale Ratio (%)

La Hu 33.3

Cong 22.2

Mang 22.2

Si La 22.2

Academic level Unlettered 42.7

Primary school 44.4

Junior high school 11.1

High school 1.5

Intermediate or higher 0.02

Job Agriculture 90.7

Self-employed/Employed 8.0

Business 0.8

Other 0.5

Standard of living Poor 83.5

Medium 11.5

Wealthier 5.0

Wealthy 0.0



Evidence in Vietnam


Samples were selected in Dien Bien and Lai Chau; in Lai Chau, a survey of La Hu and

Mang groups was conducted; in Dien Bien, a survey of ethnic groups of Cong and Si La was

conducted.

3.3. Data Collection Methods

We focus on understanding the ethnic cultural characteristics in relation to local socio-

economic conditions, which helps us ensure an objective view in the research when

acknowledging. cultural diversity of ethnic minorities in the context of integration.

As follows:

(i) In-depth interviews: 20 health workers, 40 ethnic minority women (Cong, Mang, La Hu, Si

La)

(ii) Semi-structured interview: 450 ethnic women

(iii) Group discussion: 04 meetings with 4 groups of women: Cong, Mang, La Hu and Si La.

Interviews were conducted with the assistance of an interpreter (from Vietnamese to local

languages and vice versa). Because they are not fluent in Vietnamese, they must go through

the interpretation of the local government representatives and village midwives. Interviews

are recorded and recorded in writing.

4. RESULTS AND DISCUSSION

In order to generalize the influencing factors, we interviewed grassroots health workers and

EM women groups about information related to why women use/not use reproductive health

services. Reproductive health care for women is an important part of health policies in

particular and policies for ethnic minorities in general. Because this issue is closely related to

children's health and poverty reduction effectiveness. The results of secondary data analysis

and group interviews show that the three situations of accessing reproductive health care

services in ethnic minority areas are as follows:

(1) The proportion of women attending antenatal care at health centers is not high. Among the

surveyed women, the percentage of pregnant women who had ANC at least once during

pregnancy was very low, respectively La Hu (8.99%), Si La (23.08%), Cong (36.94%). And

the percentage of women having 3 or more antenatal care visits during pregnancy accounts for

less than 10%. This also partly explains why these ethnic groups have the highest mortality

rate among children under 1 year of age (Chart 2).



Chart 1 Use health insurance Chart 2 Access to health care

Although recommended by health professionals for routine visits during pregnancy, many

women are unaware of the importance of preventing illness, they only seek medical attention

when encountering a really important problem.

We will go to the clinic if we have a stomach ache or if we are seriously ill, we will not go

there if we are normal (La Hu, group discussion of pregnant women).

(2) Home births are common among ethnic minorities. Only about 64% of births have been

performed at health centers out of the total ethnic minority. For the surveyed women, the rate

of giving birth at a health station is less than 30%, especially for La Hu ethnic group, Only

12.95% of pregnant women gave birth at a health station or have health workers giving birth

at home (Table 3).

I just want to check if there is a problem with my child. The doctor told me my baby was

healthy, so I gave birth at home because I thought he was okay (Cong ethnic group, in-depth

interview with women raising children).

This difference may be partly explained by the distance from home to the clinic/hospital.

Ethnic groups with a high rate of giving birth at a health facility are often closer to health

centers/hospitals than other ethnic groups. While the average distance to medical stations of

ethnic minorities is 3.8 km; Mang people is 15.5 km from the nearest medical station and 33.6

km from the hospital. Similarly, La Hu people are 9.1 km and 39.2 km.

(3) The contraceptive prevalence rate among ethnic minorities is still high, especially among

the Mang (51%) and the La Hu (37%), the Cong (35) %) and the Si La (27%). More than 50%

of Mang women do not use contraception, which is one of the reasons why the fertility rate of

Mang women is the highest among 53 ethnic minorities in Vietnam.

We women must find our own contraceptive method. Men do not accept condoms because

they do not like them (Si La ethnic group, group discussion of women having children, over

35 years old).

4.1. Several Factors Affecting Ethnic Minority Women's Access to Health

Services

4.1.1. Family Economy

The current work of ethnic minority groups is mainly in agriculture and forestry. The rate of

employment in industry, construction and services is limited, not exploiting the potential of

tourism and local services. The average income per capita is about 1.1 million

VND/person/month, less than half of the national average. Secondary data analysis showed

that the ethnic minorities in the survey group have very low income, averaging less than

632,000 VND/month/person, including ethnic groups such as Mang, La Hu. Accordingly, the

two ethnic groups of Mang and La Hu have poverty rate up to over 70%.

Table 3 Correlation between household economic conditions and level of interest in reproductive

health status of ethnic minority women (%)

Economic conditions The level of interest in reproductive health care

Very interested Care Do not care

Poor 0.4 22.5 77.1

Medium 9.2 22.4 68.4

Wealthier 43.5 7.6 49.4

Wealthy 50.0 0.0 50.0

* Statistical significance level p = 0.000



Evidence in Vietnam


Examining the relation by 2 tau-b quantities of Kendall, gamma of Goodman and Kruskal,

we found a relationship between the level of concern about reproductive health status and

family economic conditions (p = 0,000).

Basically, the ethnic minorities in the area get their income from shifting cultivation,

hunting, gathering as their main source of income. With the characteristics of self-sufficiency,

closed-up, very low exchange rate, outdated farming techniques, crude production tools, so

labor productivity is low. People practice shifting cultivation often lack of food. Women do

the same jobs as men, but more gently, so the income is not worth much, sometimes it is not

enough to eat daily (Male, Ethnic Minority Leader, Lai Chau)

Gender discrimination, early marriage among girls, obsolete perceptions about the role of

women in the family (doing housework, taking care of the family, etc.) have led to the main

work of women. These activities do not require skills, bring very little income (gathering,

farming, forestry, catching small animals,...).

Table 4 Correlation between economic conditions and ethnic minority women's access to reproductive

healthcare services (%)

Condition

economy

Ultrasound

during

pregnancy

Vaccination

during pregnancy

Place of birth and postpartum care

District Hospital Clinics At home

Poor 6.2 4.6 2.3 92.3 5.4

Medium 10.5 7.9 4.3 60.5 34.2

Wealthier 15.2 17.4 5.3 72.8 21.7

Wealthy 50.0 50.0 50.0 50.0 0.0

Statistical

significance level p = 0.042 p = 0.003 p = 0.000


With a statistical significance level of p <0.05, family economic characteristics are the

most influential factor in ethnic minority women's decision to use reproductive health

services. A group of women with moderate and poor economic conditions mainly use

available health services locally (commune health stations, home births).

The majority of households are in the poor group. Motorbikes are considered as a means

of transportation, supporting people in goods exchange, medical examination and treatment

but still the households in the survey group do not have this type of vehicle. The statistics

show that the Cong ethnic group has the highest percentage of households having a

motorbike, accounting for 71.9%, the remaining ethnic groups account for 34.5 - 64%, of

which the La Hu enic group accounts for a low percentage (34.5%). The absence of transport

leads to limited access to health services, due to the great distance.

I had to walk down the mountain and it was very cold and it hurt when I walked back

home after birth. If I had another baby, I would give birth at home because I didn't have

enough money to rent a motorbike (Mang woman, 34 years old, has 1 child).

Research results show that the costs (both direct and indirect) of health services are a

barrier to full access to services. Although health insurance has paid for, many ethnic minority

women do not fully understand the conditions for health insurance and how it works. Health

services also include indirect costs not covered by health insurance, such as transportation

costs such as taxi, medicine, meals, accompanying expenses and unofficial expenses ( or

envelopes) for health care workers to get good service and care. These indirect costs are

beyond the affordability of many ethnic minority families.



Going to the hospital we would have to buy many things because we could not bring

things at home, had to rent a motorbike taxi, we had no money, we were afraid of being

cheated (La Hu ethnic women)

The women interviewed said they were 'too busy' and 'did not have time' to go to the

commune health station because they had to work in the field to make sure their daily meals.

In some communes, women work in the field until delivery and they feel the need to return to

work immediately after birth due to both financial pressure and family desires. For many

women, the distance from home to health facilities is too far, meaning that if they go for

antenatal care, they lose 1 day of labor. This explains why some women go to the health

center only once or twice for antenatal care. In addition, some women are also concerned that

if they give birth in a health facility, they may have a caesarean section and that it will take

them time to recover.

Even when we had the money, we didn't go to the hospital. When we were born at home,

we could do normal housework, except for very hard work, but if we went to the hospital we

would be cut, it would be very painful, the cut would heal and be very painful (Cong ethnic

women, in group discussion, have children under 5 years old).

Table 5 Correlation between family economic conditions and the use of family planning measures (%)

Economic conditions Measures

contraception

Pregnancy check

Pediatric recurring Total

Poor 70.6 29.4 100.0

Medium 95.0 5.0 100.0

Wealthier 78.6 21.4 100.0

Statistical significance level p = 0.138


Statistics show that there is no relationship between family economic conditions and the

use of family planning measures. Because family planning in ethnic minority areas is carried

out on the basis of state policies and communal health policies (Decision No. 75/2009/QĐ-

TTg and Circular No. 07/2013/TT-BYT) is considered as an appropriate approach, but the

effectiveness is not high due to low remuneration; personnel changes; inadequate

qualifications and training, but also difficulties in terms of policy scope.

4.1.2. Some factors belong to individual characteristics of ethnic minority women

Literacy

The rate of Vietnamese language proficiency is still very low. Especially, there are ethnic

groups with more than half of illiterate population. On average only 79.2% of ethnic minority

people can read and write Vietnamese. The survey group has the lowest literacy rate such as

Mang, La Hu. The survey area has a very high rate of illiterate people of working age. This

leads to underemployment for people of working age; poverty status; limited access to social

services, including health services. Table 6 Correlation between educational attainment and reproductive health care access by ethnic minority

women (%)

Academic level

Ultrasound

during

pregnancy

Vaccination

during

pregnancy



Unlettered 18.2 3.9 0.0 83.3 16.7

Primary school 7.9 27.3 7.1 89.3 3.6

Junior high school 2.8 4.2 11.1 85.2 3.7

High school 9.3 8.0 18.4 78.4 0.5

Intermediate or

higher 31.2 14.7 77.3

19.0 0.0


Evidence in Vietnam


Statistical



Education is a factor influencing ethnic minority women's access to reproductive health

services. Well-educated women often restrict their birth choices at home. Basically, they

choose to give birth at a health station because of geographical distance. In addition,

restrictions on Vietnamese communication make women afraid to go to public administrative

places where communication is needed.

The facilities are fine but health workers have difficulty communicating with ethnic

women if they do not speak Vietnamese. Therefore, ethnic minority women do not want to go

to the clinic because the health workers say they do not understand and vice versa (In-depth

interview, local leader, Ha Giang).

Age

The selected group of women is mainly of reproductive age. Age group from 21-40 years old

accounts for 57.6%, age group from 41-50 years accounts for 20.7%. Survey results show that

the level of access to reproductive health care varies by age group, but this does not confirm

that age is related to ethnic minority women's access to this service.

Table 7 Correlation between age and ethnic minority women's access to health care (%)

Age

Ultrasound

during

pregnancy

Vaccination

during

pregnancy



< 20 years old 90.5 95.2 83.3 16.7 0.0

21 – 40 years old 90.5 83.5 14.3 85.7 0.0

41 – 60 years old 87.2 15.4 20.0 20% 60.0

Statistical



The survey showed no correlation between age and ethnic minority women's access to

health care. The majority of women surveyed chose the health clinic as the first place to visit,

during and after delivery. Because they think that giving birth is a natural thing for women, as

long as the clinic has a midwife. There is still the phenomenon of giving birth at home, but

this rate is not much, mainly among women who live far away from health centers, have

difficult transportation or because their families have no money.

Ethnic

The La Hu ethnic group has the lowest rate of antenatal care and giving birth at health centers

among surveyed groups. This is related to language and social barriers. Among the four ethnic

groups surveyed, the percentage of La Hu people speaking and writing in Vietnamese is only

34.4%, while the percentage of the Cong, Si La and Mang ethnic groups are 67.2%, 63.7%,

respectively 43.8%.

Table 8 Correlation between ethnicity and proportion of women accessing reproductive health care

services (%)

Folk More than one antenatal examination

at health facilities

Women to health facilities

give birth

La Hu 9.1 4.5

Mang 34.9 13.7



Si La 25.5 11.2

Cong 38.3 19.9

Statistical significance level p = 0.034


In addition, because La Hu ethnic people reside on high mountains, the distance from home to

remote health stations, their lives depend mainly on hunting, gathering and small-scale animal

husbandry, creating barriers in access to reproductive health care.

Geographical Distance

The survey results also show that the distance from home to health facilities is generally quite

far. Ethnic minorities are often distributed in mountainous areas, highlands, lack of

infrastructure, difficult transportation, and distance from hospitals. Being far from medical

centers is one of the reasons leading to the limitation in access to medical examination and

treatment services.

Going from home to the clinic too far, we were afraid to give birth on the way (Si La

ethnic women, group discussion)

Ethnic groups near health clinics have a higher rate of giving birth at health centers than

other ethnic groups. For example, while the average distance to EM clinics is 3.8 km; Mang

people are 15.5 km from the nearest health center and 33.6 km from the hospital. Similarly,

La Hu people are 9.1 km and 39.2 km.

If I get pregnant again, I want to give birth at home. My house is about 2 trees from the

commune health station but the road is very difficult. My parents-in-law allowed me to go to

the medical station, but I didn't want to go, especially when the weather was cold (Cong

ethnic woman, 28 years old).

4.1.3. Culture - Customs, Traditions - Folk Knowledge

For ethnic minority women, they prefer midwives from village birth attendants or family

members if the birth is not unusual and does not require the care of professional health

workers.

At prenatal check-ups, all women know whether they will give birth easily or have a

difficult pregnancy. If the birth is easy, we will give birth at home (Group discussion, La Hu

ethnic women).

In terms of psychology, giving birth and taking care of at home also help mothers feel

more secure when they and their children are supervised and protected by family members. In

addition, in remote areas, with difficult economic and geographic conditions, giving birth at

home is a reasonable choice.

Table 9 Reasons why ethnic minority women do not go to health care services (%)

Reason La Hu Cong Mang

Can be cured by folk methods 50.0 46.9 24.4

The cost of examination is high 12.4 27.1 6.7

Medical facilities far from residence 22.9 9.1 46.3

Attitudes of medical staff 14.7 4.4 15.9

The condition is not serious 0,0 12.5 6.7

Total 100.0 100.0 100.0

Statistical significance level p=0.000


Some of their preferences are not implemented or allowed at health facilities. Some

women report that they prefer to squat on a low chair during labor or kneel on the floor while

holding a towel hung on the rafters; Meanwhile, if giving birth at a health station, the supine


Evidence in Vietnam


position at birth is required. Following the customs of some ethnic minorities, families will

bury the placenta around the house especially if the child is a boy. However, if they give birth

at a health facility they will not be able to bring home pregnant vegetables.

Contraceptive prevalence rates among ethnic minorities are still high, especially among

Mang and La Hu ethnic groups. Survey results have shown that up to 23% of married women

do not use any contraception. The main reasons for not using contraceptives are given as:

unnecessary (73.9%); fear of side effects (9.5%); lack of information on contraception and

family planning (4.5%); fear of infertility (3.6%); There are no contraceptive methods

available (2.3%); reasons for religion and belief (2.1%); Costs and distance to clinics (1.0%).

Health workers may not be familiar with the cultural characteristics, beliefs, and traditions

of ethnic minority women. Moreover, rules such as women being forced to lie on their backs

during childbirth, or family members not allowed to be in the maternity room during labor

may also affect access and access to ethnic minority women's health services.

5. CONCLUSIONS AND RECOMMENDATIONS

Based on the results of the analysis, we conclude the following conclusions: The low rate

of access to and use of health services by ethnic minority women is often due to a range of

socio-economic factors and culture from service users, including: family economy;

academic level; facilities and cultural elements. In which, family economic factors and

facilities are the factors that have the most impact on the decision to use medical services

in reproductive health care of ethnic minority women. Health services that are not

appropriate for the local context or do not meet the specific needs of local people often do

not attract users.

From the results of the research and the reality in the mountainous areas of Northern

Vietnam, we propose some recommendations to improve the access to reproductive health

care services of ethnic minority women as follows: (i) need to provide higher quality medical

services than is available. Health services need to be safe, effective, reasonable and equitable

based on the customs, cultural values and diverse desires of different ethnic minority

communities. Local health services need to be improved and implemented in a humane,

respectful and supportive environment; (ii) The Government needs to ensure that ethnic

minority women have access to health insurance and understand how to use health insurance;

(iii) Guidance on the use of insurance is needed to facilitate health insurance access. Many

ethnic minority women are concerned about the ability to pay for services (including direct

and indirect costs) so increasing access to affordable services is essential.

ACKNOWLEDGMENTS

The article is the product of a state-level scientific project: “Basic and urgent solutions to

improve the effectiveness of the policy of conservation and developing of ethnic minorities in

our country today”, code CTDT 42.18/16-20.

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