Making Informed Choices: Providing Youth Friendly Reproductive Health Services in Viet Nam

HANOI, Viet Nam – “So, how many kinds of love do we know?” The actor looks at the audience, some 70 young wide-eyed Vietnamese students crammed together in a classroom in one of Hanoi’s overcrowded junior high schools, located in the centre of the capital.

This is clearly not a household subject. Girls giggle and boys look away. One girl has the courage to stand up: “love for money.” The ice is broken and others join in: “love for children,” “love within marriage.”

The actor and his colleagues, a peer education theatre group, decide to develop a story based on the “love for money” idea. They move to another room, returning in 15 minutes with a play crafted around that theme. The audience reacts to what is happening on the improvised stage by clapping and shouting comments. The play has an open end and the audience is invited to provide alternative solutions to the situation.

The young actors are trained in theatre techniques and improvisation, and in tackling issues related to reproductive health and rights. Reproductive health issues are the main focus of their plays, which they perform twice a week in various junior high schools around Hanoi. The whole enterprise is the result of a productive partnership between a Dutch/Vietnamese NGO and the Educational Board of Hanoi.

Once the play is over, the actors remain to answer questions. Students linger for some time, then approach the actors with questions on reproductive health, or to seek their help in solving personal problems that are scarily similar to what was featured on stage.

The actors refer students to appropriate services or counselling. There is only one place in Hanoi where young people can go for answers on reproductive health questions and for services: The Reproductive Health Centre for Young People, a UNFPA-funded initiative managed jointly by the Youth Union and the Viet Nam Family Planning Association. UNFPA’s activities in Viet Nam are based on the ICPD Programme of Action, which calls for increased efforts to meet the reproductive and sexual health needs of adolescents and young people by 2015.

Located on a busy street next to a high school, the reproductive health centre has a discreet, non-descript entrance. It can also be accessed through an adjacent bookshop, for those who do not want to risk being seen visiting the facility.

According to Minh, a 19-year-old girl who has come to the centre for counselling and family planning services, Hanoi is one big “gossiping community”, and she does not want anybody to know she is coming here. “If you are seen coming here, people think you are sexually active and that you are a slut,” she says matter-of-factly.

The centre is part of an EC/UNFPA programme that helps improve the reproductive health of young people. More than 52 per cent of Viet Nam’s growing population is under the age of 24; 21% are between the ages of 15 and 24. And research shows that young people are not well informed on reproductive health issues.

Viet Nam is a rapidly changing society. The country’s total fertility rate has dropped dramatically over the past three decades, from an average of five children per women in 1979 to just under 2.5 today. At the same time, the contraceptive prevalence rate has risen: currently 55% of women aged 15-49 use a modern family planning method. The education gap between boys and girls continues to narrow as well. In 2001 68% of all boys were in secondary school, compared to 61% of all girls. Similarly, another positive indicator of change is the age of first marriage: it is now 23 for girls, compared to 18 in the late 1970s.

As part of its approach to achieving the goals of the ICPD Programme of Action, the government of Vietnam launched its first National Strategy on Reproductive Health Care in 2001. This comprehensive strategy, among other things, emphasizes: maternal health, family planning, the reduction of reproductive tract infections, along with STIs and HIV/AIDS and adolescent reproductive health.

Vietnamese society is in general not very judgemental about young people’s sexuality, but there are strong taboos about discussing it openly. None of the actors in the theatre group, for instance, had received any information on reproductive health from their parents or other adults until their exposure to UNFPA’s training workshops. The result is widespread misinformation, an alarming rate of sexually transmitted infections, and many confused young people with no clue on how to deal with their sexuality.

The atmosphere at the centre is warm and welcoming. There are flowers and information materials on the table, and staff members encourage visitors to speak their mind. “Counselling is the most important part of our work, giving information and helping young people to deal with problems,” says the Centre’s enthusiastic director, Dinh Thi Hong Minh. Not surprisingly, the most frequently asked questions at the centre concern adolescent development, especially relationships.

The centre offers a complete array of contraceptives and medical services. Although the Vietnamese government wants to continue the downward trend in population growth rates by implementing a national family planning policy, most general health facilities do not cater to the special needs of young people.

The subject of the theatre play was no coincidence. In Viet Nam, the relationship between love and money is something many young people have to deal with. Nineteen-year-old Minh emphasizes the importance of the counselling services: “You do not talk about these issues with friends, as you are always afraid that they would tell others. I had a boyfriend for two years without anybody knowing about it,” she says.

" I am trying to set up a group of HIV positive women with the help of the centre. I am also warning other young people. I got AIDS from my husband who has left me. My family ignores the fact that I am ill. This is the only place where I can talk about it. "

--Hue, 22 years old

The centre also offers HIV tests and provides services for HIV positive young people. Hue, 22, has the courage to talk openly about living with AIDS, which is almost unknown in Viet Nam. “I am trying to set up a group of HIV positive women with the help of the centre,” Hue says. “I am also warning other young people. I got AIDS from my husband who has left me. My family ignores the fact that I am ill. This is the only place where I can talk about it.”

Hue is a tiny young woman, but she is strong and convincing when speaking to a group of young people about the need to use condoms and other HIV/AIDS related issues. Young people in the group stare at her with horror. For all twelve of them, this is the first time that they have ever discussed AIDS or met someone who has it.

The reproductive health centre caters to young people in Hanoi, but Viet Nam has a large rural population of adolescents. In rural areas adolescent pregnancies constitute 7% of the total number, compared to just 1.6% in urban areas. The EU/UNFPA programme is working with the Women’s Union and the Youth Union to reach this important segment through information campaigns aimed at local leaders, health personnel and teachers.

One vehicle the campaign uses is called “Window on Love,” a radio show that is broadcast countrywide every Sunday morning. Its format is simple and effective. After the show, listeners phone in to talk to any of the six counsellors waiting to answer queries. Most questions are answered on the spot, but some are selected for discussion on the next show. Listeners are also encouraged to send letters to the editors of the programme.

On this Sunday morning, phones are ringing constantly and the coffee cups of the six counsellors remain untouched. The questions fall into two categories: medical information and relationship problems. The public health structure of Viet Nam covers the whole country, and most people do have access to it, but the questions fielded by the radio show suggest that there is a lack of confidence in the skills of health personnel. Many of the questions could be answered by a nurse, but people seem to be too shy to ask them.

The radio show is very popular, and it generates lengthy discussions within families. Minh, the adolescent client at the youth health centre, says: “I was listening to the programme at my grandmother’s place. My father did not want to listen to it, but she did and we talked about it.” That was how Minh found out that she was not the first young person to struggle with issues of sexuality and relationships. “My grandmother got her first child before she was even married,” points out Minh. “But I know she is happy that I have more information than she ever got, and that I can make my own informed choices.”

--Joke van Kampen