Feature Story

08 July 2010

When Girls Don’t Count as Much as Boys: Pre-natal Sex Selection in Viet Nam

YEN HA VILLAGE, Viet Nam — May 19 was a special day for Thuy and her husband Nghe. Their son was one month old and, as dictated by Vietnamese tradition, they invited their relatives for a party. It was a big reunion, with more than 15 people celebrating the arrival of the new baby. And because it was a baby boy, after three girls, the celebration was all the more heartfelt.

Son preference in Viet Nam has deep cultural roots. It is linked to traditional Confucian beliefs, which are predominant in the country, as well as practical concerns. A popular Confucian saying goes, “With one son you have a descendant, with 10 daughters you have nothing.” This traditional preference for sons, coupled with increased access to sex selection technology, have increased pressure on smaller families to fulfill their wish for a son. The resulting skewed gender balance could have severe social consequences.

After three baby girls, the couple finally has a boy.
Photo: UNFPA/Viet Nam

Male descendents perpetuate family lineage

The prevailing patriarchal system requires male descendants to perpetuate the family lineage across generations. Moreover, men are considered necessary for old-age security. Parents are usually supported in their later years by their sons, whereas girls move away to their husband’s family when they get married, a tradition that puts a premium on sons.

In addition, sons confer greater social status. A family without sons may be looked down upon by the extended family. “After the third daughter, we planned to have a son,” says Thuy. “We were scared that if we had only daughters nobody would take care of us when we get older.”

Steadily increasing access to affordable prenatal sex determination has allowed couples to more methodically pursue their desire for having sons, leading to remarkable sex ratio at birth imbalances across much of the country. “When I was some months pregnant I went to the doctor for an ultrasound,” Thuy explains. “I really wanted to know the sex of the baby. If it was another girl, I would have had an abortion. Luckily it was a boy.”

Thuy and Nghe live in a small village in Bac Giang province in the northeastern part of the country, where ultrasound is not normally available. But people can easily travel to district and provincial medical facilities for the service. “We decided to go to the provincial capital, Bac Giang City, as doctors are more qualified
there. For 80,000 Vietnamese dong [slightly more than $4], we got the ultrasound.”

In Viet Nam, ultrasound and abortion services are legal and readily available. However, the identification of the sex of a foetus and abortions based on that information are illegal. Nevertheless, these services are available in private clinics.

“We knew it was illegal to select the sex of the baby, but we were determined, so we went to a private doctor,” Thuy adds.

In rural areas, many couples still use traditional methods to select the sex of the foetus. One of the common strategies is the consumption of certain foods – such as salted fish, bean sprouts and pumpkins, in order to have a son.

Bon with her mother-in-law and her children.
Photo: UNFPA/Viet Nam

In rural areas, couples may try traditional methods of sex selection

Bon lives in the same village as Thuy, and she also has three daughters. Next year Bon and her husband, Chung, plan to have a boy. “It is up to my son to make the decision, though,” clarifies Chung’s mother who lives with the couple. In any case, Bon and her husband, who are both farmers, have never heard about ultrasounds. They plan to have a son in the traditional way. “First we will go to the fortune teller to check the best date for having a son and then we will visit a traditional doctor in order to take medicines and herbal remedies, such as thuoc bac, to have a baby boy,” she explains.

Gender imbalance is rapidly rising

According to the 2009 population and housing census, Viet Nam’s sex ratio at birth (SRB) imbalance is estimated to be 110.5 male births per 100 female births. As recently as 2000, the ratio was still at what is considered a normal level (106.2). In Bac Giang province, where Thuy and Bon live, SRB has reached 116.8, ranking it fourth in the list of provinces with the highest SRB, after Hung Yen (130.7), Hai Duong (120.2) and Bac Ninh (119.4).

Christophe Guilmoto, a demographer who is carrying out the analysis of the census data on SRB with the support from the General Statistics Office and UNFPA, the UnitedNations Population Fund, considers that the new figures available are key to better understanding the sex ratio at birth situation in Viet Nam.

“Before we only had information from smaller surveys. Having a larger sample size provides the robust and detailed evidence to support effective policy interventions,” he said. “Furthermore, we now have more reliable regional data. For example, we know that birth masculinity is significantly higher in some regions, such as in the Red River Delta,” he explains, adding that the census is also important to understand when sex selection takes place in the course of a family’s formation.

“In Viet Nam, sex selection is already visible for the first and second births, although it is higher for the third or later births. In other countries, it is usually more the second or even the third birth which is affected by discriminatory practices,” Guilmoto says.

Based on the information provided by the census, Guilmoto has come up with a series of population projections. In his ’worst case’ scenario, in which no interventions are undertaken, SRB will rise to 115 by 2015 and stay constant. His more optimistic scenario, in which there is a concerted attempt made to reverse current trends, indicates that the imbalance will rise to 115 by 2020 and then fall back to 105 by 2030.

Implications for society

The exact consequences on society of extreme sex ratio imbalances are difficult to predict, but studies based on other nations suggest that there could be an impact on the family structure. “The patriarchal system prevailing in most of Viet Nam requires male descendants, but the difficulty of surplus men getting married 20 years from now may jeopardize the feasibility of patrilineal transmission,” explains
Guilmoto.

And a shortage of women may actually diminish their status. “Women would face more pressure to marry at a younger age, perhaps losing opportunities for education and formal employment, and such an imbalanced ratio could also fuel the sex work trade, as well as trafficking,” says Bruce Campbell, UNFPA Representative in Viet Nam.

Addressing the issue

“Viet Nam’s SRB is a demographic manifestation of profound son preference,” says Campbell. “Therefore, actions are needed, specifically more behaviour change communications, to promote gender equality and improve women´s status in society.

“The country is moving in the right direction,” he added, “but it is important to do even more to involve leaders, policy makers, and mass media and persuade them to promote gender equality messages. Social security schemes for the elderly could also be strengthened so that families are not entirely dependent upon sons in their old age,” adds UNFPA Representative.

In addition to supporting the analysis and dissemination of the census, the UN has carried out other surveys and research to provide the evidence base for policy development. Last year, for example, UNFPA published a report titled “Recent change in the sex ratio at birth in Viet Nam.A Review of evidence”. All these efforts in collecting and analyzing SRB data along with the advocacy work done to ensure the issue is on the policy agenda are already having an impact as the Vietnamese Government responds to the problem.

For instance, the General Office for Population and Family Planning is implementing a pilot programme to reverse the SRB trend in 20 provinces. Sex ratio at birth has also been one of the key concerns addressed by the upcoming National Strategy on Population and Reproductive Health 2011-2020.

“The Government has committed to gender equality and is a signatory of international treaties such as the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW). At the national level, we have recently passed the Law on Gender Equality and have outlawed sex identification and sex selective abortion. We are determined to curb the existing sex ratio at birth imbalance and will continue to implement behavior change communication activities in order to prevent couples from accessing illegal practices,” said Nguyen Ba Thuy, Vice Minister of Health.

These are certainly encouraging steps but more needs to be done. “The more we wait, the stronger the trend and the more difficult it will be to reverse the accumulative impact of SRB in the population structure,”concludes Guilmoto.

— Maria Larrinaga