Family Planning in Vietnam: Fighting inequality is not enough

When I first went to Vietnam in 1992, the population of that country was 68.4 million people, or about four million more than the Philippines.   Traveling through Songbe Province, where I was inspecting Oxfam-supported projects, was like being in the Philippine countryside in many respects, especially when it came to encountering large numbers of very young children in rural communities.

This was a time of transformation in Vietnam, with the economy shifting from classical centralized socialism to one that had a greater role for the market.  The early 1990’s was also the time that, with the government recognizing that large families, especially in rural areas like Songbe, threatened to foreclose any possibility of sustained economic growth, family planning was set in stone as official policy.  In the historic words of the Population and Family Planning Strategy to the year 2000, the objective of the program was to “have small, healthy families in order to make favorable conditions to have a prosperous, happy life.”

Contrast

Nearly 20 years later, in both the countryside and the cities, children are less ubiquitous, and they certainly look better fed and better clothed than they were two decades earlier.  In Hanoi, where I was last month, one sees few of the armies of street children that populate Manila and other urban centers in our country.

In terms of stabilizing the population, the family planning program has been a big success.  In 1989, Vietnam’s population, at 64.7 million was bigger than the Philippines’ 60.1 million.  By 2010, the situation was reversed, with 93.6 million Filipinos to only 88.2 million Vietnamese.   Absent the family planning program, demographers estimate that Vietnam would now have 104.4 million people.

18 million less births meant that Vietnam could devote more resources to upgrading the quality of education, alleviating poverty, and raising investment.  The country registered a growth rate of 7.2 per cent per annum in the period 2000-2010.  One per cent of that figure, according to Pham Van Chuong, a central figure in the country’s population management effort, is attributable to the family planning program.  This is critical since developing countries have to grow by at least 6 to 7 per cent a year to achieve sustained growth and stave off poverty.  By 2010, average per capita income had tripled in one decade—a reflection of how economic growth was outpacing the population growth rate.  In contrast, the Philippines, burdened with a continuing high population growth rate and a low economic growth rate, could only double its per capita income.

Vietnam’s demographic bonus

It was a remarkable performance for a country that was mired in war while the Philippines was one of the more advanced Asian economies in the 1950’s and 1960’s.  Some estimates now put Vietnam as overtaking the Philippines in GDP per capita by 2015.

The disparity will increase owing to Vietnam’s entering the so-called “demographic dividend” period.  This is a period where the proportion of people of working age (15-59) relative to the rest of the population is high, at some 50 per cent and above. This means a relatively small dependent population of people below 15 and above 59 – which translates into, among other things, a bigger part of economic production being invested instead of being consumed, resulting in faster economic growth.  This “window of opportunity” arrived in 2010 and is expected to last till 2040, when the dependent population will rise to some 50 per cent and above.

In contrast, given its current fertility trends, the Philippines is not expected to enter its demographic bonus period until 2030, by which time Vietnam will have pulled away in economic terms.

Why did Vietnam succeed?

What accounted for Vietnam’s success?

First of all, there was always a sense that abolishing inequality, which is the primordial objective of revolutionary movements like the Viet Minh, is not enough to promote social welfare.  Even when the country was still North Vietnam and fighting to incorporate “South Vietnam” in the period 1961-75, family planning was promoted, aiming at smaller sized family with three children, longer birth spacing, and delayed births in order to achieve “better maternal health, good nurturing of children, as well as happiness and harmony in the family,” as one early family planning guidebook described it.

Second, national support for the program was consistent and deepened over time.  Following the expulsion of the US in 1973-75, family planning became a central concern of the now unified nation, with the National Committee for Population and Birth Control established in 1984.  In 1993, the program was institutionalized in both government and civil society, with the landmark document referred to earlier, Population and Family Planning Strategy to the Year 2000, setting the goal of persuading families to limit their size to “two children [on the] average in order to stabilize the population size by the middle of the 21^st century.”

From 2003 on, the focus has not only been extending the reach of family planning services but improving their quality and “improving the quality of the population.”

Third, family planning has been extremely well-organized, being carried out with that flair for comprehensive organization with which the Vietnamese conducted their war for national liberation against the French and the Americans.  Three interrelated organizational structures have been used to promote family planning: the communist party structure, the governmental structure, and the mass movement.  To promote family planning as a mass, grassroots movement, the Vietnam Family Planning Association (VINAFPA) was set up in 1993.

The battle for effective family planning has been waged like a political campaign, and the results have been impressive. The population growth rate is down to 1.2 per cent, compared to the Philippines’ rate of 2.04 per cent. The total fertility rate (TFR), or the average number of children per woman of reproductive age, dropped from over 6 in 1961, when the program first began, to 2.1, a figure that demographers tag as “replacement level fertility.”

The Philippines’ TFR is much higher, at 3.5.  The contraceptive prevalence rate (CPR), or contraceptive use among women of reproductive age is almost 80 per cent, compared to 51 per cent in the Philippines. Seven out of ten women of reproductive age use modern methods like the pill, injectables, or intrauterine devices (IUDs), while one of ten resorts to less reliable traditional methods like withdrawal or calendar-based methods.

Still, Vietnamese reproductive health experts worry about an unmet need for family planning, especially among adolescents and in remote rural and upland areas.  According to the World Health Organization, up to 11.2% of adolescents in Vietnam have sex and 34% of them do not use any contraceptive.  Lack of access to contraceptives as well as rudimentary knowledge about the ABC’s of reproduction among the young, say Vietnamese experts I interviewed, contributes to the country’s high abortion rate.

Family Planning as antidote to abortion

The country’s reproductive health leaders go to a great extent to claim that, unlike in the case of China, which has a one-child policy, Vietnam’s family planning program is not coercive.  And unlike in China, the menu of family planning methods excludes abortion.  The country, they say, is a signatory to the 1994 International Conference on Population and Development Program of Action and takes seriously Paragraph 8.25 of this code, which states that:

“In no case should abortion be promoted as a method of family planning. All Governments and relevant intergovernmental and non-governmental organizations are urged to strengthen their commitment to women’s health, to deal with the health impact of unsafe abortion as a major public health concern and to reduce the recourse to abortion through expanded and improved family planning services. Prevention of unwanted pregnancies must always be given the highest priority and all attempts should be made to eliminate the need for abortion.”

The answer to abortion, in other words, is better access to contraceptives and better counseling.

Stressing reproductive rights

The family planning program began with an overwhelming focus on the need to limit fertility to provide the space for development.  Over the years, however, the stress on the need for family planning to promote women’s reproductive health has become an equally central concern.  Reflective of this is the felt need for improved delivery of counseling and supplies in order to avert abortion and what Vietnamese health practitioners see as its negative impact on woman’s health.  Indeed, family planning is now also being popularized with a rights-based justification. As the Vietnam Family Planning Association (VINAFPA) Strategic Plan for 2004-2010 put it:

“Sexual and reproductive rights are human rights.  VINAFPA advocates recognition and respect for these rights.  Sexual and reproductive health services must reflect high quality practices and standards.  VINAFPA advocates and demonstrates these standards, particularly in the care and respect for the privacy and confidentiality of all clients.  All people have the right to receive services of the highest quality; furthermore, this quality of service will in itself motivate the people using these services.”

Vietnam’s lessons for the Philippines

Vietnam has many lessons for the Philippines, among them the importance of a sustained national commitment to family planning, a comprehensive approach that involves both government and mass organizations, and a perspective that rests on the twin pillars rational population management and promotion of reproductive rights.

But perhaps the most important lesson is that, contrary to what some well-intentioned but unfortunately misinformed anti-reproductive health people think, measures to promote social justice and reduce inequality are not enough to end or reduce poverty. No government has been more dedicated to promoting social justice and abolishing inequality than the Socialist Republic of Vietnam.

A key measure of income distribution is the Gini Index; the lower it is, the more equal a country’s income distribution is.  With a score of 34, Vietnam, along with Laos, has the lowest Gini Index in East Asia.  Japan’s is 37, Malaysia’s is 49, and the Philippines’ is 44.  Despite its having waged a revolution for social justice and achieving a rate of income distribution that is the best in the region, Vietnam still found the need to promote comprehensive family planning to bring about economic development and end poverty.

Without an effective population management and reproductive health program, which is a necessary condition for economic takeoff and growth, measures to redistribute income and assets will merely result in a redistribution of poverty, say reproductive health practitioners I met in Hanoi.  Family planning + economic growth + redistribution remains the indisputable formula for ending poverty and improving the welfare of the people.

*Walden Bello represents Akbayan (Citizens’ Action Party) in the House of Representatives.  He recently traveled to Indonesia, Thailand, and Vietnam to investigate family planning programs in those countries.