From the decades of the 60s to 90s, the Ministry of Health – Department of Treatment defines that abortion services are provided to women upon request at public clinics by trained physicians/midwives.

In the 1980s, the government encouraged small-sized families, ideally with two children, spaced three to five years.

Government Decree No. 104/2003/ND-CP dated 16 September 2003 guiding the implementation of some articles of the Ordinance on Population strictly prohibits choosing the sex of the fetus (Art.10)

In 2003, the Minister of Health published the National Standards and Guidelines (NSGs) for Reproductive Health Services including a Chapter on Safe Abortion. It is stated in the NSGs that trained obstetricians, assistant doctors with obstetrics – pediatric specialist or trained midwives can legally perform abortions. It is also defined that abortion services are provided at three administrative levels of the health system: (1) abortion of 6-22 weeks gestation provided at central and provincial hospitals; (2) abortion of 6-12 weeks gestation is provided at district health stations; and (3) abortion up to 6 weeks gestation is provided at community health centers. Private clinics in certain provinces are allowed to perform abortion up to 6 weeks gestation if they meet the required criteria set out by the Provincial Health Services.

During 2007 – 2009 Vietnam Ministry of Health (MOH) work together with UN agencies and International NGOs to upgrade the National Standards and Guidelines for Reproductive Health Services. The new version of the NSGs was published in 2009.
During 2010 – 2011 Vietnam MOH develops 10 years of national strategies for reproductive health in which safe abortion is one of the key components. Based on these national strategies, a master plan was developed. Training for the health providers at the commune level on MVA and for the health providers at the district level on MA is included in the master plan and the government budget is located for this activity.

In this new version the following techniques/issues are mentioned:

• MVA
• MA using combined Mifepristone and Misoprostol regiment for gestation up to 63 days (gestation limitation for district-level: 49 days; provincial level: 56 days; and central level: 63 days).
• Second-trimester abortion by D&E
• Second-trimester abortion by combined Mifepristone & Misoprostol and Misoprostol alone regiments for gestation 13 – 22 weeks.
• Abortion counseling
• Instrument processing
• In this version of the NSGs, providers are advised to screen second-trimester abortion cases to avoid sex-selected abortion.

Since 2001, Vietnam MOH works together with Ipas Vietnam on developing Comprehensive Abortion Care (CAC) Model at two central hospitals – National Obstetrics & Gynecology Hospital (NOGH) and Tu Du Hospital – and two provinces with their districts and communes. The CAC model aims to improve the quality of abortion care through improving counseling, qualifying abortion procedures, standardizing infection prevention practices, and linking abortion service with contraceptive service. Since 2006, the CAC model is scaled up in 5 other provinces as well as a strong team of Safe Abortion trainers have been developed in order to widen the CAC model in the country. Many CAC training courses have been held by the MOH for providers from the provincial level and NOGH & Tu Du Hospitals have become two CAC training centers.

Vietnam has signed ICPD and CEDAW. The Government is trying its best to realize its commitment to ICPD and CEDAW.

Women’s rights are upheld and protected by the law: Female workers on maternity leave, no matter how many births they have given, are entitled to natal allowance. Single women are entitled to pregnancy supporting techniques at the instructions of specialized doctors.

Vietnam has a large number of sectoral documents stipulating ways to better protect mothers, including the Safe Motherhood Programme, tetanus vaccination and iron tablets for pregnant women programme, protection of pregnant women during floods and other natural disasters.

Vietnam is considered to have one of the highest abortion rates in the world − about 500,000 cases were reported from the public sector in 2006, and at least the same number have been provided in the private health sector as estimated by the public abortion providers. The ratio of abortions to live births in Vietnam is high.

According to Vietnam Abortion Situations Country Report 2001, there are 45.1 abortions per 100 live births.

There are no official statistics on adolescent abortion but it is estimated that about 20 – 30% of all abortion cases belong to young, unmarried women. There are no official statistics on unsafe abortion and complications.

First-trimester abortion by manual vacuum aspiration (MVA) is provided at central, provincial, district, and commune levels, while medication abortion (MA) is provided at central, provincial levels, and some districts but not at the commune level.

Although D&C is removed from Vietnam National Guidelines for Safe Abortion sharp curette checks following MVA procedure are still applied at provincial and district levels.

For second-trimester abortion, dilatation and evacuation (D&E) have been introduced to central and many provincial hospitals. Medical abortion protocols applied for the second trimester have been included in the updated version of the National Guidelines for Safe Abortion.

National Standards and Guidelines for Reproductive Health Services. However, outdated and unsafe techniques such as Kovac’s method are still used at some provincial hospitals.

The cost of abortion services varies by gestation, abortion method, and service site.

Approximately, an MVA case cost 4-7 USD, an MA case cost 20-25 USD and a D&E case cost 80-100 USD

Policies allow trained private providers to provide MVA and MA services for gestation up to 6 weeks. There is no government system that manages the number and quality of abortion services in the private sector. Abortion complication treatments in the public sector are often for cases that come from the private sector.

The cost for abortion services in the private sector differs for gestations and specific clinics ranged from 18 – 100 USD.

There is no recent research on abortion techniques in Vietnam, following is the observation of the author:

• There is a big percentage of abortion cases by MVA but the technique is not standardized for all cases.
• The percentage of abortion cases by MA is increased, at some big hospitals the MA cases count for about a half of total abortion cases.
• Other techniques including EVA, D&E, and Kovac’s.
• Recently, second-trimester abortion by combined Mefepristone & Misoprostol and Misoprostol alone regiments are practiced at some central and provincial hospitals.

It is stated in the recent NSGS :

• • MVA providers include doctors, assistant doctors (Obstetric-Pediatric specialists), secondary and college-level Midwife who are trained in MVA.
  • MA providers include obstetric and gynecological doctors who are trained in medical abortion. Midwives are encouraged to provide MA counseling and follow-up care.
  • D & C providers include doctors, obstetric-pediatric assistant doctors who are trained in D&C.
  • D & E providers include obstetric & gynecology doctors who are skilled in first trimester D&C and trained in D&E.

Causes of Maternal Mortality in Vietnam by MOH, Reproductive Health Department, 2002.

In spite of the liberal law and availability of abortion services in public and private sectors unsafe abortion is still one of the common reasons for maternal death, estimated at 11.5% of direct causes of maternal mortality in Viet Nam in 2002.

Manufacture and/or available through the import of abortion equipment (MVA syringes, EVA equipment):

Ipas MVA instruments including Ipas Single Valve and Ipas MVA Plus are made in Taiwan and distributed through 4 local distributors.

Available EVA instrument produced by Doctor Friend and Sturdy in Taiwan, by Sharp/Shin-ei in Japan, and Gima in Italy.

There are 3 kinds of Mifepristone in Vietnam:

• Mifestad 200 by STADA, a Vietnam-Germany Joint Venture Company import mifepristone, and misoprostol powder and make tablets in the country;
• MIFE – 200 by Pharbaco Central Pharmaceutical JSC
• Mifepristone CIEL by Ba Dinh Pharmaceutical Company

There are 3 kinds of Mifepristone in Vietnam:

• Misoprostol STADA by STADA company
• Misoprostol CIEL by Ba Dinh Pharmaceutical Company
• Alsoben is imported from Korea

In remote areas, untrained providers even quack still provide unsafe abortion services but there is no official data on this issue. The problem of unsafe abortion and illegal providers some time discussed in newspapers while there is a serious abortion complication reported.

Vietnam has a population of about 86 million by the 2009 national census with 29.6% urban and 70.4% rural population. There are no official statistics on abortion services ratio to population but it is not too difficult to access abortion services in rural areas except remote areas.

As stated in laws and policies, Vietnam Government supports abortion but there is a very limited annual budget allocated for safe abortion training and equipment.

Religion leaders in Vietnam do not officially against abortion but never support it.

• WHO provides technical support to safe abortion in Vietnam.
• Ipas Vietnam used to provide technical support and work together with Maternal & Child Health Department – Vietnam MOH in designing, facilitating, monitoring/evaluating and scaling up CAC model in Vietnam.
• Concept Foundation introduces product for medical abortion through a clinical trial which proved the effectiveness of 96.7%.
  Pathfinder International, Path, Marie Stopes International (MSI), and Vietnam Family Planning Association (VINAFPA) design, facilitate and implement Reproductive Health Projects which include Safe Abortion component.

Vietnam Obstetric and Gynecology Society supports abortion.

While quality of abortion services at project sites is high at many provinces there is still a lot of work to do in order to improve the quality of abortion care. The effort needs to be focused on:

• Improving abortion/contraceptive counseling
• Standardizing abortion practice including infection prevention and instrument processing
• Linking abortion service with contraceptive service
• Simplifying administrative procedure for abortion clients

Vietnam people are aware of abortion legality and availability of the service. Even though, Vietnam culture is against pre-married sexual intercourse and therefore against pre-married abortion. Because of this cultural barrier young unmarried women often delay accessing safe abortion services or go to untrained private providers for abortion.