economist – BRIGHTLY coloured plastic flowers greet patients at the reception desk of Nguyen To Hao’s abortion clinic. Yet the mood in her waiting room is grim. Ms Hao, an obstetrician and gynaecologist, says that many of her patients are teenagers who know shockingly little about sex or its consequences. Some young women with late-term pregnancies are sent to a nearby hospital for abortions; others carry their pregnancies to term and leave their newborn babies in the care of Buddhist monks.
Unwanted pregnancies could be avoided if only Vietnam had better sex education in secondary schools. A Vietnamese adage claims that avoiding discussions of sex is the surest way to “prevent the deer from running”. Yet the deer are “already running”, Dr Hao insists, and the government is failing to guide them.
Vietnam’s abortion rate is not known for certain, but is thought to be among the world’s highest. According to researchers at the Central Obstetrics Hospital in Hanoi, the capital, two-fifths of all pregnancies in Vietnam end in abortion—double the government’s tally.
Ignorance about sex and contraception is one glaring factor. Some women who have abortions never meant to get pregnant. Others desperately wanted a boy, since male children keep the family bloodline going and are traditionally expected to look after their elderly parents. Sex-selective abortions have been illegal since 2003, but the ban is hard to enforce. Ultrasounds are widely available. Nguyen Thi Hien, a mother of two in Hanoi, says that for $75 doctors at the capital’s private clinics are happy to tell couples the sex of their fetus.
So for every 100 girls, 111 boys are born in Vietnam, according to the UN Population Fund—a sex ratio at birth nearly as lopsided as neighbouring China’s. Vietnam’s Communist Party worries that this sex imbalance will leave a generation of men struggling to find a mate. As in other societies with lots of frustrated single men, that may mean more trafficking and prostitution, more rape and a greater risk of political instability.
Vietnam’s reproductive and demographic policies are in flux. China’s recent decision to relax its one-child policy may prompt Vietnam to reconsider its own (more loosely enforced) two-child policy, says a former official from Vietnam’s health ministry. The ministry is now soliciting public comments for a revision of that law, and the National Assembly may take it up this spring.
It is not a moment too soon. A whopping two-thirds of the country’s 90m people are of working age. That gives Vietnam a chance to boom economically over the next three decades. But the “demographic dividend” may then stop abruptly. Fertility rates in some Vietnamese cities have fallen to below the population replacement rate, a trend that could eventually lead to a shortage of workers, as Japan and other rich countries have learnt to their cost. The difference is that Vietnam risks growing old before it grows rich.
The new population law, in its current wording, would not help. It proposes to leave the two-child policy in place and ban abortion after 12 weeks, down from the current limit of 22 weeks, except in cases of rape. That may send even more pregnant Vietnamese into shadowy abortion clinics. In September some 17 public-health professionals complained about the proposed law in a letter to the health minister. Such pressure may prompt the government to extend the proposed 12-week limit.
However, the population-control measures being mulled by the ministry contain another troubling feature: a pre-natal focus on “population quality”. That sounds harmless enough, but the underlying idea, according to a foreign health-policy expert in Hanoi, is that health officials could encourage mothers to abort fetuses showing signs of disability.
Some in the ministry have also proposed lifting the two-child policy in cities while continuing to enforce it in the countryside—ie, encouraging the better-educated and better-off to have more children while denying the same right to poor folk, including ethnic minorities, who view their children and grandchildren as their only social safety net. That would allow the bureaucrats in charge of the two-child policy to keep their jobs. But the idea is regressive, unfair and needs to be junked.