Vietnam: Difference between revisions

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'''Note: This is the country page for Vietnam. To get more detailed information, please visit our city pages, like [[Hanoi]] or [[Ho Chi Minh City]], where you can find local recommendations on hospitals, clinics, pharmacies and gynecologists. This is the country page, so it focuses on national laws and cultural norms.

[[File:Flag of Vietnam.svg.png|300px | thumb|right]]

'''OVERVIEW'''  

Vietnam has many women's health resources. Contraceptives, including emergency contraceptives, are legal and do not require a prescription. There are a plethora of pharmacies throughout the city though you may struggle to find certain international brands. Since the 1960s, the North Vietnamese government has advocated family planning -- and, after reunification in 1975, family planning policies extended throughout the country. There is a 2-child policy that has remained in place for decades, although this policy seems to be on its way out. Nowadays in Vietnam, you can get STI tests at many hospitals and clinics. However, if you're a foreigner or don't speak Vietnamese, it's recommended that you visit an international facility (list of such facilities below). You can find both pads and tampons, typically without applicators (like OB), at many markets and stores. Furthermore, abortion is fully legal for up to 22 weeks of pregnancy, and there are no known restrictions related to age or reasons. Due to its high prevalence, Vietnam has been called the "abortion capital" of Asia, a title that has also been given to [[China]]. You will find that both surgical and medical abortion options are available, and there are many resources, including international organizations like Marie Stopes, that can help you identify the appropriate services.

[[File:Contraceptivefilmvietnam.jpg|300px | thumb|left|'''Spermicide found in Hanoi pharmacy (Hoan Kiem district)''']]

Birth control is legal and widely accessible in Vietnam. It is estimated that 73%-75% of Vietnamese women (of reproductive age) use some form of birth control.<ref>[http://www.dktinternational.org/country-programs/vietnam/ DKT International: Vietnam]</ref> Typically, you'll be able to find oral contraceptive pills, IUDs, injectables (Depo Provera) and Implanon. The most commonly used forms of modern contraceptives tend to be IUDs and condoms. However, it is estimated that approximately 54% of Vietnamese women use modern methods of birth control; the remaining percentage use older methods, like withdrawal, the rhythm method or periodic abstinence.<ref>[https://www.guttmacher.org/about/journals/ipsrh/2002/12/accessibility-and-use-contraceptives-vietnam Accessibility and Use of Contraceptives in Vietnam]</ref>

Since 1963, Vietnam has had some form of population control. This began under the Democratic Republic of Vietnam (North Vietnam), when the government advocated capping families at two to three children. After reunification of Vietnam in 1975 under the communist government, family planning policies extended throughout the country. Ultimately, a 2-Child Policy was implemented in 1983. During the 1980s, the Vietnamese government provides incentives for those who followed the policy, like contraceptive availability, and those who do not, like enforcing penalties. The government also took cue from the Chinese government's stance by encouraging its citizens to get married later and to space out children 3-5 years apart. This policy is currently being reconsidered but seems to remain in place.<ref>[https://en.wikipedia.org/wiki/Two-child_policy Wikipedia: Two-child Policy]</ref>

Despite widespread contraceptive use in Vietnam, there is limited knowledge of all methods. According to one study in the late 1990s: "Several contraceptive methods, such as the pill and the condom, are not widely used even in urban areas, where they are easily obtainable. A study on oral contraceptives in Vietnam indicated that the major reason women who had used modern contraceptive methods had never used the pill was that they did not know about the method. If this lack of information is the result of the strong campaigns conducted in Vietnam in the 1980s to promote IUD use and in the mid-1990s to promote sterilization, contraceptive use depends not only on availability but also on the intensity of promotion. Thus, along with availability of contraceptives, access to information on individual methods could reduce the bias in Vietnam toward urban areas and toward IUD and traditional contraceptive use."<ref>[https://www.guttmacher.org/about/journals/ipsrh/2002/12/accessibility-and-use-contraceptives-vietnam Accessibility and Use of Contraceptives in Vietnam]</ref>

For local recommendations of clinics, pharmacies and hospitals, please visit the city pages, like [[Hanoi]] or [[Ho Chi Minh City]], but here's some general stuff to keep in mind:

* For birth control pills (oral contraceptives), you can buy them at the many pharmacies (called "nha thuoc") throughout Hanoi. The word for birth control is Vietnamese is "thuốc tránh thai" (how to pronounce it: thwork chanh tide). Some of the reported brands include HN Choice, Rigevidon, Marvelon, Microgynon. There are also many generic or Vietnamese brands in Hanoi pharmacies, and most medications appear to be made in Vietnam or India.  

* Nuvaring is not available Vietnam. We asked many pharmacies -- and none of them carried Nuvaring.  

* For the contraceptive patch, you can purchase it at private hospitals for about $18-20/month.

In Vietnam, emergency contraception is available directly from pharmacists without a prescription. There appears to be no age restrictions. However, if you want to purchase certain EC brands, like ella, Ciel EC and Mifestad 10 you may need a prescription.<ref>[http://www.cecinfo.org/country-by-country-information/status-availability-database/countries/vietnam/ EC Status and Availability: Vietnam]</ref>

Generally, Vietnamese pharmacists support EC usage but lack proper understanding of its usage and side effects. According to one study: "A series of focus group discussions and in-depth interviews conducted in 1995-96 with hospital-based family planning workers from Ho Chi Minh City, Viet Nam, revealed widespread support for the concept of emergency contraception, but a lack of accurate information about method use. Emergency contraception was regarded as especially appropriate for rape victims, unmarried adolescents, those not in a permanent union, and perimenopausal women. Providers from eight of the nine hospital sites had heard of or used Postinor (a levonorgestrel-only regimen), while participants at seven sites were familiar with the Yuzpe regimen (ethinyl estradiol and either norgestrel or levonorgestrel) and postcoital insertion of a copper-bearing IUD. Providers typically learned about postcoital methods during medical school or at a continuing education seminar. However, even those aware of emergency contraception had substantial misinformation about dosages, intervals between doses, and the maximum length of time after intercourse that the regimen can be initiated. Moreover, they tended to exaggerate side effects and specify unnecessary contraindications. All participants expressed a need for more comprehensive training. Because these methods are often available from pharmacies, respondents urged that druggists be trained to counsel women about the correct use of emergency contraception and suggested that the regimens be specially packaged with clear, simple instructions."<ref>[http://www.ibisreproductivehealth.org/publications/knowledge-attitudes-about-ec-among-health-workers-ho-chi-minh Knowledge and attitudes about emergency contraception among health workers in Ho Chi Minh City, Vietnam]</ref>

[[File:Victoriavietnam.jpg|300px | thumb|right|'''aseVictoria - an emergency contraceptive that can be purchased in Hanoi''']]

You can buy emergency contraception for 45,000 dong (less than $2 as of 2016) in any pharmacy. One popular brand is Victoria. Below, we have listed the main brands and types of EC available in Vietnam:

''Dedicated Products / Anti-Progestin

Take 1 pill within 120 hours after unprotected sex:''

* Mifestad 10 (this appears to be a Vietnamese brand)

''Dedicated Products / Progestin Only

Take 1 pill within 120 hours after unprotected sex:''

* Escapelle  

''Take 2 pills within 120 hours after unprotected sex:''

* Postinor-2 (global brand, but here's the [http://postinor.com.vn/vi Vietnamese website for Postinor])

''Oral Contraceptives used for EC / Progestin-Estrogen Combined

Note: in 28-day packs, only the first 21 pills can be used

* FMP

Take 4 pills within 120 hours after unprotected sex and take 4 more pills 12 hours later:

* Anna

* Rigevidon

'''Important Notes - Learn about PEP and PrEP:''' If you think that you've been recently exposed to HIV (i.e. within 72 hours), seek out PEP (Post-Exposure Prophylaxis). It's a month-long treatment to prevent HIV infection after exposure, and it may be available in your city. Take PEP as soon as possible. For more information, click [https://www.aids.gov/hiv-aids-basics/prevention/reduce-your-risk/post-exposure-prophylaxis/ here]. If you are at risk of HIV exposure, seek out PrEP (Pre-Exposure Prophylaxis). It's a daily oral pill that can prevent HIV infection before exposure. To learn more about PrEP, click [http://www.whatisprep.org/ here].

There are no known travel restrictions or requirements attached to any STI, including HIV, in Vietnam. For foreigners seeking work, especially teaching, there are some reports of schools asking for health checks (especially agencies that recruit from public ones). However, health checks are not required by authorities in order to receive a work permit. Important Note: There is a decree requiring HIV positives to report to the immigration officer. However, the ordinance is not applied. None of my friends have ever declared their condition. Therefore, we don't know what would happen if somebody would actually do it!"<ref>[http://www.hivtravel.org/Default.aspx?PageId=143&CountryCode=VN VIETNAM - REGULATIONS ON ENTRY, STAY AND RESIDENCE FOR PLHIV]</ref>

Today, there is no conclusive data on STI rate in Vietnam, with estimated infection rates ranging from 300,000 to 2 million annually.<ref>[http://e.vnexpress.net/news/news/plastic-bag-is-the-new-condom-vietnamese-injured-after-strange-safe-sex-practice-3468256.html Plastic bag is the new condom? Vietnamese injured after strange safe sex practice]</ref>

In Vietnam, HIV testing began in 1988.<ref>[https://ethnomed.org/clinical/communicable-diseases/hiv-std-infection HIV/STD Infection in Vietnamese and Vietnamese Americans]</ref> The first reported positive result came in 1990. Throughout the 1990s, HIV rates began to raise. Although infection rates in Vietnam were low overall, the female sex worker (FSW) and injection drug user (IDU) communities began to experience substantially increased infection rates. In 2002, a study of 400 female sex workers (FSW) in Hanoi found that 12% were HIV+ and 17% were infected syphilis, 3.8% with chlamydia and 6.3% with gonorrhea. The study concluded: "Vietnam is in a critical period. HIV is spreading rapidly among the risk groups, but the country can prevent a widespread epidemic if it acts quickly. The country must take the opportunity to act wisely and to make sound decisions. Strategies to reduce HIV in FSWs should include reduction of stigmatization, reduction of sharing drug paraphernalia, promotion of nonstigmatizing voluntary counseling and testing, and aggressive marketing and promotion of condoms. To achieve these goals, the government should adopt a multisectoral response that includes other government agencies, nongovernment organizations, and the vulnerable populations."<ref>[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2908502/ HIV Infection and Risk Characteristics Among Female Sex Workers in Hanoi, Vietnam]</ref>

For people living with HIV in Vietnam, lack of government funding and social stigma are harsh realities. The majority of HIV/AIDS program funding (70%) comes from international organizations with only about 13% coming from the Vietnamese government. There is also a shortage of health workers with only 1300 in 2011. And there is also social stigma. "Social stigma against HIV/AIDS patients presents a major obstacle to contain HIV/AIDS. HIV/AIDS patients are treated unequally in the hospitals and denied employment. Children with HIV are not welcomed in school. In 2009, parents in Ho Chi Minh City forced officials to expel children with HIV.[9] Discrimination thus discourages people to go for screening or to take medication in fear of revealing their HIV status."<ref>[https://en.wikipedia.org/wiki/HIV/AIDS_in_Vietnam HIV/AIDS in Vietnam]</ref>

Regarding HPV, Vietnam has a vaccination pilot program in place.

There is no PrEP (Pre-Exposure Prophylaxis) in Vietnam. The closest country that appears to have this is [[Thailand]].

There seems to be PEP (Post-Exposure Prophylaxis) in Vietnam: According to UNAIDS: " In such cases, there is PEP at some private clinics if the person can afford, such as the Family Medical Practice clinics in Ha Noi and Ho Chi Minh City."<ref>[http://unaids.org.vn/en/frequently-asked-questions/ Frequently Asked Questions: Vietnam]</ref> Furthermore, "Mylan Pharmaceuticals donated a supply of tenofovir/emtricitabine tablets to provide free post-exposure prophylaxis (PEP) after high-risk sexual exposure to HIV in Hanoi and Ho Chi Minh City."<ref>[http://carmah.vn/partners.html Carmah]</ref>

There are no known specific or appropriate HIV treatment centers in Vietnam. But here are some resources in Hanoi and Vietnam:

* Ford Foundation: Phone: 976 0164 , Fax: 976 0163 , E-mail: l.messersmith@fordfound.org, Contact person: Lisa Messersmith (Programme Officer)  

* NGO Resource Centre: Phone: 832 8570, Fax: 832 8611, E-mail: NGOCentr@netnam.org.vn, Contact person: Michelle Brown (Co-Director)  

* Institute for Social Development Studies (ISDS): Conducts research, advocacy, information dissemination efforts and trainings in gender, sexuality, social development and health.

'''Important Note:''' Avoid self-diagnosing or seeking treatment (before diagnosis) at a pharmacy. According to one study: "Even though 74% (51 of 69) of pharmacists and drug sellers know that they should not treat STD patients, in fact 84% (250 of 297) did treat. When they did treat, no one gave the correct combination of drugs for treatment by the syndromic approach, as only 12% (36 of 297) gave tetracycline or doxycycline, and of those who sold them no one gave them for a sufficient number of days. Quinolones were by far the most common drug given but are not recommended by the Vietnam Institute of Venereology..."<ref>[http://sti.bmj.com/content/76/4/299.full STD management by private pharmacies in Hanoi: practice and knowledge of drug sellers]</ref>

For a long time, Vietnam (along with many other Southeast Asian countries) was known as place where you could buy virtually any medication or antibiotic over the counter. In Vietnam, this is no longer the case. Antibiotics and stronger medications are more strictly regulated at pharmacies. However, you will still find some pharmacies that are more lenient in their sales. Remember that some pharmacies focus on "herbal" or traditional medicine, meaning that they do not carry modern pharmaceutical products. Other pharmacies do carry modern products, but they may sell medications that are inauthentic (i.e. incorrect or sugar-pill like medicine) or expired. Try to visit pharmacies that you know or trust, or that someone who has experience in a Vietnamese city recommends. Overall, Vietnamese pharmacists speak very little English. So it is recommended to know that name of the medication you need in advance or to bring a translation device.

Note: While this is an unverified, a Hanoi pharmacist has told us that yeast infections in Vietnam are fairly common due to the low-quality tap water. When women wash or douche themselves with the water, they may develop yeast infections. While this cannot be entirely avoided, it's something to remember.

[[File:Canestenvietnam.jpg|300px | thumb|left|'''Canesten - yeast infection medication, which requires that you insert pills vaginally''']]

* For details on PrEP and PEP, visit the "Sexually Transmitted Infections (STIs/STDs)" section of this page

* If you have a yeast infection, try to say "Nhiễm nấm âm đạo" (can someone confirm if this is correct?). If you go to a pharmacy, you can ask for "Canesten." This is basically the Asian version of Monistat. Note that you may receive a pill version, which means you have to insert pills into your vagina through an insertion device. The pills need to actually dissolve inside of you and, if they're clumpy at all, the pills may not work. So the pharmacists may also recommend that you buy some sort of vaginal lubricant/cleaner that will help dissolve and clean out the pills.

* If you have a urinary tract infection (UTI), you can try to say "nhiễm trùng đường tiết niệu," though we're not sure if this is accurate (can someone confirm?). If you go to a pharmacy, may be given Midasol at a Hanoi pharmacy. But first confirm that you have a UTI before you proceed wit medication.

There is little social stigma attached to menstruation in Vietnam, where both pads and tampons are available. But there is not yet widespread knowledge of alternative menstrual products, like menstrual cups or menstrual underwear. The country does not have a massive range of international or foreign brands, so these products are not yet on Vietnam's radar. But this could easily change in the coming years as the economy grows and the government continues to ease restrictions on foreign investment.

Please visit city pages for local recommendations, like [[Hanoi]] and [[Ho Chi Minh City]].

In Vietnam, new mothers get 4-6 months off for maternity leave with 100% of income covered.<ref>[https://en.wikipedia.org/wiki/Parental_leave Wikipedia: Parental Leave]</ref> According to a 2013 Save the Children report: "Vietnam, for example, though quite poor, scored relatively well as a place for moms, in part by cutting its newborn death rate by an impressive 47 percent over 20 years."<ref>[https://www.washingtonpost.com/news/worldviews/wp/2013/05/08/heres-a-map-of-the-best-and-worst-countries-to-be-a-mother/ Here’s a map of the best and worst countries to be a mother]</ref>

Pregnancy tests are widely available at pharmacies throughout the city. Pharmacies in tourist areas most likely have someone who speaks English.

[[File:Php2C2C8tAM.jpg|400px | thumb|right|'''Vinmec - an international hospital in Hanoi that provides abortion services''']]

Abortion is fully legal for about to 22 weeks of pregnancy. All reasons for an abortion, including to save the life of the woman, to preserve physical health, or mental health, rape or incest, fetal impairment, social/economic reasons, or available upon request, are all considered valid. As stated in the Law on Protection of People's Health (1989), "Women have the rights to have abortion; to receive gynecological diagnosis and treatment; and health check-up during pregnancy; and medical service when giving birth at health facilities.” There are three administrative levels that perform abortions in Vietnam, depending on the stage of the pregnancy: 1) For 6-22 weeks, central and provincial hospitals 2) 6-12 weeks, district health stations and 3) up to 6 weeks at communal health centers (and, in some cases, private clinics, if they meet certain criteria).

In Vietnam, abortion became fully legal since reunification in 1975. Since that time, and especially since the 1980s, the country has had a rather high abortion rate. Between 1982 and 1994, the abortion rates rose six-fold. In 1996, the abortion rate was 83.3 abortions per 1000 women. In 2014, it was reported that 40% of pregnancies end in abortion. As reported: "Sexual behaviour among young Vietnamese has radically transformed in the last few decades -- they have sex earlier and marry later -- but the state's old-fashioned family planning services offer little advice or suitable contraception to young, unmarried couples, experts say.As a result they suspect that abortion -- permitted up to 22 weeks and widely available, particularly at legal but largely unregulated private clinics -- is being used to prevent unwanted pregnancies more often than in other countries." <ref>[http://www.dailymail.co.uk/wires/afp/article-2848236/Sky-high-abortions-Vietnam-family-planning-excludes-youth.html Sky-high abortions in Vietnam as family planning excludes youth]</ref>

To find clinics or hospitals where abortions are performed, visit city pages like [[Hanoi]] or [[Ho Chi Minh City]].

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