An invisible and marginalised trauma Socioeconomic determinants Ethnicity/culture Religion/conceptions Education/skills Economy/wealth Proximate determinants Interventions Outcome Maternal factors Emancipation Nutrition Occupation Age Civic status Birth spacing Household structure Health system factors Access Distance Attitudes Awareness Resources Competence Neonatal factors Sex Gest. age at birth Birth weight Birth order Delivery factors Place Mode Assistance Complications Postnatal care Surveillance Nutrition Hygiene Care seeking Temperature control Resuscitation Exclusive breast feeding Infection management Survival Mortality Fig. 1. Conceptual framework for factors inﬂuencing neonatal mortality, adapted from Mosley and Chen (21). education affecting the amount of income, generating wealth, or sustaining poverty, while at the same time a high economic status increases the possibilities for a better education. Even in Vietnam, being a communist country, this is valid, especially with the transformation from planned to market economy and rapid economic development of recent years. The influence of maternal educational level on child health has been explored in many studies. In a seminal paper from studies on maternal mortality in Nigeria in 1979, Caldwell discusses the reason that well educated mothers have better health indicators as being due to their ability to better under- stand and use the health system, compared to their less educated peers (26). It would also be reasonable to assume that mothers with higher education are more prone to internalise and adopt new knowledge and behaviour for the benefit of themselves and their off- spring. The impact of household economy on neonatal survival could be both direct through payment capacity Citation: Global Health Action 2011, 4: 5724 - DOI: 10.3402/gha.v4i0.5724 directly related to delivery or sickness and indirect, by the manifestation of better nutritional status. In Vietnam, there are now user fees in the health care system, both official as well as unofficial (27). However, if a family is poor, it can obtain a certificate from the authorities stating their low economic capacity and thereby assuring them health care free of charge (at least when it comes to official fees). Religion and conceptions about life influ- ence cultural pre-understanding as well as how to relate to wealth and education. Religious beliefs and customs also affect neonatal health and the chances for survival such as the Vietnamese tradition of not considering a newborn child fully human until it has reached 1 year of age (28). Another factor that could greatly influence the care and survival of newborns: the preference for sons, which is closely related to patrilinearity and patriarchal structures (29) and in the end affects the decision-making power of women. Vietnam for many years has had a two- child policy, and the desire to breed sons together with an 3 (page number not for citation purpose)