DOI: 10.14457/tu.the.2023.1012
title: Pathways of inequality in maternal and under-five child mortality rates among ethnic minority communities in Vietnam

description: Background: Over the past decades, most ethnic minority groups in Vietnam have been excluded from the processes of making significant progress in maternal and child mortality, maternal health, and gender equality indicators across the country. The maternal mortality rate of ethnic minority women was significantly higher than this national average rate, with 100 to 150 compared with 46 deaths per 100.000 live births. The under-five mortality rate among ethnic minority groups was 3.5 times higher than for the Kinh people. In addition, infant mortality and stillbirth were popularly reported in mountainous rural areas, where most ethnic minorities lived. In Vietnam, ethnic minorities' access to maternal and child healthcare services remains inequality status. Objectives: Updates on pathways to vulnerability and inequality in maternal and under-five child mortality rates among ethnic minorities in Vietnam since the previous work subject of Malqvist et al. and extension of analyses for the role of governmental agencies and policy in addressing the gaps and inequalities in healthcare outcomes of ethnic minorities in Vietnam. Methods: The research was conducted under a purposive narrative literature review method. The electronic databases included Pubmed, The Lancet, Google Scholar, Google, and Thammasat University’s electronic library were searched for relevant studies from 2011 to the present. PRISMA Flowchart was used to select the relevant articles for this review based on inclusion and exclusion criteria. Results: Out of the 91 identified sources, 26 were eligible for analysis in the study. These sources provided relevant data and information on vulnerability and inequalities in maternal and under-five child mortality rates among ethnic minority groups in Vietnam. These inequality pathways occurred at all five levels. Firstly, individual level, including maternal ethnicity, low income, low educational attainment, childbirth at an earlier age, and the tendency to have more children in ethnic minority women. Relationship level: poor economic households, cultural and language barriers such as not knowing the Vietnamese language, and patriarchal structures in ethnic minority communities limited the self-determination right of ethnic minority women in access to and use of health services during pregnancy. Organization level focused on health facilities: Lack of medical equipment and human resources, limited capacity in providing reproductive healthcare services, and managing complications in pregnancy and childbirth. In addition, discrimination based on ethnicity persisted in health facilities leading to obstacles for ethnic minorities to access quality maternity healthcare. Community level: Ethnic minority groups maintained backward traditional practices such as preferring delivery at home, early marriage, or consanguineous marriage, which had increased the risk of complications and maternal and neonatal mortality. Inequalities in accessing antenatal and postnatal care services among ethnic minority mothers and infants, and ethnic minority groups' residence areas in remote and mountainous areas with long distances from health facilities led to difficulties in finding health care. Policy level: Intervention policies and the implementation of universal health coverage lacked cultural adaptation and sensitivity in ethnic minority communities, and overlapping policy frameworks reduced the effectiveness of interventions in improving ethnic minority health outcomes. Conclusions: Pathways to vulnerability and inequality in maternal and under-five child mortality rates among ethnic minority groups remained in all five levels of individuals, relationships, organizations, communities, and policies. To address these inequalities, the Government of Vietnam needs more strengthening in reforming the health system and implementing intervention programs to ensure equitable access to healthcare services for ethnic minority mothers and children, promoting the process of poverty reduction and reducing socioeconomic disparities among regions, increasing awareness and health information for the ethnic minority communities in maternal and child healthcare practices during pregnancy and childbirth.