Advancing women's sexual reproductive rights in Vietnam – Hang Nguyen, MSI Reproductive Choices

Our guest this week is Ms Hang Nguyen, the Vietnam Country Director for MSI Reproductive Choices, formerly Marie Stopes International. 

With almost 9000 staff working across 37 countries, MSI works to ensure that reproductive choice is possible through access to advice, contraception, and safe abortion.  

Hang has held the position of Vietnam Country Director for MSI for 18 years. She has been recognised by the Ministry of Health and the international NGO community in Vietnam for her leadership of the most innovative and sustainable foreign NGO in Vietnam.

In this episode we discuss:

• Hang’s work with MSI over the past 18 years.
• The global challenges in satisfying unmet demand for sexual and reproductive health services.
• The specific challenges that women face in accessing sexual and reproductive health services in Vietnam.
• How MSI works in partnership with public and private health service providers, international development organisations, and businesses to expand the availability of essential services and advance women's sexual and reproductive health and rights in Vietnam. 

We encourage you to join the conversation on Twitter at @CentreHealthSec. You can follow MSI Reproductive Choices on Twitter at @msichoices.

Transcript

Please note: We provide transcripts for information purposes only. Anyone accessing our transcripts undertake responsibility for assessing the relevance and accuracy of the content. Before using the material contained in a transcript, the permission of the relevant presenter should be obtained.   

The views presented in this podcast are the views of the host and guests. They do not necessarily represent the views or the official position of the Australian Government. 

Mr Robin Davies 00:22

Hello and welcome to Contain This. I'm Robin Davies. I'd like to acknowledge the Traditional Owners and Custodians of Country throughout Australia and recognise their continuing connection to land, waters, and community. I recently stepped down as head of DFAT’s Global Health Division and the Indo Pacific Centre for Health Security after nearly six years late last year while I was still in the job.

I travelled to Vietnam to talk to a range of people about priorities for Australia's future health assistance. While I was there, I was lucky enough to meet a well-known public health leader, Ms. Hang Nguyen. She's the Vietnam Country Director for MSI Reproductive Choices, formerly Marie Stopes International. In March of this year, I was able to record a fuller conversation with her.

With almost 9000 staff working across 37 countries, MSI works to ensure that reproductive choice is possible through access to advice, contraception, and safe abortion. In this episode, Hang discusses her work with MSI, the global challenges in satisfying unmet demand for sexual and reproductive health services, and the specific challenges that women face in accessing those services in Vietnam.

She talks about how MSI works in partnership with public and private health service providers, international development organisations and businesses to expand the availability of essential services and advance women's sexual and reproductive health and rights in Vietnam. I hope you enjoy the conversation. 

Just before we talk about the role of MSI, globally and in Vietnam. Could you tell us just a bit about yourself I know you've been in your position now for I think 18 years, it would be interesting to to know a bit about your background, how you came to take up the position. 

Ms Hang Nguyen 02:16

Thank you very much, Robin. My name is Ms Hang Nguyen. I'm from Hanoi, Vietnam. I have been working for MSI in Vietnam for more than 25 years now in the role of the country director. And before MSI, I worked in the private sector. And I graduated from the national universities in Vietnam with you know, my English language degree as well as law degrees and later on, I had an MBA degree from the University of Hawaii in Manoa. And I'm very passionate about women's health and sexual and reproductive health and that's the main reason why I've been here for a very long time. 

Mr Robin Davies 03:13

Thank you. I'd like to ask before we talk about the role of MSI in Vietnam. Could you say a little about the global mandate the global role of the organisation

Ms Hang Nguyen 03:26

MSI reproductive choices, and with a previous name as Mary Stopes International has been working in many country in 37 countries since 1976. And the organisation is very specialised in providing sexual and reproductive health education and, and supporting services. And the the mission of our organisation is kind of to provide the fundamental rights to to ensure the fundamental rights of individuals and to have children by choice not by chance. And MSI has a very bold our strategy by 2030, that no abortion will be unsafe. And everyone who needs contraception can access it. And at the heart of this vision is every woman can be in charge of her own body.

Mr Robin Davies 04:26

Can you give us a sense of the scale of the challenge in terms of the level of unmet demand for sexual and reproductive health services? 

Ms Hang Nguyen 04:36

At the global level, although a lot of progresses have been seen. And the use of modern contraception is soaring around the world, with an estimated 371 million women of reproductive age now, using a modern methods of family planning 87 million more than just a decade, compare with 87 million more than just a decade ago. And many more policymakers and governments are beginning to understand that you can’t have a gender equality without access to sexual and reproductive health and rights. However, in many places, access to sexual and reproductive health and rights, it's under attack. You probably know about the recent United States Supreme Court ruling overturning Roe v Wade imperils not only about not only abortion access but also the right to contraception as well. Access to sexual reproductive health and right funding and services have also been disrupted by increasing conflicts, crisis insecurity and just recently with COVID 19 prevention activities, for example, the global hunger crisis, the devastating floods in Pakistan, the ongoing impact of the climate crisis and the conflict in Ukraine have dramatically restricted reproductive choices for women and men. So zooming in the Southeast Asian region, Guttmacher Institute from the US estimated in their report in 2021, that there was 89 million women of reproductive age want to avoid a pregnancy 21 million of them have an unmet need for modern contraception. The unmet need for contraceptive to avoid pregnancy amongst adolescents aged 15 to 19 was 31%. In comparison to 24% among all women aged 15 - 49 and there is 11 million women give birth every year many do not receive needed care. And so the lack of high quality, sexual reproductive health care puts women at risk. Also, according to Guttmacher’s Institute's estimate that 2.4 million women have abortion in unsafe condition, and 16,000 would die from causes related to pregnancy and childbirth, and 10 million do not receive the treatment they need for chlamydia, gonorrhoea, syphilis, and trichomoniasis. So these are the common situation of Southeast Asia countries. 

Mr Robin Davies 07:37

Thank you. Let's move to this the situation specifically in Vietnam. Could you talk a little bit about the challenges that women face in accessing services in Vietnam? 

Ms Hang Nguyen 07:53

In Vietnam, as you probably know, the Vietnam population likely reaches 100 million people in 2023. And the country is in a, in a unique demographic window of opportunity until 2033 With more than 21% of the total population are young people aged 10 to 24 years. And this demographic bonus can be tapped into to accelerate the country's socio-economic growth. Vietnam also made a significant progress in improving sexual and reproductive health and especially family planning services during the past 20 years. And you to you could probably see Vietnam has reduced our fertility total fertility rates from you know, as high as is a three now to the replacement level and it's even lower than the replacement level. Most of the sexual and reproductive health indicator have been significantly improved, and at the policy level, as sexual and reproductive health strategy and action plans integral part of the National Strategy for socio economic development. However, the appalling situation is reported widely by UN and international organisation. First of all, there still disparities and inequalities remain in sexual and reproductive health among different population groups, including ethnic minorities, migrant workers, young people and those living in remote location. And among those who have a different level of education and socio-economic condition. The unmet needs for essential sexual reproductive health services in Vietnam in 2019. And again, this is according to the estimates by the Guttmacher Institute's unmet need for modern contraception is 21% equaling to 3.4 million women, unmet needs among women of 15 to 19 was much higher at 36%. Recently, recent reports published by UNFPA indicated higher unmet need for contraceptive contraceptives due to the impact of COVID 19. According to our operant operation, survey, MSI Vietnam operational survey, the unmet need for contraceptive is much higher among female factory workers ranging from 45% to 48%. Even amongst married or an in-union women. This is, you know, very, very special group. Abortion in Vietnam is still one of the top country with real high cases of abortion in the world. In 2015 to 2019 There was a total of 3.7 million pregnancies annually. And of this, about 2.1 million pregnancies were unintended. And more than 1.6 million ended in abortion. Abortion in Vietnam is it's of course it's legal on request. But of course it's abortion would have a kind of adverse impact on the on the health and mental health as well as physical health of women as well. And there is still low awareness and limited choices of contraceptive methods I have an opportunity to share what you when you visited Vietnam last time about the unmet needs among different women's groups and of course, due to many factors, Vietnam, in general phase with the limited choices for contraceptive methods, especially the effective long-acting contraceptives, as you know, so these are the unmet needs in Vietnam. And it is also, you know, in terms of in terms of STI, or especially cervical cancer, there is a, there's a very, very low usage of the testing, only more than 13% of the women of reproductive age in Vietnam actually have a one test and less than 20% have a second test. And, you know, the cervical cancer screening test is not available at many at most of the public health facility at the at the community level, but it's also not many private providers, offering that services. 

Mr Robin Davies 12:56

Thank you. Could you tell us about the role that MSI reproductive choices plays in Vietnam? How do you work with government? What are your main priorities in Vietnam? 

Ms Hang Nguyen 13:08

MSI in Vietnam, we all our overall objectives is to work with work in partnership with the public and private health partners, and development partners and business partner to expand the availability and accessibility to essential sexual reproductive health services, including contraceptive and safe abortion, post abortion care, STI treatment and cervical scans and screening and preventive treatment, as mean to materialise women's sexual reproductive rights. We focus on increasing the value for money by targeting specific population group with the highest unmet needs, including adolescent and youth, we have the programme reaching out to them for sexual education, and in at the university, secondary schools and also through other other like platform, technical, the tech companies in Vietnam as well. And we also targeted low-income women working in the factories and industrial zones. We have a kind of an ongoing programme, since 2005. Working with all the corporates and suppliers here to bring sexual reproductive health education and supporting services to the factory floor. We also have the programme we call public sector strengthening programme that's a long term programme lasted it lasted for 15 years whereby we continuously and consistently focus on to working with the with the government, the provincial governments department of health as well as the population offices in order to provide training and monitoring the qualities of the public service provider, but also work with other partners to make sure that that commodities as well as as well as the medical supply to be available and available to a to service provider at the community health level for them to provide services. And so, you, you we also focus like on a poor and ethnic remote woman in remote areas and women in the areas that are most affected by climate change. And many of our programmes are actually funded by DFAT and you know, we can cannot say thank to DFAT enough for the trust as well as you know, for, for the continuous support for us to, you know, endeavour to, you know, address the unmet needs for women in Vietnam. You know, our objectives and other objectives in Vietnam is that we want to, to use, like evident to action approach, because you probably know that the health management information system in Vietnam is not really very good. And then there's why many times the policymakers or you know, decision maker who cannot have a, you know, equalities and reliable data and information to make their decision. And that's why we tend to work with the population group with the highest unmet needs and we, we pilot various model and in different contexts, so for example, we work with different groups in the northern mountainous area where the, there's a high concentration of ethnic minorities, but it's also in central high land, we work with women. In factory workers, we work with women in the in Mekong Delta as one so we collect the the datas, on unmet needs and also the availability accessibility and affordability and qualities of the essential reproductive health services from the field to create better understanding. So, you know, either we could share with donors or other organisation like UNFPA and other organisations that work at the policy level for advocate, you know, advocate some more attention and investment in improving sexual reproductive health for women and men. You know, finally, you know, we are a service provider. So we really focus on access to services as well as you know, quality improvement as well. So, that's basically our role in Vietnam. 

Mr Robin Davies 18:04

You've talked about donor financing for your work with low-income groups. MSI also provides services in the private sector, are you able to cross subsidise some of your work with low-income groups from the revenue that you raise in the private sector?

Ms Hang Nguyen 18:23

Yes, we started our work with the private sectors primarily with a big with a retail brand like Adidas in 2005. And we started that programme and later on, we started expanding our relationship to suppliers, you know, DFAT funded our four years programme to work with one of the biggest apparel, shoe manufacturing factories under Pou Chen group in in Vietnam, they had 95,000 When we started with that programme, they had 95,000 workers and 85% of them or were female. And when we conducted our very first baseline survey there as the most the kind of the problems with the reproductive health there is unwanted pregnancy. It there was 30% 30% of the women who deliver who deliver actually want unwanted they have no father. And 40% of the women who go who went on maternity leave have to quit their job because they can they do not have this kind of kindergartens or any facilities on they don't have money to spend on childcare services, and many of them actually have to send their small, young kid to back home to the countryside for their parents to take care of. And, you know, our reproductive tract infection was very high 68 to 70% of the women of the female factory workers had at least one reproductive tract infection and you know, the there's no sexual and reproductive health information available to them at the factory. And of course, there's no, absolutely no family planning no SRH services available on the factory floor. For the female factory workers, although, you know, company like Pou Chen, they invested a lot of money in running their general clinics, you know, it costs them like $1 million a year to run that, that clinics, but basically, they refer most of the most of the cases outside for for treatment. And it's actually impacted directly on the not only on the turnover in general, but it's also impacted their productivity as well. 

Mr Robin Davies 21:28

So I won't ask you about any particular company, but let's say you want to approach an apparel company about providing support or services to, to their workforce, what do you say to them? Do you do you make a case in terms of productivity? Do you make a case in terms of, you know, the rights of their workers, how to how do you actually open that conversation?

Ms Hang Nguyen 21:52

Most of the time, we work with the with the brand, and the retail brands do or they, I think most of them are very supportive of the improving the sexual reproductive rights and health for women, within the these factories, and, and that's why they contributed financial support to this programme. And later on, you know, the suppliers also contributed, as well. So that that's how we like leverage the financial resources from the private sector to for these healthcare. And I think, you know, it was not easy from the very beginning. But then we, it took us many years to work with the senior management, senior management's and to provide information as well as, you know, knowledge on sexual reproductive health. And we also conducted some kind of operational survey, in order to have a very initial evidence on on the impact on productivity, absenteeism, as well. For example, at one factory, we had, we had a data that, you know, averagely one female factory workers spend 14 days off work a year on or sexual reproductive health, women's health related issues. So it's actually impact have a direct impact on the productivity of the business.

Mr Robin Davies 23:51

And again, I mean, without asking about any particular company, to what extent are these businesses willing to finance your services? Do they contribute just a little? Or are they increasingly taking on responsibility for fully financing the provision of the services to their workers? 

Ms Hang Nguyen 24:13

I think most of the it's the level of commitments and the level of investments is actually varies from one to another. Some, some willing to provide financial support, it's like in like under the under the forms of like a contractual service contract for us to come in and provide education services as well as supporting services and they pay for that. But some is actually only limit themselves in in providing sexual and reproductive health education only. So there are different level, but when they realise that they realise the importance of investing and women's health, I think most of them feel like you know, they are willing to put aside their financial resources to do that. I think, I think one of the one of the main barriers and one of the main challenges for us as an NGO to really engage the private sectors into investing, but not only investing financial resource, but especially like committing their, the management commitment to facilitate the activities within the factories, it is also a very important factors. Some invest money in but they, they feel reluctant, or at least it is the middle management, not the top management where the top management say this is very important for us and we should do that. But the middle management because it is social activities, it's not part of their KPI and that's why, you know, most of the time they say, oh, why, you know, they probably don't say anything, but then they will feel very reluctant to the workers to have the time off, to have the time off to attend this kind of on site, education section. And this is one of the ongoing challenges that make MSI in Vietnam, change our approach to, you know, to sexual, sexual education to develop the digital platform, so workers can access to information at their time, convenient time. So, yeah, so that's why the, I think, why the general attention, general intention is good. And everybody see, it isn't, there's a need to do that. But I think the level of commitment is still low. And on the on the NGO side, I think there is still the lack of really compelling business case. And then also the programme should be actually tailor to tailor to, you know, the bottom line, like, I mean, the, the business results, or any kind of social incentive for them. I don't think we we have done that we, we are a service provider, or we are very good at providing education, counselling and services, but we are advocating at, at a higher level is, you know, our core competency.

Mr Robin Davies 27:59

Now, obviously, your priority is to work in a cooperative way with these companies, whether they're apparel companies or electronics companies, but are there some circumstances where you find it impossible to work with a company? And you might make a public statement about their work practices? Or do you prefer to just keep trying to bring them on board?

Ms Hang Nguyen 28:24

I think, oh, that's, that's a very good question. Because that's one of the ones one of the main challenge for us, for example, you know, we have been, there is a brand, and we have been trying to approach them to in different ways, and we, we could conduct this kind of survey with their workers and about, you know, the unmet need, as well as the general practices in order to prove to them that that Oh, okay. Yeah, why you pay your employees, you know, at the high rates within the market, but obviously, they have a, they have these issues, and it's actually impact on your business. But, you know, for almost 10 years, we could never, we could never, you know, they never opened the door for us. And because I think there is a common thinking that they that's exactly what you just say that they they consider NGOs like the watchdog, and they never want you know, their internal practices to be known and to be public. And that's why we normally don't, you know, we don't public any of these practices, we use this as evidence to discuss with development donor with donors like DFAT, I think we came into this kind of conversation with you know, many times with DFAT before and other and we also talked to the brand as well, you know, sometimes supplier suppliers sometime don't want their, their buyer to know about all these issues and, and so we must be very tactful and we and most of the time we have to choose an indirect way.

Mr Robin Davies 30:20

It must be a delicate balance as a service delivery organisation, it's not easy to flip into advocacy mode. I wanted to ask you about the impact of the pandemic on Vietnam's health system and particularly on the delivery of sexual and reproductive health services. Now, Vietnam, of course, had some extremely strict lockdowns in place for quite a long time. Have you seen the flow on effects of all of that on service delivery? And are you now having to, I guess, rectify some of the gaps that emerged during the last two or three years.

Ms Hang Nguyen 31:03

I think COVID-19 has actually placed a lot of burdens on the health system in Vietnam. And of course, there was the title pre COVID issues in terms of providing essential reproductive health care services like you know, still like limited choice for contraceptives and, and shortage of commodities, things like that there is a pre COVID issues and with COVID It's actually accelerate accelerated the problem make it more serious. And, you know, UNFPA is actually conducted this kind of research on impacts of the COVID on you know different population in Vietnam, but in general, you know, COVID took away a lot of health resources. Before COVID, Vietnam, the national government, the national government has already decided not to, not to provide kind of free commodities from the national budgets, that kind of responsibilities already passed on to the provincial level. But then the, but with the, with the COVID. It's even, there's no support at all of the commodities to the to the public sector. And I think the most of the most of the service provider at the communal level as well you know, the district level they will or most of them were utilised for other COVID prevention activities in this way, you know, both in terms of the financial resources, as well as the human resources, they were all concentrated in on COVID prevention. So, you know, there's no one actually talks about family planning and you know, and of course, because of the lack of this and the lack of contraceptive methods, we do not why we do not have the kind of realistic data, but obviously, among our private provider networks, there was the level of requests for abortion was increased significantly and also you know, the private sector will actually try to do some kind of online by telephone questionings and you know, getting the information and also send medical abortion pill to them. So many of them many of them actually with the lockdown, they probably decided to go ahead with the with the pregnancy, of course.

Mr Robin Davies 34:13

Finally, can I ask you about your, I guess your vision for the for the next few years? What would you hope that MSI is able to achieve in Vietnam in the coming years, obviously, dealing with that legacy of COVID and its impact on service delivery. But where would you hope to be in a few years’ time?

Ms Hang Nguyen 34:38

We would hope that we would be able to continue to target to focus on the on the target population book like adolescent and youth and adolescent Are you factory workers and women in remote rural areas to you know, to help them to address their unmet needs in in family in contraceptives, as well as, you know, abortion. But we also i understand, I understand that MSI in the region is actually apply is applying for a cervical cancer screening programme within, you know, the financial support from DFAT, so we just hope that we will be able to, to work more on cervical cancer screening, while we continue our core support to, to women in in Vietnam, and we will focus a lot more on working with young people, I understand, you know, young people in Vietnam, you know 21% of the people from 10 to 24. And, and, and there are so many young women's who, joining the workforce within the workforce within the big city. So, we will, will identify the the points that we can reach out to them. And at the moment, we are in discussion with a with a tech company that we recruit young people and train them and provide them provide human resource to the food and beverage industry in Vietnam, which is, you know, with high the high-rate turnovers and the low level of skill. And that would actually impact directly on the on the, the economic development in Vietnam, which is also a form of empowering young people, to many of them, kind of students, so they could have a part time work to, to, to earn money to continue their education, but it's also to develop their financial securities in city as well. So that's one of the biggest focus for us. But on the other on the other hand, you know, we'll continue serving the factory workers, you know, there's still a lot of women who need contraceptives and, you know, find, like women's health services there. And on our public sector strengthening we, we already established a network of 3000 qualified public service provider within 20 provinces, and it's very easy for us to really help them to expand the coverage of essential family planning services. So, and DFAT and Australian government funded us to, in many in many projects funded us to develop that kind of network of public service provider and private service provider now and so I'm very confident that now it's easy for us to, to work like a result based like kinda on a result-based contract to deliver services to different population groups. And we also hope that we are very, we are quite aggressive in working with the corporate sector, we are working with the Apple group now in Vietnam. And since actually I have to say, kind of that DFAT programme response has actually provided us with a great opportunity to really leverage our reputation, donor reputation and our mandatary to go into these kind of provinces. And, and so, you know, to attract the attention, as well as you know, and commitment by big brand like Apple, Samsung's and other big brands who are using a lot of, you know, what, forces is in Vietnam. So that's, and so that's my hope.

Mr Robin Davies 39:20

Thank you that that's an enormous agenda. So I won't ask any further questions, but I do want to thank you very much for giving us this insight into how MSI reproductive choices works in Vietnam, and giving us the benefit of your very long experience there. There must be a lot of people hoping that you are never going to retire. So thank you very much. 

You've been listening to Hang Nguyen, Country Director for MSI Reproductive Choices in Vietnam. I hope you've enjoyed the conversation. I'm Robin Davies, the outgoing Head of DFAT’s Global Health Division and the Indo Pacific Centre for Health Security. Contain This aims to bring you fresh insights, analysis and updates on issues and developments shaping the health of our region. We look forward to having your company on the next episode.