HA NOI—In an effort to make childbirth safer for ethnic minority women, who typically give birth at home, Viet Nam has trained 1,000 minority midwives from 30 provinces. Chamaléa Thi Thue, from the Rac Lay ethnic group, is one of them.
After nearly six years working as a midwife, she says, “Now I feel confident providing family planning services and pre- and post-natal care, and attending normal deliveries. And I know how to refer complicated cases to higher levels so they can get the needed care.”
Six years ago, Thue participated in a six-month midwifery training organized by the Ministry of Health with the support of UNFPA, the United Nations Population Fund. The exercise involved midwives from different ethnic minorities as a way to reach remote communities where many people are not aware of the benefits of giving birth with skilled assistance at a commune health centre or a hospital.
"Rac Lay people prefer to give birth at home, rather than at hospitals or a health centre. We feel shy to deliver at the health care centre because there are too many people around," explains Thue. Unattended home deliveries and traditional cultural practices have led to many tragic deaths in these remote areas of the country.
Understanding the language, culture and belief system of an ethnic group is key to gaining trust and encouraging women to receive appropriate health services. “At first, many women did not pay attention to my advice,” says Thue. “I spent a lot time explaining the benefits of giving birth at the commune health centre. Happily, I persuaded many women to go to the centre for regular health check-ups and to give birth. There were still some women who did not want to go, so I visited them regularly and assisted them when they delivered at home.”
According to the Ministry of Health the maternal and infant mortality rates in remote and mountainous areas are three to four times higher than those in the delta regions of the country. Over 50 per cent of women in mountainous provinces give birth at home. "Without trained health workers, especially ethnic minority midwives with midwifery skills, pregnant women and newborns will continue to die needlessly, particularly in hard-to-reach areas," explains Mandeep K. O'Brien, UNFPA Deputy Representative in Viet Nam.
Skilled health personnel attend 88 per cent of births in Viet Nam. To increase this proportion and reduce maternal and newborn mortality rates, the Government is investing in human resources for maternal and newborn health. As part of this programme, trained professionals like Thue are now officially recognized ethnic minority midwives explicitly tasked with providing maternal and child health care services in remote and mountainous areas where women usually give birth at home.
This recognition implies that midwives will receive a monthly allowance from the state budget, as part of a strategy that aims to keep trained midwives on the job and increase safe motherhood services in remote areas. The strategy complements efforts to ensure that the health system has adequate infrastructure, equipment, drugs, communications and transport networks and comprehensive emergency care.
“Investing in human resources for health, especially at village level, is one of the soundest investments a country can make,” O'Brien emphasizes. “If village health workers, including ethnic minority midwives, are empowered to provide the services they are trained to deliver, we will save many lives and also improve the nation’s economic and social productivity.”
