The difficult problem of achieving replacement fertility in Nghe An

Record high birth rate

While the whole country has reached the replacement level of fertility and continuously maintained the total fertility rate (the average number of children per woman of childbearing age) at below 2.1 children for over 10 years, in Nghe An, reaching the replacement level of fertility is still quite difficult. CurrentlypopulationNghe An has over 3.3 million people, ranking 4th in the country. The large scale combined with the still high birth rate makes reducing birth rate still a challenge every year.

Nghe An is one of the provinces with the highest birth rate in the country. Having too many children puts a lot of pressure on the education, health care and many other sectors. Photo: Duc Anh

The 2019 provincial population census also showed that Nghe An's fertility rate has changed a lot over the past decade and is at a high level compared to the national average and above the replacement level. In particular, the estimated total fertility rate (TFR) 6 from the 2019 Census results is 2.75 children/woman, above the replacement level. In addition, the total fertility rate continues to increase from 2.55 children/woman in 2009 to 2.75 children/woman in 2019.

Even in 2017, it reached 2.87 children/woman and was the highest birth rate in the period 2009 - 2019, possibly due to the psychology of wanting to give birth in a good year. Nghe An's population is at over 3.3 million people with a high crude birth rate (20.8 live births/1,000 people), which is an alarming number for the highest birth rate compared to the provinces in the North Central region, Central Coast and higher than the average birth rate of the whole country (the whole country: 16.3 live births/1,000 people).

Regarding the birth rate in Nghe An, there are also many things to ponder because the birth rate in rural areas is increasing quite rapidly while the birth rate in urban areas is decreasing. In recent years, the total birth rate in rural and urban areas has changed, specifically in the period 2015 - 2019, if in the areacountrysideincreased quite rapidly from 2.54 children/woman in 2015 to 2.82 children/woman in 2019, while in urban areas it decreased from 3.43 children/woman in 2015 to 2.32 children/woman in 2019.

Consulting people in Dien Chau district about reducing births. Photo: MH

The analysis also shows that the age-specific fertility rate in urban areas is not only lower but also lags behind that in rural areas, meaning that urban women give birth later and have fewer children than rural women. Another difference is that the adolescent age group (15-19 years old) in rural areas has an age-specific fertility rate 1.5 times higher than that in urban areas.

Currently, in the whole province, the proportion of underage women giving birth accounts for 2.2‰, of which the highest is in the highlands (9.8‰), 12 times higher than in the plains (0.8‰). The lowlands are the region with the second highest rate of women aged 10-17 giving birth (1.6‰). The explanation for this difference is due to difficult living conditions, limited propaganda work to raise awareness about maternal and child health, reproductive health, and the impact of early marriage and childbirth on the health of mothers and children. Another reason is the customs of ethnic minorities regarding early marriage and childbirth. The rate of women aged 10-17 giving birth in rural areas is 2.4‰, 3 times higher than in urban areas (2.6‰).

Struggling with birth rate reduction

Faced with a still high birth rate, Nghe An strives to achieve a natural population growth target of no more than 1% per year in the 2020-2025 period, and to sustainably reduce the birth rate of the third child or more by 0.3% per year in order to reach the replacement birth rate by 2030.

However, achieving this goal is still very difficult because the province's population development is currently revealing many shortcomings in terms of scale, structure, quality and population distribution. Specifically, Nghe An is still the province with the largest population, ranking 4th in the country, with a high population density (202 people/km²) and the province has the second highest birth rate in the country (after Ha Tinh province). In addition, the third child birth rate has not decreased, the gender imbalance rate at birth is at an alarming level (114 boys/100 girls). Although the population quality has been improved, it is still low, especially in remote, rural and coastal areas.

People of Thai Hoa town learn about population policy. Photo: MH

One of the barriers that makes it difficult to reduce births is that the rate of having three or more children in the province is still very high, accounting for over 28%, even over 30% in many localities. Previously, from 2009 to 2019, within 10 years, the ratethird childin the whole province increased by 6.92%.

Over the past decade, the rate of women giving birth to a third child or more in rural areas has been 1.4 times higher than in urban areas, and this rate tends to decrease more in rural areas than in urban areas. This also explains why the current trend of giving birth to a third child or more is concentrated mainly in well-off families with economic conditions and urban areas.

Meanwhile, the propaganda of birth reduction still faces many difficulties when the mechanisms to punish violations are currently loosened. In some localities in the province, the work of advising the Party Committee and the government in leading, directing and investing resources for population work has not received due attention; there is no coordination and integration of the goals and targets of population work with programs and plans at the local and unit levels. Another objective reason is that the number of women entering childbearing age in the province is increasing, especially the age group with high birth rates from 22 to 29 years old, which is causing the birth rate to increase.

People in Thanh Chuong district register for reproductive health examination services. Photo: MH

To implement the Vietnam population strategy for the period 2020 - 2025, with a view to 2030, and to achieve the goal of achieving replacement fertility, Nghe An has also issued many policies and action programs, including Plan 456/KH-UBND issued at the end of August 2020. Thereby, the main purpose is to synchronously, promptly and effectively implement the goals, tasks and solutions set out in the Vietnam Population Strategy to 2030.

At the same time, create a strong change in the awareness and actions of Party committees, authorities at all levels, the political system and the people towards population work in the new situation. In particular, it is necessary to clearly define the main contents and tasks for departments, branches and localities to develop programs and plans to organize the implementation, inspection, supervision and evaluation of the implementation of the Population Strategy.

The head of the provincial population sector also said that in the current context, in order to effectively implement population work, it is necessary to continue to review, improve and supplement population policy mechanisms. Focus on current support and incentive policies such as encouraging couples, families, collectives and communities to not have a third child or more; supporting people to implement family planning services, including contraceptives; training and supporting service providers and advocates for family planning... At the same time, it is necessary to develop the network and improve the quality of population services and ensure resources for the population sector to operate and achieve the set goals.