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GLOBAL DEBATES, LOCAL DILEMMAS Sex-Selective Abortion in Contemporary Viet Nam

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GLOBAL DEBATES, LOCAL DILEMMAS Sex-Selective Abortion in Contemporary Viet Nam GLOBAL DEBATES, LOCAL DILEMMAS Sex-selective Abortion in Contemporary Viet Nam GLOBAL DEBATES, LOCAL DILEMMAS Sex-selective Abortion in Contemporary Viet Nam TRAN MINH HANG VIETNAM SERIES In memory of my father and for my family Published by ANU Press The Australian National University Acton ACT 2601, Australia Email: [email protected] Available to download for free at press.anu.edu.au ISBN (print): 9781760462420 ISBN (online): 9781760462437 WorldCat (print): 1079011471 WorldCat (online): 1079011443 DOI: 10.22459/GDLD.2018 This title is published under a Creative Commons Attribution-NonCommercial- NoDerivatives 4.0 International (CC BY-NC-ND 4.0). The full licence terms are available at creativecommons.org/licenses/by-nc-nd/4.0/legalcode Cover design and layout by ANU Press This edition © 2018 ANU Press Contents Acknowledgements . ix Abbreviations . xi Glossary . xiii Introduction . 1 1 . Chasing the gender dream . 25 2 . Sex-selective abortion decision-making: Beyond ‘a woman’s right to choose’ . 57 3 . Sex-selective abortion: Dilemmas in the silence . 91 4 . After the abortion: Suffering, silence and spiritual relief . 125 5 . Social responses to sex-selective abortion . 157 Conclusion . 185 Bibliography . 195 Acknowledgements There is a Vietnamese saying: ‘Uống nước nhớ nguồn [When drinking water, remember its source]’. This book would not have been possible without the contribution of numerous people and institutions. I owe a profound debt of gratitude to the study participants for contributing their valuable time and for sharing with me the intimate details of their lives. This book is dedicated to advocates for women’s reproductive health in Việt Nam. This research was supported by the Harvard–Yenching Institute. I am thankful for the kind assistance of the institute’s staff, especially Professor Tu Weiming, Professor Elizabeth Perry, Dr Nguyễn Nam and Mrs Susan Alpert. This book is based on my PhD thesis, which was completed at The Australian National University. The book was made possible by a generous grant from the 2015 ANU Vietnam Writing Fellowship and the 2017 ANU Publication Subsidy Fund. I would like to thank Professor Ken George, Melissa Orr and Anthony Chan for their great support, and Dr Carolyn Brewer, Jan Borrie, Emily Hazlewood, Teresa Prowse and staff of ANU Press for their assistance in editing and preparing this book for publication. I am most deeply indebted to Professor Philip Taylor, who provided me with unflagging support throughout my studies and helpful advice on all the steps in writing this book. I benefited a great deal from the expert advice provided by members of my supervisory panel: Professors Philip Taylor, Tine Gammeltoft, Kathryn Robinson and Terence Hull, and Associate Professor Christine Phillips. I am indebted to Professor Annika Johansson, Professor Monique Skidmore and Dr Jennifer Alexander for their intellectual support. I am grateful to my colleagues at The Australian National University. My heartfelt thanks also go ix GlobAl DebAteS, locAl DilemmAS to Professor Kent Andersen and Professor Alan Rumsey, as well as Stephen Meatheringham, Fay Castles, Jo Bushby and Pen Judd for their generous support in smoothing out administrative issues. In Hà Nội, I benefited from the cooperation and friendship of Dr Nguyễn Quốc Anh, Dr Nguyễn Duy Khê, Nguyễn Huy Bạo, Nguyễn Văn Minh, Phạm Ngọc Bỉnh, Vũ Thị Vân, Hoàng Tú Anh and Nguyễn Song Hà. I am also thankful for the assistance provided by the following institutions and organisations: the General Office for Population and Family Planning, the Department of Maternal and Child Health of the Ministry of Health, the health promotion consultancy group CIHP, and the hospitals and clinics where I conducted this research. I wish to express my gratitude to all staff of the Institute of Anthropology in Hà Nội, with particular thanks to Associate Professors Phạm Quang Hoan, Vương Xuân Tình, Nguyễn Ngọc Thanh and Nguyễn Văn Minh for encouraging me and giving me leave of absence to go abroad for further study. I am particularly indebted to my parents, my sisters and my brothers. I can never fully express my gratitude to my husband, Đỗ Văn Dũng, and my children, Đỗ Minh Quân and Đỗ Minh Hiếu, for providing me with continuous encouragement and emotional support. x Abbreviations CVS chorionic villus sampling D&E dilatation and evacuation GOPFP General Office for Population and Family Planning ICPD International Conference on Population and Development IPAS International Projects Assistance Services IUD intrauterine contraceptive device LH luteinising hormone MOH Ministry of Health NSGs National Standards and Guidelines for Reproductive Health Services SRB sex ratio at birth UN United Nations UNFPA United Nations Population Fund US$ United States dollar VND Vietnamese dong WHO World Health Organization xi Glossary Bà cô Spirit of unmarried female lineage member Bất hiếu Filial impiety Cảnh giới Specific realm Canh trứng Detecting ovulation Cắt tử cung cả khối Total hysterectomy Cầu tự Praying for a child Chết oan Unnatural death Có thờ có thiêng; To worship is to have sanctity; có kiêng có lành to abstain is to have goodness Đàn lễ giải nghiệp Incarnation-freeing ritual Đầu thai cửa khác Reincarnated into another family Đổi Mới Renovation Lễ cầu siêu Requiem ritual Lễ cầu siêu cho thai Requiem ritual for foetus Phá thai to Late-term abortion Ruộng sâu, trâu nái, không Having a piece of fertile land and a fertile bằng con gái đầu lòng buffalo is not as valuable as having a daughter as your first child Tam nam bất phú, tứ nữ With three sons, one will not be rich; with bất bần four girls, one will not be poor Thừa tự Male heir Tổ tiên Ancestor spirits Trời sinh voi; Trời sinh cỏ God gives elephants; God gives grass xiii Introduction On a rainy day in the summer of 2003, I met Hương1 and her husband in an obstetrics and gynaecology hospital in Hà Nội sitting on a bench outside the ultrasound room. I was in the hospital undertaking a research project on prenatal screening in Việt Nam.2 The couple looked anxious as they waited for a three-dimensional ultrasound scan. Hương borrowed my pen to fill in her medical admissions form. I took this opportunity to ask her about her pregnancy. I learnt that the couple were doctors who worked for a provincial hospital about 100 kilometres from Hà Nội. They already had one daughter and Hương was 14 weeks pregnant. ‘I will only fulfil my obligations to my husband’s family if I have a son,’ she said. ‘If I have no son, my husband’s lineage will be considered extinct.’ The couple’s worries began when a two-dimensional ultrasound scan at the provincial hospital where they worked revealed Hương’s foetus was female. If they proceeded with this pregnancy and then later tried for a son, they would violate the country’s two-child policy. So, they had come to Hà Nội for a three- dimensional scan3 to obtain a more accurate diagnosis of the sex of the foetus. Hương confided to me tearfully that she would have an abortion if the ultrasound showed conclusively that she was carrying a female baby. 1 All personal names given in this book are pseudonyms. 2 Funded by the Danish International Development Agency, the project’s title was ‘Population, Development and New Reproductive Health Technology: Pre-natal screening in Việt Nam’. 3 Prenatal ultrasonography is the use of high-frequency soundwaves, which pass through the abdomen with the aid of a transducer to generate a video or image of the foetus. Three- dimensional ultrasonography is equivalent to two-dimensional ultrasound, but it also releases soundwaves from different directions and consequently makes a life-like image that plainly shows the characteristics of the foetus. 1 GlobAl DebAteS, locAl DilemmAS My conversation with Hương has stayed with me to this day. She was just one among a number of women I met in that hospital who were using ultrasonography to diagnose the sex of their foetus. Her story offered a glimpse into how new reproductive technologies were being utilised in Việt Nam, and it was my first evidence that some women were using them to prepare the way for, and obtain, a sex-selective abortion. Meeting Hương made me eager to learn more about such contemporary forms of reproductive agency and to better understand the motives, circumstances and experiences of women who use technology to change their reproductive destiny. In the early 2000s, there was a dispute about whether the sex ratio at birth (SRB)—the ratio of males to females at birth—was increasing in Việt Nam. Hospital data on the SRB suggested that some Vietnamese families might have been resorting to sex-selective abortion. Data collected on all births at two major hospitals in 2001—one in Hà Nội (9,924 cases) and the other in Hồ Chí Minh City (29,437 cases)— indicated that mothers who were government employees tended to have a higher SRB for third-born or higher birth order children (Bélanger et al. 2003). The National Census of Population and Housing in 1999, however, recorded Việt Nam’s SRB as 107, which was not far above the global standard (105 boys to 100 girls),4 and demographers had no evidence on the use of sex-selective abortion in the country (Bélanger et al. 2003; UNFPA 2007). In a discussion of the issue, Danièle Bélanger and Khuat Thi Hai Oanh (2009) concluded that it remained an open question whether or not sex selection was occurring in Việt Nam. Despite mounting evidence of an imbalanced SRB in Việt Nam (Guilmoto et al. 2009; UNFPA 2012, 2015), whether or not sex-selective abortions are occurring is in dispute. When I began research for this book in 2009, I believed an ethnographic study could provide a definitive answer to this question, while also offering insights into the circumstances of those involved in sex-selection practices and the meaning sex-selective abortion held for them.
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