Thứ Ba, 30 tháng 8, 2011

Theoretical Framework: Sexuality in Vietnam

Theoretical Framework: Sexuality in Vietnam

Changing Vietnam
It would be difficult to deny that Vietnam is rapidly changing. Vietnam is literally building on its future, considering all the construction sites, which can be found in nearly every street of any city. The economic development is the result of a shift from a socialist economic system to a more liberal and open system. This new openness, in Vietnam referred to as Doi Moi, started in the late 1980s. Initially it expressed itself in the decollectivization of  agricultural production, which resulted in an enormous growth of export[1]. But also other sectors of the economy grew impressively. The economic development changed Vietnam from a low income country to a lower middle income country in the year 2010[2], although the welfare and growth is far from equally divided between urban and rural areas. The rapid change is especially apparent in the big cities, like Ho Chi Minh City and Hanoi, which attract a vast amount of foreign investment, far more than in the countryside.
Change and development are visible and tangible in many ways and aren’t limited to the economy alone. Gammeltoft (2002, in Hoang Tu Anh et all, 2008: S107) says about Hanoi:

 Since the adaption of the economic reform policy […], the surface and atmosphere in the city of Hanoi have changed dramatically. Glittering neon signs and colorful billboard advertisements announce the arrival of the market economy, young women ride their Honda Dreams, wearing fancy hats, sunglasses and miniskirts, the tones of Western pop music seep out from CD stores and mix with loud roars of motorbikes, and privately owned shops, cafés and restaurants have cropped up throughout the city.

The social impact of the economic change is enormous. The market economy made social life more open and relaxed. There is less control on citizens, more access to information and travelling, enhanced religious activity, and growing influence of cultural and recreational spheres (Phuong An Nguyen, 2007: 287-8). Internationalization is influencing society in many aspects, in which the influence of neighboring Asian countries is at least as big as western influence, with Japanese karaoke bars, Korean soap operas and pop idols, trendy new motorbikes and many other foreign consumer goods. The social change also means a change of values, norms, ideas and practices. Tensions between new modern notions and more traditional values are especially notable in the field of love, sex, and marriage, where new liberal notions and practices replace and reformulate gradually old ones and lead to new trends in sexuality, especially for today’s youth of Vietnam.

The sexualization of society
Despite the illegal status of prostitution in Vietnam and despite state censorship on pornography and  media that ‘stimulates curiosity’ (Nguyen Bich Thuan and Thomas, 2004: 134), the market economy definitely brought a certain amount of sexualization of society. New images of love, marriage, romance, sexual intimacy and sexual relations coexist with more market opportunities and freedoms (Phinney, 2008: 652-3). Unintended consequences of the Doi moi politics in this field include the commercialization and sexualization of men’s leisure activities in which women are often used to attract customers and a growing sex industry, which promotes, especially in combination with more travel opportunities, premarital and extramarital sex for men and leads to a new male identity in which it is important to show off with women towards each other (Phinney, 2008: 653).  Consequences for women include new images of femininity and beauty, which are influenced by the images of the entertainment industry, the mass media, and advertisement (Nguyen Bich Thuan and Thomas, 2004: 135). In urban elites more and more money is spend on bodies, cloths, cosmetics, tattoos, hair and beauty salons, whitening creams etc and beauty concerns for women are growing. (Nguyen Bich Thuan and Thomas, 2004: 142-4 ‘from model citizens to models’).

Social change, youth and sexuality
Current trends in sexuality, mainly find their way into society via an emerging youth culture. Youth is most susceptible for socioeconomic changes, far more than for older people. The reality in which youth identities are formed sometimes clash with the expectations of society and elder generations. The youth has long been seen, by the socialist party, as vanguard of the socialist revolution, but is now also associated with the so-called ‘social evils’, like alcohol addiction, drug abuse, prostitution and crimes. Although the party is still positive about the youth, about its ‘activeness, vitality, responsiveness to social change and bravery’, it is also worried. (Phuong An Nguyen, 2007: 288). New notions about sex often lead to conflicts within families. Especially girls often have arguments with their parents about cloths, boyfriends, and sexuality (Nguyen Bich Thuan and Thomas, 2004: 146).

History of Values: Tradition, Colonialism, Socialism and the Free Market
So how did the values of sexuality change over time. A brief history report:
1.     In traditional Vietnam the strongly patriarchal and hierarchal Confucian philosophy was the ruling norm. Premarital sex and unwanted pregnancy were strongly condemned, and in general women were more blamed for that than men. Marriage was highly valuated in Confucianism and the only way, at least for women, to get into sexual relationships. For women Confucianism prescribes chastity – for dignity, morality, and reputation – before the marriage and faithfulness and devotion to the husband during the marriage. For men chastity was formally required as well, but practically often not achieved. For men it was also possible to have more than one wife.
2.     French colonialism influenced urban elites and introduced new notions such as feminism, women’s rights, individualism, personal freedom, free marriage, romantic love and suicide.
3.     Socialism also stressed the equality of men and women. Furthermore the state was directly involved in people’s lives in many ways. Marriage, for example, needed official state approval which involved checking life histories[3] of the bride and groom. In choosing spouses the political background of the spouse’s family became important. (Phuong An Nguyen, 2007: 294-6; Bélanger et al, 2001; Nguyen Thi Thuy Hanh, 2009)
4.     Current trends in youth sexuality – emerged by the influence of market reforms on moral codes, values, and perception –  include premarital sex, unmarried cohabitation, multiple dating, and internet dating (Phuong An Nguyen, 2007). In the same time traditional values, especially propriety and chastity for women, continue to stay important too (Phuong An Nguyen, 2007; Trang Quach, 2008). In the following paragraphs we will discuss the current continuities and discontinuities in the perception of sexuality

Marriage, establishing a family, and sex are still seen as inseparable in Vietnam, although underlying values and practices around it are gradually changing. The choice of a partner is more free than ever and, although formally people often still ask permission for engagement to their parents, the actual influence of parents is waning. The most important reason for engagement nowadays is a love relationship (Bélanger et al, 2001). Marriage based on romantic love[4] isn’t a new idea in Vietnam, but it is a relatively new practice. Also young people are more focused on education and careers than former generations which make them delay the moment of marriage, especially in urban areas. This lengthens the period of sexual experimentation (Phuong An Nguyen, 2007: 309). This is extra problematic for women, because of the ideas about the ideal age for marriage. For men it is fully accepted to marry somewhere in their thirties, whereas women are reckoned old at that age (Bélanger et al., 2002).

Premarital Sex
Since sex is traditionally seen as inseparable from marriage premarital sex is still seen as undesirable, although it gets gradually more accepted and acknowledged. It occurs in many ways – with stable partners, casual partners and prostitutes – and for various reasons – often ‘romantic reasons’, but also for pleasure and other reasons that are detached from reproduction. For men premarital sex can be with girlfriends or prostitutes, for women it should be with serious boyfriends. The parents involvement with girls is bigger than with boys. They try to extent their  virginity as long as possible. Despite the growing openness about the topic premarital sex, and especially unwanted pregnancies that result from it, can still be reason for a lot of shame. (Phuong An Nguyen, 2007: 301-4)

Dating (multiple dating and internet dating)
Dating becomes more popular. People date mainly to find romantic love and possible marriage candidates, but also to find casual relations, to experiment, or for commercial sex. Sometimes people date more people at the same time. The initiative is supposed to be with the man, whereas  women play the role of the inexperienced innocent girl, which resists to sex and never seduces, but give the man the change to let him seduce her (Trang Quach, 2008). Internet dating is getting more popular as well. Initially internet dating was something of the elite, since internet access wasn’t as common as it is today. This made internet dating partners more likely to be high educated and wealthy. Nowadays it gets more common outside the elite as well. Internet offers the advantages of privacy, especially because it is not controlled by parents. Sometimes today’s youth is referred to as ‘the @ generation’ (Nguyen Bich Thuan and Thomas, 2004: 137), since internet became such an important part of their lives. Government censorship of the internet becomes less. After chatting, the most popular activity on the internet is viewing pornographic material. Also ‘new’ and ‘foreign’ lifestyles are promoted on the internet, certain beauty ideals for example (Phuong An Nguyen, 2007: 305-8, Duc Anh Ngo, 2008: s203-4). And internet gives the opportunity to find and share information about sex that wasn’t taught on school[5] or learned from parents and the opportunity to express sexual desires and form sexual identities. (Anh Duc Ngo et al, 2008: s201)

Unmarried Cohabitation
Unmarried cohabitation is rising in popularity, especially for people living in urban areas, but not themselves from these areas, away from the support and supervision of the family. The Marriage and Family Law of 2000 recognizes the phenomenon. It is now legal to get children out of such relations, but this ‘progressive law’ is not perceived well among everybody. (Phuong An Nguyen, 2007: 304)

Another problem that derives from the strong association of marriage, sex, and family is the stigma and taboo about homosexuality. Homosexuality is not normal nor acceptable in Vietnam. It never was explicitly illegal, but it is often seen as deviant, and subject to social stigma and discrimination. Men who have sex with men (MSM)[6] often keep their identities and desires secret, but since recently there are more opportunities and freedom for sexual expression for homosexuals. Especially the internet provides many possibilities (Duc Anh Ngo et al, 2009: 252)[7].
Youth Sexuality and Sexual Health
How do the current trends in youth sexuality effect sexual health? And how are current policies tackling these issues? A denial or disapproval of premarital and/ or extramarital sex by policy makers can be fatal.  Gammeltoft (2002 in Trang Quach, 2008: s158) puts it in the following words:

“In the context of Vietnam the general societal condemnation of pre-marital sex makes it difficult not only for youth to acknowledge their own sexuality, but also for policy makers and program managers to respond to the needs of youth”

The message to the youth in general is not to have safe sex, but to have no sex. Contraceptive methods are almost only used within marriage, because it is viewed as irrelevant for people who are not married and thus are not supposed to have sex[8]. This hinders programs that want to prevent HIV/AIDS and STDs. It also might be one of the reasons that Vietnam, despite enough contraceptive means and policies available, has the highest abortion rate in the world (Nguyen Thi Thuy Hanh, 2009; Hoang Tu Anh et al, 2008)[9][10]. Besides the focus on married people contraception policies are also almost exclusively focused on women, who are seen as responsible in this case[11].  Men have their own sexual health concerns. For example excessive drinking and smoking can affect their sexual health, as well as social stress does (Vu Hong Phong, 2008). Policy makers see youth sexuality mostly as problematic, instead of acknowledge it. Policies are usually not focused on the joy and pleasure one can have out of sexual relations, which is in the end also important for sexual well being, but instead focus on  fear, guilt and shame (Trang Quach, 2008: s158). Another tendency seems to be to see young people as victims of social change, although they are also active agents of change (Trang Quach, 2008). All in all it seems that policies aren’t working well enough to gain a better sexual health situation. Policy change, in which youth sexuality is recognized and concerns of young people are taken serious, seems to be needed.

Research question
This research tries to explore perceptions of sexuality and current sexual trends in central Vietnam. Whereas other research mainly was done in the big cities of Hanoi and Ho Chi Minh City, this research was done in a much smaller city, Hue, and in the rural area of Nam Dong. This gives us the opportunity to compare the impact of new notions and trends in sexuality from an urban area with a rural area. Furthermore we compare the situation of ethnic Kinh (in Hue and Nam Dong) with the situation of ethnic Catu (in Nam Dong). Furthermore, like other research that was done before, this research is concerned with the impact and consequences of the current trends in sexuality on the sexual health of young people in Vietnam today. The research question was:

What are new trends in youth sexuality in Central Vietnam and how do these trends affect sexual health?

That Vietnam changes is not a question, but how the changes take place, and how they differ in different areas and among different people is still an open question to which this research tries to give an answer.

[1] Vietnam became the second largest rice exporter in the world
[2] See
[3] There was even a regulation of ‘informing the working place’, when a relation emerged. This ‘reporting to the organization’ is still referred to when people make their relation public.
[4] See for the concept of ‘romantic love’ Giddens in Phuong An Nguyen, 2007: 292.
[5] Sexual education in Vietnam is limited and doesn’t include emotional or moral information (but is very much focused on health and reproduction) (Anh Duc Ngo et al, 2008: s201)
[6] MSM are a very heterogeneous group, for which local terms make clear distinctions. Within the group of MSM the following subgroups exists: self identified gay, bisexuals, transgenders and heterosexuals that have sex with men (Duc An Ngo et al, 2009: 252). Some of the emic terms that differentiate between various groups within the group of MSM in Duc An Ngo et al, 2009 are dong lo, bong kin, bong lo, bong nua mua, bong men, bong bao and bong kinh. See this article for more information.
[7] This research is one of the first about homosexuality in Vietnam. A similar research about lesbians in Vietnam is still unknown, but would be an interesting field of study.
[8] Premarital sex is sometimes stigmatized by retailers and pharmacists which makes the accessibility to these means difficult for young unmarried people (Hoang Tu Anh et al, 2008: s107)
[9] Vietnam has the highest rate of induced abortion in the world, 1,5-1,8 abortions per woman (Hoang Tu Anh et al, 2008: s107).
[10] A high abortion rate might also affect the sex ratio, which is uneven since boys are preferred over girls (Bélanger, 2002). 110 boys are born for every 100 girls (Hoang Tu Anh et al, 2008: s107).
[11] Condom use is still very low for the reason of trust and sexual pleasure (Vu Hong Phong, 2008; Duc Anh Ngo et al, 2009) Men say that they would use condoms with sex workers, but within the marriage condoms are almost not used at all to avoid suspicion (Phinney, 2008: 655).

Picked up from The Athnopology and Qualitative research traning course in Hue, Vietnam. (7/2011)

Chủ Nhật, 14 tháng 8, 2011

Hội nghị quốc tế về Y tế công cộng các nước tiểu vùng sông Mê-Kông lần thứ 3 tại Vientiane, Laos

Từ ngày 9/08 đến 10/08/2011 hội nghị về Y tế Công cộng các nước tiểu vùng sông Mê Kông lần thứ 3 với chủ đề “Những thách thức toàn cầu về các vấn đề dự phòng y tế công cộng trong các nước tiểu vùng Sông Mê-Kông” được tổ chức tại Trung tâm Hội nghị Quốc tế (ICTC), Viêng Chăn, Lào. Đây là Hội nghị thường niên và luân phiên giữa 3 khoa của 3 trường, là Khoa Y tế công cộng –Đại học Khon Kaen, Thái Lan; Khoa Y tế công cộng, Trường Đại học Y Dược Huế và Khoa Sau Đại học, Đại học sức Khỏe, Lào.
Ngoài ra ở hội nghị này còn có sự đóng góp của các bài báo cáo của các trường Đại học và các tổ chức phi chính phủ (NGOs) như Trung Quốc, Miama, Campuchia, Malaysia, Pháp và các tổ chức WHO, Unicef, CMB, ARD, UNFPA …

Hội nghị ghi nhận 55 bài báo cáo miệng và 115 bài báo cáo bằng poster tập trung vào 2 chủ đề lớn của hội nghị:

- Thế mạnh của hệ thống y tế và chăm sóc sức khỏe ban đầu

- Những thách thức và cơ hội thúc đẩy Y tế vì mục tiêu thiên niên kỷ (MDGs)

Ngay sau phần phát biểu chào mừng của Phó bộ trưởng Bộ Y tế Lào Giáo sư Som Ocl Kingsada ở lễ khai mạc hội nghị, các đại diện của các khoa Trường có các bài phát biểu. Đại diện cho đoàn Khoa Y tế công cộng, Đại học Y dược Huế, Ts Võ Văn Thắng, có bài phát biểu ngắn về những ấn tượng mà hội nghị mang lại cũng như những vấn đề Y tế công cộng sẽ thảo luận trong hội nghị này. Sau phần khai mạc buổi sáng và các báo cáo tập trung. ngay trong buổi chiểu và ngày thứ hai hội nghị chia hai hội trường để tập trung thảo luận với các nội dung: Chăm sóc sức khỏe ban đầu; Tài chính y tế; Nhân lực dành cho y tế; Các bệnh không lây; sức khỏe bà mẹ và trẻ em; Sức khỏe sinh sản; Sức khỏe môi trường và Sự phát triển bền vững và phúc lợi; Dinh dưỡng và an toàn thực phẩm; HIV/AIDs; Các bệnh truyền nhiểm đang nổi lên và quay trở lại.

Đoàn khoa Y tế Công cộng, Đại học Y Dược Huế đến với hội nghị lần này có 20 thành viên, gồm có, giảng viên, cán bộ khoa và sinh viên. Với 4 báo cáo của Ts Võ Văn Thắng, Trưởng Khoa Y tế Công cộng về “chăm sóc sức khỏe ban đầu ở Việt Nam”; “Nghiên cứu về nguyên nhân chấn thương và các hoạt động chăm sóc ban đầu ở 14 tỉnh Miền Trung Tây Nguyên, Việt Nam” ; Ts Nguyễn Hoàng Lan, giảng viên khoa Y tế công cộng với báo cáo “Gánh nặng kinh tế đối với bệnh nhân đái tháo đường ở Thành phố huế, Việt nam” và Ts Trần Kim Phụng, Phó giám đốc sở y tế Quảng Trị, giảng viên Kiêm nhiệm Khoa Y tế công cộng Huế “Tỷ lệ nhiểm virus Viêm gan B và Viêm Gan C trong số người trưởng thành ở vùng Nông thôn Việt Nam”. Và hơn 20 báo cáo bằng poster của các giảng viên, cán bộ và sinh viên khoa.

Trong buổi họp số 1, ngày 10/08/2011, các Trưởng khoa hoặc đại diện trường tham gia hội nghị đã thảo luận về việc củng cố và mở rộng sự hợp tác đào tạo, nghiên cứu về y tế công cộng trong tương lai, đồng thời phác thảo ý tưởng chuẩn bị cho Hội nghị lần thứ 4 về Y tế công cộng năm 2012. Có hai nước tình nguyện tổ chức tiếp theo là Đại học Côn Minh (Trung Quốc) và Myanma.

Buổi họp số 2 cùng ngày 10/08/2011, dưới sự chủ trì của tổ chức China Medical Board (CMB) với các thành viên mở rộng; hội nghị bàn về chăm sóc sức khỏe ban đầu. Kết quả đạt được là sẽ có một cuộc đánh giá cơ bản về chăm sóc sức khỏe ban đầu tại các nước, sau đó sẽ đưa ra một chiến lược chung về chăm sóc sức khỏe ban đầu theo tuyên ngôn Ama-Ata của Tổ chức Y tế thế giới.

Khép lại, trong phiên bế mạc, Phó hiệu trưởng trường Đại học sức khỏe Lào đã chuyển quyền tổ chức cho Đại học Côn Minh, Trung quốc trong lần hội nghị thứ 4 (8/2012) và sau đó là Myanma.

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Hi guys,
From Vietnam, i would like to thanks for your websites, it's connecting who is working at research field and other. i accessed to website at International conference on Public health in Vientiena, Laos.
I will post some activities in the next time.
Here is some photo's Hue (Vietnam) public health faculty paticipated in conference.

Dr Vo Van Thang, Dean, Faculty of Public health, Hue college of med&Phar.(Hue University, Vietnam)

Ms Hoang Lan, Oral presentation.
Dr Tran Trong Phung, Vice-director of Quang Tri Province health Service, Lecturer of Public Health faculty of Hue medical school.


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