A newborn baby at Tu Du Hospital in HCMC, January 2020.
Photo by VnExpress/Le Cam. 

Regional differences in fertility rate, sex imbalance at birth, aging population and “low quality” of the population are four key challenges Vietnam is facing. 

"We used to have to focus on only solving family planning problems to stabilize the population size, but now we have to deal with issues in terms of size, structure, and distribution of the population, especially improving the quality of the population," Deputy Minister of Health Nguyen Truong Son said Thursday at a meeting in Hanoi.

The fertility rate is significantly different among regions, provinces and cities, he said.

There are places in southern Vietnam where the rate has dropped too low while in the northern mountainous region, the Central Highlands and the central region, it is too high, he added.

In HCMC, the rate is 1.39 per child per woman of reproductive age, while it is 2.75-2.38 in central provinces of Ha Tinh and Nghe An. In the southern provinces of Dong Thap, Hau Giang and Ba Ria-Vung Tau, the rates are 1.34, 1.53 and 1.37, respectively.

"Meanwhile, the sex imbalance at birth has been happening at a critical level, and increasing rapidly," Son said.

In 2006, the country's sex ratio at birth started to exceed normal levels (104-106 boys to 100 girls). In 2013, it was 113.8 boys for every 100 girls. In 2018, it was 114.9:100. Last year, it dropped slightly to 111.5:100

The United Nations Population Fund says in its State of World Population report 2020 that every year, the long-standing preference for boys in Vietnam’s society terminates 40,800 baby girls before they are born.

The report said this demographic imbalance was a result of pre-natal sex selection - termination of a pregnancy when the fetus is determined to be female, or pre-implantation of sex determination and selection, or "sperm-sorting" for in-vitro fertilization. Around 40,800 female births are thus doomed in Vietnam each year.

Vietnam’s imbalance last year stood behind only China and India, the two most populous countries in the world.

Getting old

Vietnam is currently among the most rapidly aging countries in the world. It officially entered the aging phase in 2011 when the number of people over 60 made up 10 percent of the population. That ratio climbed to 12 last year for a population of 95 million and is expected to rise to 17.9 percent in 2025, and to more than 20 percent in 2038. By then, the nation will officially become an aging country.

So it will take Vietnam just 30 years to transit from the aging phase to becoming an aging country, compared to 115 years in France, 69 in the U.S. and 85 in Sweden.

Regarding population quality, a government study revealed recently that Vietnamese live longer, yet suffer many diseases.

According to the General Statistics Office, from 1989 to date, the average life expectancy of Vietnamese citizens has continuously increased, from 65.2 in 1989 to 73.6 last year, 1.6 years higher than the global average.

In Vietnam, women live up to 77.1 years on average but spend 11 years in sickness, while the corresponding figure for men is 74.4 and eight years.

At present, around 60 percent of elderly people suffer chronic diseases with each contracting three to six on average, including metabolic disorders, musculoskeletal pain, and diseases related to cardiovascular, neurology, respiratory, digestive, hearing and visual problems.

Apart from these challenges, Vietnam has been able to maintain its replacement level fertility, or the total fertility rate, which is the average number of children born per woman, at which a population exactly replaces itself from one generation to the next, without migration, over the past 14 years.

Average population growth rate has stayed at 1.05-1.15 percent per year, and the population size is now around 96.5 million people.

A decision issued in April by Prime Minister Nguyen Xuan Phuc encourages people to marry before they are 30 and bear children early.

Women should have their second child before 35, it advised.

The decision aims to maintain a replacement total fertility rate between 2 and 2.2 children for each woman in her reproductive life, increasing it in areas where it is currently low and vice versa.