A generation overthinking giving birth

"Am I abnormal?" Mai asked an interviewer.

It's been three meetings and Mai hasn't been able to resolve her own puzzle about whether to have a baby or not. Mai understands that a child is an irrevocable lifelong responsibility. She is afraid to have children even though her parents always say that everything will work out, via the adage: "Heaven sends elephants, heaven sends grass."

"You're overthinking it," Mai's father tells her.

"In the past, when we had you and your siblings, our family was very poor, but now everyone has grown up nicely," he says.

That's the story I encountered at a coaching session - a service that many young people seek when they encounter confusions that are difficult to resolve on their own.

Mai said giving birth is not like raising a cat. If you like the cat, you take it home and raise it. If you don't like it anymore, you can give it away. To Mai, giving birth is even more serious than getting married. Marriage, in the worst scenario, leads to divorce. But after giving birth, Mai said, we can never hit "undo."

Being afraid to give birth does not mean not wanting to give birth. Mai explained that the whole journey of having a child makes people like her feel hesitant.

The first part is about giving birth and related medical care. Mai lives in Ho Chi Minh City, where women have been crudely called the "laziest to give birth in the country," because the city has had the lowest birth rate in Vietnam for nearly two decades. Yet most maternity hospitals and children's hospitals there are already overloaded.

Research by the Institute of Health Strategy and Policy at the Ministry of Health demonstrates the overload situation at the 5 largest hospitals in Hanoi and Ho Chi Minh City. HCMC’s largest maternal health hospital, Tu Du, is always between 165 and 200% filled, meaning the hospital has actually had to house twice the number of occupied beds for which it was designed.

At Children's Hospital Number 1 in 2018, the number of pediatric patients hospitalized is always nearly twice the number of sick beds (165).

Medical care issues also include vaccines, or lack thereof.

According to the 2023 report "The State of the World's Children" by the United Nations Children's Fund (UNICEF), one in five children is not vaccinated, or is incompletely vaccinated, and 48 million children globally have not received a single dose of vaccine. Vietnam is among the 20 countries with the highest number of children having zero vaccine doses in the world, with more than 187,000 children under one year old not being vaccinated in 2021.

A mother holds her newborn child after giving birth at Tu Du Hospital in HCMC in 2020. Photo by VnExpress/Le Cam

The second problem with having a child is to send them to school. It is difficult for the Ho Chi Minh City public school system to meet demand as the number of primary school students has been increasing too rapidly. In 2020, the city received an extra 54,000 students compared to the previous year. Most public schools have to accept exceeding their size standards, meaning a class can sometimes have up to 50-60 students. Few people have the financial means to send their children to private schools that have better facilities and smaller class sizes.

Third is the living environment and support system for children. According to the UNICEF report "Promoting Development for All Children in Vietnam" in 2019, 33,000 children under 5 years old died from preventable diseases, and 7.7 million children did not have access to services like clean water and sanitation at school. In the 1- to 14-year-old group, more than 7 out of 10 children were disciplined with violence.

Moreover, Vietnam does not have many public organizations to support children born with defects such as paralysis and mental illness, like autism. In many public places, Mai doesn't even see a path for wheelchairs.

But the biggest problem with having a child is the financial burden. Parents cannot tell how much money goes into raising a child. The risk of losing jobs in an increasingly competitive environment makes many couples hesitant.

Mai said she believes that the low birth rate is partly because modern women do not want to be tied down and instead want to focus on personal plans. But she believes that not giving birth without the right conditions is a mature decision that shows a woman’s responsibility to herself and society.

The fear of giving birth is not Mai’s alone. And it’s not just the problem of modern Vietnam. Birth rates are declining globally. United Nations statistics show that in the early 1950s, each woman gave birth to an average of 4.7 children. This rate dropped to 2.3 in 2021. During that period, South Korea had the world's largest decline in birth rate (-86%). Vietnam ranked 23rd with a decrease of 61%.

Seeing the risk of population aging, many governments have quickly applied birth promotion policies, starting with generous cash bonuses such as in South Korea, Singapore, Finland, Japan, Sweden, and Canada. But these governments soon realized that cash support did not significantly improve the situation. So, they gradually changed their policies. In Singapore, the government has gradually added measures such as supporting social housing, increasing maternity leave and tax reductions for large families.

Giving birth is not a once-and-done thing, but a long-term process of care and nurturing. Therefore, any support needs to be long-term, aiming to comprehensively improve health, education, and the living environment surrounding a child's family.

Vietnam can learn valuable lessons from other countries' policies.

Vietnam cannot afford to apply generous cash support measures, and the experience of other countries has also proven that this is not the decisive factor. Thus, we can take actions to gradually create a quality living environment, improve the healthcare system and educational facilities, and strengthen the support system for children with disabilities and autism. These can have a lasting impact.

Having children or not, sooner or later, is ultimately each person's personal decision. The way the government can support families is to create the most favorable "birth infrastructure," so that people feel that giving birth and raising children is a joy, not a burden.

*Ngo Tu Ngan is working for a multinatinoal corporation, and member of HCMC Bar Association.