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Vietnam has made impressive advances during the past 25 years in lowering rates of maternal, child (ie, younger than age 5 years), and infant mortality. A strong political commitment to meeting targets set by the Millennium Development Goals has contributed to this progress (Minh, Oh, Hoat, & Lee, 2016a); however, this country-wide success obscures regional and ethnic inequalities (Ministry of Planning and Investment, 2015; Malqvist, Lincetto, Du, Burgess, & Hoa, 2013). Dien Bien Province (DBP) is a small, mountainous province with a population of about 550,000 (General Statistics Office of Vietnam, 2016a) in the northwest part Vietnam, bordering Laos and China. The predominantly ethnic minority and rural population of DBP experiences poverty rates, and infant, child, and maternal mortality rates much higher than Vietnam as a whole (Table 1).
Ethnic minority women in Vietnam are less likely to access antenatal care or give birth at a health facility (Do, 2009; Goland, Hoa, & Malqvist, 2012; Ministry of Planning and Investment, 2015; Malqvist et al., 2011; Malqvist, Lincetto, Du, Burgess & Hoa, 2013a; Minh et al., 2016b), and there is evidence that inequity in service use is increasing along ethnic lines (Malqvist et al., 2013a). Ethnic minority status often intersects with other factors associated with a lower level of health care use in Vietnam, including geographical and physical access factors such as difficult terrain and lack of transportation (Binder-Finnema, Lien, Hoa, & Malqvist, 2015; Do, 2009; Toan, Trong, Höjer, & Persson, 2002), lower educational level of mothers (Do, 2009; Duong, Binns, & Lee, 2004), and the continued practice of traditional customs in remote areas (Binder-Finnema et al., 2015). Although it is unclear how ethnicity and distance from primary care services interact to affect access to antenatal care and delivery services, ethnicity has been found to be a significant determinant of maternal health care use after controlling for household income and maternal education (Goland et al., 2012).
There are also communication barriers that affect ethnic minority peoples' access to and quality of care. The patient–health professional interaction is an essential pillar of primary care; however, in addition to linguistic and cultural barriers, ethnic minority people in Vietnam often experience obstacles related to the patient–health professional interaction, including discrimination, poor attitudes from health staff, and a...