title: The use of reproductive healthcare at commune health stations in a changing health system in Vietnam.
abstract: BACKGROUND
  With health sector reform in Vietnam moving towards greater pluralism, commune health stations (CHSs) have been subject to growing competition from private health services and increasing numbers of patients bypassing CHSs for higher-level health facilities. This study describes the pattern of reproductive health (RH) and family planning (FP) service utilization among women at CHSs and other health facilities, and explores socio-demographic determinants of RH service utilization at the CHS level.
  
  
  METHODS
  This study was based on a cross-sectional survey conducted in Thua Thien Hue and Vinh Long provinces, using a multi-stage cluster sampling technique. Questionnaire-based interviews with 978 ever-married women at reproductive age provided data on socio-demographic characteristics, current use of FP methods, history of RH service use, and the health facility attended for their most recent services. Multiple logistic regression analyses were used to identify socio-demographic determinants of their use of CHS RH services.
  
  
  RESULTS
  Eighty nine percent of ever-married women reported current use of birth control with 49% choosing intra-uterine device (IUD). Eighty nine percent of pregnant women attended facility-based antenatal care (ANC) with 62% having at least 3 check-ups during their latest pregnancy. Ninety one percent of mothers had their last delivery in a health facility. Seventy-one percent of respondents used CHS for IUD insertion, 55% for antenatal check-ups, and 77% gynecological examination. District and provincial/central hospitals dominated the provision of delivery service, used by 57% of mothers for their latest delivery. The percentage of women opting for private ANC services was reported at 35%, though the use of private delivery services was low (11%). Women who were farmers, earning a lower income, having more than 2 children, and living in a rural area were more likely than others to use ANC, delivery, and/or gynecological check-up services at the CHS.
  
  
  CONCLUSIONS
  Women choice of providers for FP and RH services that help them plan and protect their pregnancies is driven by socio-economic factors. While the CHS retains significant utilization rates, it is under challenge by preferences for hospital-based delivery and the growing use of private ANC services.
authors.affiliation: Social Epidemiology and Evaluation Research Group, School of Health Sciences, University of South Australia, City East Campus, Adelaide, SA 5000, Australia. Anh.Ngo@unisa.edu.au
authors.forename: Anh D
authors.initials: AD
authors.lastname: Ngo
authors.forename: Peter S
authors.initials: PS
authors.lastname: Hill
mesh_terms: D000328:Adult; D016000:Cluster Analysis; D003153:Community Health Services / Q000706:statistics & numerical data*; D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D003906:Developing Countries; D005193:Family Planning Services / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D018166:Health Care Reform; D006801:Humans; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data; D019984:Quality Indicators, Health Care; D060728:Reproductive Health; D034121:Reproductive Health Services / Q000191:economics / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014744:Vietnam; D055815:Young Adult