title: Sex of newborns associated with place and mode of delivery: a population-based study in northern Vietnam.
abstract: BACKGROUND
  There is increasing evidence of an elevated sex ratio at birth (SRB) in many Asian countries, including Vietnam, and that this prenatal gender inequity is related to sex-selective abortion. However, few studies have investigated the relation between the sex of offspring and delivery care utilization.
  
  
  OBJECTIVE
  The aim of the present study was to relate sex of newborns to place and mode of delivery in a province in northern Vietnam.
  
  
  METHODS
  A population-based surveillance system within the Neonatal Health-Knowledge Into Practice (NeoKIP) project (ISRCTN44599712) recorded all births within eight districts of Quang Ninh province in northern Vietnam from July 2008 to June 2011.
  
  
  RESULTS
  In total, there were 22,377 live births within the study area. SRB was 108 boys per 100 girls. There was a large difference in SRB depending on place of delivery, with 94 boys per 100 girls being delivered at home, whereas 113 boys per 100 girls were delivered at a district-level hospital. Cesarean section (CS) rate was 17%, and within the CS group, the SRB was 135:100.
  
  
  CONCLUSIONS
  We demonstrated an elevated SRB, especially at district hospital level, and that sex of offspring influenced place and mode of delivery. Although mothers to boys were more likely to receive more qualified delivery care, they were at the same time more likely to undergo unnecessary surgery. Correct information to women and family members about CS and stricter implementation of the medical indications for CS are urgently called for.
authors.affiliation: Hanoi School of Public Health, Hanoi, Vietnam.
authors.forename: Dinh Thi Phuong
authors.initials: DT
authors.lastname: Hoa
authors.forename: Lina
authors.initials: L
authors.lastname: Börjesson
authors.forename: Nguyen Thu
authors.initials: NT
authors.lastname: Nga
authors.forename: Annika
authors.initials: A
authors.lastname: Johansson
authors.forename: Mats
authors.initials: M
authors.lastname: Målqvist
mesh_terms: D002585:Cesarean Section / Q000706:statistics & numerical data*; D005260:Female; D006700:Home Childbirth / Q000706:statistics & numerical data*; D006779:Hospitals, Public / Q000706:statistics & numerical data*; D006801:Humans; D007231:Infant, Newborn; D050498:Live Birth; D008297:Male; D010342:Patient Acceptance of Health Care; D011247:Pregnancy; D012744:Sex Ratio; D014744:Vietnam