Nobody left behind? Equity and the drivers of stunting reduction in Vietnamese ethnic minority populations

Abstract

Vietnam has successfully reduced population stunting, but ethnic minority groups are being systematically left behind, limiting progress on national reductions. This mixed methods study aims to understand how policy drivers of stunting reduction differ between ethnic majority and minority communities. We used decomposition analysis to explain key determinants of stunting change between 2000 and 2010; and framework analysis to qualitatively assess changes in policy, actors and narratives that have underpinned these over decades. Our analysis shows that stunting reductions are associated with increased household wealth (accounting for 61% of change), improved access to specific health services (16%), and changes in level of maternal education (12%). Despite multiple actors involved in change and a large set of policies designed to address inequities, many among Vietnam’s defined ethnic minority groups are not finding themselves able to effectively engage with central government plans for their communities, and central policies often do not consider their preferences or limitations. This in turn impacts the nutrition of minority groups through the determinants above. Vietnam has achieved the easier portion of stunting reduction through national economic growth and sustained commitment to socially-oriented policy. In order to tackle the remaining pockets of high malnutrition, more attention, thought and funding will need to focus on marginalised ethnic minority communities. The current national development discourse aims to incorporate minorities into mainstream majority systems. This paper argues that policy should rather take into account their particular needs and preferences to address and overcome the identified determinants of malnutrition.

The Indirect Impact of Smallholder Vegetable Production on Children's Nutrition Outcomes in Rural Vietnam

“…In the broader context, the above results highlight similar findings of previous studies in Vietnam where significant reductions in child undernutrition can be driven by improvements in household income, maternal education, hygiene, and health and nutrition services (Kien et al, 2016;Nguyen et al, 2017;Beal et al, 2019;Harris et al, 2021). Research has shown that hard infrastructure alone, e.g., provision of roads or sanitation facilities, must be coupled with adequate levels of soft infrastructure investments (human capital and innovation) to maximize impact on the target beneficiaries.…”

“…Current estimates indicate about 14, 29, and 52% of young children are vitamin A-, iron-, and zinc-deficient, respectively (Chaparro et al, 2014). However, declining financial support from the national and local governments for these activities, lack of strategic oversight and reduction of international aid, and the poor nutritional knowledge of mothers and other household members (Socialist Republic of Vietnam, 2012;IFPRI, 2016;Harris et al, 2021), have impeded progress. The positive impacts of these changes also differ between urban and rural areas, by region, and between the Kinh majority and ethnic minorities.…”

Revisiting food security in 2021: an overview of the past year

“…Another theme among the nutrition-oriented articles of 2021 is the issues of equity and empowerment. Harris et al ( 2021 ) for instance consider how and why nutrition outcomes are poorer for ethnic minority groups in Vietnam; Lentz et al ( 2021 ) show that women’s empowerment are associated with their nutritional status in Niger; and Maia and Santos ( 2021 ) assess the socio-demographic drivers of food insecurity for children in Portugal. Focusing on interventions and actions, Cauchi et al ( 2021 ) draw on community perspectives to understand perceptions of healthy food; and Nordhagen and Traoré ( 2021 ) examine the sustainability of women’s groups in facilitating nutrition-sensitive agriculture.…”

“…In the introductory article, Gillespie et al ( 2021 ) lay out the rationale for combining clear qualitative and quantitative evidence with compelling narratives to catalyse action on multiple forms of malnutrition in Africa and Asia. Two articles have been published in this series so far: Harris et al ( 2021 ) look at the history and policy drivers of malnutrition among different ethnic groups in Vietnam; and Aryeetey et al ( 2021 ) analyse the policy and programmatic drivers of reductions in child stunting and anaemia in Ghana. This series will continue into 2022 with several more articles.…”

How Did Covid-19 Affect Food and Nutrition Security of Migrant Workers in Northern Vietnam?

“…However, undernourishment tends to be higher in rural than urban areas, and highest in the areas of the Central Highlands as well as the Red River Delta (Kim et al 2021). Similarly, Harris et al (2021) show that malnutrition persists among Vietnam's ethnic minorities while the Kinh majority was able to make significant progress in the past few decades. For instance, stunting rates have decreased from 33.4 per cent in 2000 to 15.2 per cent in 2010 for the Kinh people but for ethnic minorities it reduced from 50.6 per cent to 34.8 per cent during the same period.…”