Vietnamese health professionals’ views on the status of the fetus and maternal and fetal health interests: A regional, cross-sectional study from the Hanoi area

Abstract

Background: Obstetric ultrasound is a significant tool in the clinical management of pregnancy and is increasingly used globally. The status of the pregnant woman and the fetus may vary regarding clinical management, views in the community and legislation. The overall aim of the study was to investigate experiences and views among health professionals in Vietnam on different aspects of the fetus, prioritisation and potential conflicts between maternal and fetal health interests. Methods: A cross-sectional study design using a structured questionnaire. Eligible participants were obstetricians/gynecologists, midwives and sonographers. Public health facilities were purposively selected to obtain a representative sample in the Hanoi region, Vietnam. The final sample included 882 health professionals. Results: Participating health professionals were obstetricians/gynecologists (n=289; 32.7%), midwives (n=535; 60.7%) and sonographers (n=58; 6.6%). The mean age was 34.8 years, and mean years in the profession were 10.3. 60.3% of participants agreed that “The fetus is a person from the time of conception”. 19.7% agreed, and 60.5% disagreed with the statement, “The fetus is never a patient, only the pregnant woman can be the patient”. A majority of the participants (54.4%) agreed that “Maternal health interests should always be prioritised over fetal health interests in care provided”, whereas 18.7% disagreed, and 27.1% were neutral. Participants who performed ultrasounds were more likely to agree that “Fetal health interests are being given more weight in decision-making, the further the gestation advances”, compared to those who did not perform ultrasounds (cOR 2.47, CI 1.27-4.79: n=811). Conclusions: Our results indicate that a large proportion of health professionals in Vietnam assign the fetus the status of being a person, where personhood gradually evolves during pregnancy. To a large extent, the fetus was considered a patient with its own health interests, although a majority gave priority to maternal health interests. Health professionals appear to favour increased legal protection of the fetus. Strengthening the legal status of the fetus might have adverse implications for maternal autonomy however and would need careful monitoring if this were to occur. Maternal reproductive rights might need to be further safeguarded.