Health systems responsiveness towards needs of pregnant women in Vietnam

Health systems that are responsive to maternal mental health recognise the importance of integrating mental health services into maternal care. Studies from Vietnam have reported particularly high rates of common perinatal mental health disorders (CPMDs) in both rural and urban areas of the country. Despite the increasing burden of maternal mental health conditions, there is currently no guidance on the screening for CPMDs within maternal care, both antenatal and postnatal. In this paper, we report the findings from a survey that examined health systems responsiveness to the needs of pregnant women at the primary care-level in Vietnam, utilising the WHO's validated responsiveness questionnaire.

Cluster sampling was used in two districts, in Bac Giang Province. Data were collected using the WHO responsiveness tool, including questions on the domains of responsiveness relating to pregnant women's last antenatal visit. SPSS (version 24) software was used for data entry and analysis, respectively. Bivariate and multivariable logistic regression were computed to identify the associated factors of health system responsiveness in maternity care at 95% CI.

We found that the overall mean health systems responsiveness score was 2.86 (out of maximum 4), with 30.4% pregnant women rating responsiveness as "poor" for maternal health care (based on the cutoff point of 60 for overall score). The three highest scoring domains were "social support", "trust", and "dignity" and lowest scoring domains were "choice of providers", "prompt attention", and "communication". There is a strong preference for seeking maternal health care at private facilities which meet women's needs of "confidentiality" and "basic amenities". Household income was found to have a significant impact on the six responsiveness domains. Finally, only a small proportion of pregnant women self-reported having CPMDs and accessed mental health facilities.

These findings highlight the need to improve the responsiveness of the Vietnamese health system to meet pregnant women's expectations, mainly in relation to prompt attention and communication. This study also highlights the importance of specifically targeting efforts towards improving the responsiveness of the public health sector. Integrating maternal and mental health at the primary care-level can be one approach to tackle the mental health treatment gap experienced by pregnant women in Vietnam. This can promote early detection and intervention of CPMDs, but may also contribute towards reducing mental health-related stigma.