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.
Highlights
Vietnam has achieved significant progress in reducing undernutrition over the past several decades, and is held up as a regional example of what can be accomplished through sustained commitment to coherent policy across economic and social development, including nutrition
In assessing the enabling environment for stunting reduction in ethnic minority communities, we find that key issues have been: 1) narratives moving away from the issues of hunger, food insecurity and undernutrition that still affect minority communities, as well as not considering ethnic minorities in the emerging nutrition transition; 2) the evolving national economic and institutional context making it harder for departments and organisations focused on nutrition to strategically consider or serve ethnic minority groups; and 3) a limited national and international civil society failing to bring services to ethnic minority areas or the voices of ethnic minorities into nutrition policymaking processes
Each pillar is conducive to undernutrition reductions, but our work indicates that focusing on inclusion of different perspectives and preferences and respecting different contexts and forms of knowledge is more likely to lead to engagement with the policy on the key determinants of malnutrition reduction, and to equitable malnutrition reductions in minorities that have so far been left behind
Summary
Vietnam has achieved significant progress in reducing undernutrition over the past several decades, and is held up as a regional example of what can be accomplished through sustained commitment to coherent policy across economic and social development, including nutrition. Since the opening-up of Vietnam’s economy in 1986, poverty rates have fallen significantly, from 58% in 1993 to 10% in 2012; the country achieved middle-income status in 2008 and is the world’s second-largest exporter of rice (Mbuya et al, 2019). The primary beneficiaries of higher living standards have been the Kinh majority, along with the ethnic Chinese Hoa; expenditure levels of Khmer and Cham groups, largely in the south-east, have increased to around the national average, but the remaining minorities have expenditure significantly lower than the national average, and often below the poverty line (Baulch et al, 2010). In particular smaller ethnic groups in the central and northern highland regions, have fallen significantly behind in Vietnam’s advance to middle-income status, and a large proportion of the remaining burden of undernutrition falls in ethnic minority communities (Thang & Popkin, 2003)
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