The Ministry of Health says the underlying causes remain gender bias and patriarchal values that persist in some families: the desire for a son to continue the family line, perform ancestral worship and care for parents in old age. Most reports from localities agree that son preference is a major factor.

Reports from Nghe An, Ha Tinh, Quang Binh (now part of Quang Tri) and Nam Dinh (now part of Ninh Binh) point to pressure from families and extended clans, along with a “risk-buffer” mentality, as factors leading many couples toward prenatal sex selection.

From a social perspective, “risk buffering” can be understood as some families viewing a son as a safeguard against uncertainties in the future, particularly in old age. As families become smaller and many couples have only one or two children, the desire to “have at least one son” can become stronger.

Meanwhile, the social security system remains insufficient, particularly for older people without pensions or stable allowances, further reinforcing the tendency to rely on sons for support in old age.

Alongside this mindset, rapid advances in medical technology have made it easier for a preference for a particular sex to translate into action. Ultrasound, early sex-determination techniques and embryo sex testing have become increasingly accessible, particularly in the private healthcare sector.

Enforcement is therefore difficult. Over the past decade, more than 50 violations have been handled, mostly involving the circulation or advertising of methods for determining or selecting the sex of a fetus or embryo. Very few cases have been detected directly at healthcare facilities because information about fetal sex is often conveyed verbally or through coded signals, leaving no record in medical files.

Combining ‘hard’ and ‘soft’ measures

If the imbalance persists, the gap between the number of men and women of marriageable age will widen, leading to a surplus of men and a shortage of women and creating future pressure on marriage patterns. The situation also carries risks of worsening gender inequality, trafficking in women and girls, gender-based violence and other social consequences.

Under the draft Project on Controlling the Sex Ratio Imbalance at Birth for 2026-2035, the Ministry of Health aims to continue bringing down the ratio, targeting 106 boys per 100 girls by 2035.

Addressing the problem will require not only “hard” measures, such as strengthening the legal framework, inspections and enforcement, but also “soft” solutions designed to reduce the motivation for son preference.

These include improving the status of girls, supporting families with only daughters, strengthening social security and reducing dependence on sons for support in old age. As the risks families worry about are eased, the perceived need to regard a son as a “fallback option” may also diminish.

The Ministry of Health says Vietnam is now in a period in which the sex ratio imbalance at birth has begun to level off. According to projections, restoring the ratio to its natural range by 2035 is achievable, but only if measures are maintained consistently, continuously and effectively.

Vo Thu