The Ministry of Health is seeking public feedback on a draft plan to address the sex ratio imbalance at birth for 2026-2035, with the goal of bringing the ratio back to its natural balance within the next 10 years.

Commenting on the draft plan, Professor Giang Thanh Long, a senior lecturer at the National Economics University in Hanoi, said it had correctly identified the fundamental causes of Vietnam’s sex ratio imbalance at birth. However, he argued that its targets can only be achieved if policy tools are strong enough to address the deeper reasons why many families still feel they “must have a son.”

Pace of improvement needs to nearly double

According to Long, to reduce the sex ratio at birth from 110 to 106 over 10 years as targeted by the draft plan, Vietnam would need to lower the ratio by an average of around 0.4 points each year. Yet a review of the 2016-2025 period shows that the average decline over the previous decade was only 0.22 points annually. Meeting the new target would therefore require the pace of improvement to nearly double over the coming decade.

The Ministry of Health considers bringing the ratio back to its natural balance by 2035 “feasible,” but Long said: “This will be a major challenge, particularly as communication interventions tend to become less effective over time.”

South Korea’s experience also shows that restoring the sex ratio at birth to its natural balance is a long process that cannot rely on any single measure. Starting from around 116 boys for every 100 girls, South Korea took nearly 20 years to bring the ratio close to its natural level. More importantly, the process involved multiple measures implemented simultaneously, from restrictions on prenatal sex determination and changes to discriminatory regulations to campaigns aimed at reshaping perceptions of daughters’ value, such as “Love Your Daughter.” According to Long, the lesson is that legislation must go hand in hand with cultural change and broader social reforms.

Another challenge is the rapid development of technologies related to sex selection. The draft plan acknowledges that inspection, monitoring and enforcement are becoming increasingly difficult because fetal sex can be disclosed verbally or through coded signals, leaving no documentary trail. Meanwhile, technologies such as blood tests conducted very early in pregnancy and embryo sex selection through IVF are creating new regulatory challenges.

Drawing on international experience, Long argued that prohibitions have limited effectiveness as long as the underlying demand for sons remains. As technology advances, sex-selection practices can simply shift to more discreet methods that are harder to detect and regulate.

Strengthening oversight at healthcare facilities, particularly in the private sector, and improving authorities’ capacity to regulate emerging technologies are therefore necessary. But Long said controlling the supply side alone is not enough. As long as demand persists, people will remain motivated to find alternative ways of achieving their desired family composition.

Reducing son preference means addressing old-age security

According to Long, one of the deepest roots of son preference is the belief that sons will provide support for their parents in old age. The draft plan, however, only refers to “researching and proposing” forms of social security support for older people without setting out specific measures.

“This is an important gap,” he said, pointing to Singapore’s experience. By using social security to reduce reliance on family support, the country has fundamentally changed behavior surrounding son preference. Stronger pension provision, healthcare, and long-term care at home and in the community have significantly reduced the burden on families with older members, meaning children and grandchildren are less likely to have to leave the labor market or give up employment opportunities simply to care for their parents or grandparents.

“With more than 15% of the total population aged 65 or above and the proportion of older people living alone doubling compared with 10 years ago, Singapore’s investment in its social security system has played an important role in reducing older people’s dependence on their children and changing the belief that ‘only sons can provide support in old age,’” Long said.

For Vietnam, Long said the draft plan should set out more concrete steps to reduce older people’s reliance on their children. These could include expanding social insurance coverage in terms of both participation and benefits; strengthening healthcare, disease prevention and chronic disease management; creating age-friendly environments; and developing a well-structured long-term care system.

Long also argued that the draft plan still lacks specific, systematic economic instruments capable of creating incentives for behavioral change. Measures that stop at “encouragement,” he said, are unlikely to generate a sufficiently strong impact.

To sustainably address the imbalance in the sex ratio at birth, Vietnam cannot focus solely on the final stage of the problem by trying to prevent prenatal sex selection, according to Long. More important is gradually removing the underlying reasons why some families still feel they need to have a son.

Vo Thu