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Women’s fear and uncertainty about vaginal deliveryand lack of empowerment in decision-making generate decision conflict and the overuse ofcaesareansectionsin low- and middle-income countries (LMICs). This decision analysis tool(DAT) aims to help pregnant women make an informed choice about the planned mode of deliveryin Vietnam, Thailand, Argentina, and Burkina Faso.The DAT targets low-risk pregnant women with a healthy, singleton foetus, without any medical or obstetric disorder, no previous caesarean scarring, and eligibility for labour trials.

Este folleto es una herramienta de apoyo a la decisión que se está utilizando en un proyecto de investigación llamado QUALI-DEC. El objetivo del proyecto es mejorar la toma de decisiones sobre el parto. Esta herramienta la entrega un profesional sanitario a las mujeres embarazadas para ayudarles a elegir el modo de parto más adecuado para ella y su bebé. &nbsp

Ce livret est un outil d’aide à la décision quiest utilisé dans un projet de recherche intituléQUALI-DEC. Ce projet a pour objectif d’améliorerla prise de décision concernant l’accouchement.Ce support est remis par un professionnel de santé aux femmes enceintes pour lesaider à choisirle mode d’accouchement le plus approprié pour elleet sonbébé.

Women’s fear and uncertainty about vaginal deliveryand lack of empowerment in decision-making generate decision conflict and the overuse ofcaesareansectionsin low- and middle-income countries (LMICs). This decision analysis tool(DAT) aims to help pregnant women make an informed choice about the planned mode of deliveryin Vietnam, Thailand, Argentina, and Burkina Faso.The DAT targets low-risk pregnant women with a healthy, singleton foetus, without any medical or obstetric disorder, no previous caesarean scarring, and eligibility for labour trials.

Background While cesarean sections (CSs) are a life-saving intervention, an increasing number are performed without medical reasons in low- and middle-income countries (LMICs). Unnecessary CS diverts scarce resources and thereby reduces access to healthcare for women in need. Argentina, Burkina Faso, Thailand, and Vietnam are committed to reducing unnecessary CS, but many individual and organizational factors in healthcare facilities obstruct this aim. Nonclinical interventions can overcome these barriers by helping providers improve their practices and supporting women’s decision-making regarding childbirth. Existing evidence has shown only a modest effect of single interventions on reducing CS rates, arguably because of the failure to design multifaceted interventions effectively tailored to the context. The aim of this study is to design, adapt, and test a multifaceted intervention for the appropriate use of CS in Argentina, Burkina Faso, Thailand, and Vietnam. Methods We designed an intervention (QUALIty DECision-making—QUALI-DEC) with four components: (1) opinion leaders at heathcare facilities to improve adherence to best practices among clinicians, (2) CS audits and feedback to help providers identify potentially avoidable CS, (3) a decision analysis tool to help women make an informed decision on the mode of birth, and (4) companionship to support women during labor. QUALI-DEC will be implemented and evaluated in 32 hospitals (8 sites per country) using a pragmatic hybrid effectiveness-implementation design to test our implementation strategy, and information regarding its impact on relevant maternal and perinatal outcomes will be gathered. The implementation strategy will involve the participation of women, healthcare professionals, and organizations and account for the local environment, needs, resources, and social factors in each country. Discussion There is urgent need for interventions and implementation strategies to optimize the use of CS while improving health outcomes and satisfaction in LMICs. This can only be achieved by engaging all stakeholders involved in the decision-making process surrounding birth and addressing their needs and concerns. The study will generate robust evidence about the effectiveness and the impact of this multifaceted intervention. It will also assess the acceptability and scalability of the intervention and the capacity for empowerment among women and providers alike. Trial registration ISRCTN67214403

Un des paradoxes de la situation du Viêt Nam, pays à forte croissance économique qui a accédé au rang de pays à revenu moyen en 2010, réside dans le surgissement de nouveaux défis, en raison même de ses succès. Le pays doit en effet opérer les mutations nécessaires pour assurer la durabilité de la prise en charge de vastes problèmes sociétaux dans le contexte de la disparition de puissants appuis dont il a bénéficié au cours des dernières décennies. C'est notamment le cas dans le domaine de la santé. De fin 2017 à fin 2018, les principaux programmes internationaux d'aide à la lutte contre le VIH/sida financés par le Fonds mondial, la Banque asiatique de développement et le Plan d'urgence des États-Unis pour l'aide en matière de Sida (PEPFAR) arrivent à terme. Le ministère de la Santé a lancé un appel à toutes les ressources nationales susceptibles d'être mobilisées. Il craint une résurgence de l'épidémie (Bô Y tê [Ministère de la Santé], 2017). Comment les sciences sociales peuvent-elles aborder de telles questions ? Pour illustrer l'approche adoptée dans le domaine des études de population, j'évoque ici quelques recherches que j'ai coordonnées après un rapide aperçu de leur contexte sociodémographique et culturel.

The situation of contemporary Viet Nam raises a paradox. On one hand this country with strong economic growth has enjoyed noticeable improvements in its social and economic conditions, which allowed it to become a middle income country in 2010. On the other hand, because of this success, it is gradually deprived of the powerful international support it has enjoyed during the last decades. This compels the government to undertake measures necessary to ensure the sustainability of its social model. This constraint is especially true in the health sector. The fight against HIV/AIDS will reach a milestone at the end of this year when the main international programs will have come to an end. At this date, the main supports from the Global Fund, the Asian Development Bank and the United States Emergency Plan of Aid for AIDS (PEPFAR) will have withdrawn. Consequently, the Ministry of health has recently appealed to all national resources that could be mobilized. It fears that there would be a resurgence of the epidemic (Bô Y tê [Ministry of health], 2017). How can social science address these issues? To illustrate the approach adopted in the field of population studies, I will present research works that I have coordinated and before that, provide a quick overview of their socio-demographic and cultural context.

Le Viêt-Nam traverse une phase de transitions sociales, économiques, politiques et culturelles, le rythme variant d'un domaine à l'autre. Ce pays émergent tente d'articuler socialisme et économie de marché en redonnant à chacun le goût d'entreprendre, tout en conduisant des réformes institutionnelles. Parviendra-t-il à cet objectif ? Sous quelles conditions et avec quels effets à long terme ? Cet ouvrage permet d'identifier et de comprendre les transformations de la paysannerie, les changements dans l'alimentation et la consommation, les évolutions des politiques publiques dans les domaines de la santé et des pratiques matrimoniales, les mutations de la façon de vivre en ville, les innovations développées par les étudiants pour trouver un emploi - sans éluder les efforts de ceux dont la survie dépend d'un travail informel. Historiens, anthropologues, démographes, sociologues, ethnologues, géographes et économistes, grâce à l'apport des sciences humaines et sociales et à leurs études de terrain, nous donnent une vision d'ensemble de ces transitions à l'oeuvre au Viêt-Nam.

Introduction La présente contribution expose la méthodologie, le processus de recherche et quelques résultats d’une étude sociodémographique articulée à l’initiative pilote de traitement gratuit par antirétroviraux des séropositifs VIH/sida au Viêt-Nam. Il porte plus spécifiquement sur le déroulement de ce programme à Hanoi et Haiphong, intervenu au moment d’une propagation accrue de l’épidémie VIH/sida dans un contexte de restructuration du secteur sanitaire. L’enquête vise à identifier les ...

Cet ouvrage est issu des activités scientifiques menées dans le cadre d’une collaboration entre des chercheurs et enseignants-chercheurs français et vietnamiens, au sein d’un vaste programme de recherche et de formation. Intitulé Projet Arcus Viêt Nam, lequel impliquait en France les Régions Ile-de-France et Midi-Pyrénées. Pluridisciplinaire, il comprenait cinq sous-projets : mathématiques et STIC, matériaux et nanosciences, énergies renouvelables, eau-environnement-océanographie, sciences hu...

International audience; Women's fear and uncertainty about vaginal delivery and lack of empowerment in decisionmaking generate decision conflict and is one of the main determinants of high caesarean section rates in low-and middle-income countries (LMICs). This study aims to develop a decision analysis tool (DAT) to help pregnant women make an informed choice about the planned mode of delivery and to evaluate its acceptability in Vietnam, Thailand, Argentina, and Burkina Faso. The DAT targets low-risk pregnant women with a healthy, singleton foetus, without any medical or obstetric disorder, no previous caesarean scarring, and eligibility for labour trials. We conducted a systematic review to determine the short-and long-term maternal and offspring risks and benefits of planned caesarean section compared to planned vaginal delivery. We carried out individual interviews and focus group discussions with key informants to capture informational needs for decision-making, and to assess the acceptability of the DAT in participating hospitals. The DAT meets 20 of the 22 Patient Decision Aid Standards for decision support. It includes low-to moderate-certainty evidencebased information on the risks and benefits of both modes of birth, and helps pregnant women clarify their personal values. It has been well accepted by women and health care providers. Adaptations have been made in each country to fit the context and to facilitate its implementation in current practice, including the development of an App. DAT is a simple method to improve communication and facilitate shared decision-making for planned modes PLOS GLOBAL PUBLIC HEALTH