Prevalence and determinants of induced abortion among women migrant workers in an industrial zone in Vietnam: A cross-sectional study

Abstract

Migrant women workers in Vietnam face significant barriers in accessing subsidized sexual and reproductive health services, as these are frequently linked to their official residence status. This lack of access increases their vulnerability to unintended pregnancies and unsafe induced abortions due to limited availability of contraception. This study examined the prevalence of induced abortion and associated factors among sexually active women migrant workers working in the industrial zones (IZs) in Vietnam. A cross-sectional study was conducted from January 2019 to November 2020 among 512 sexually active female migrant workers aged 18 to 29 living in rent clusters and dormitories in Thang Long Industrial Park, Hanoi, Vietnam. The primary outcome was self-reported induced abortion. Multivariable logistic regression identified factors associated with induced abortion. Participants had a mean age of 24.8 years; 42.0% were single, and 85.4% lived in rent clusters. Among 512 sexually active female migrant workers, 10.5% reported having had an induced abortion. Compared to single women, married women had significantly higher odds of abortion (adjusted odds ratio [aOR] = 8.13, 95% confidence interval [CI]: 2.44–27.05). Longer duration since first sexual intercourse (aOR = 1.30, 95% CI: 1.12–1.52), and lower monthly income (aOR = 0.994, 95% CI: 0.99–1.00) were also associated with abortion. In addition, belonging to a non-Kinh ethnic group was associated with lower odds of abortion (aOR = 0.32, 95% CI: 0.16–0.62). This study reveals significant reproductive health challenges, including a high prevalence of abortion, among sexually active women migrant workers in a Vietnamese IZ, particularly for married women. These findings underscore the urgent need for targeted interventions such as accessible contraception, extending service hours into evenings or weekends, offering mobile sexual and reproductive health services near IZs, culturally sensitive comprehensive education, and programs addressing gender inequities to reduce unintended pregnancies and lower abortion rates. For routine practice, prioritize accessible contraception and culturally sensitive sexuality education in Vietnamese IZs. In addition, stronger monitoring and enforcement of regulations for private clinics are needed to ensure the safety and quality of abortion services. Future research should investigate contraceptive use, cohabitation dynamics, and unsafe abortion rates within this population to inform more effective interventions.

1. Introduction

Globally, around 73 million induced abortions occur annually, making up 61% of all unintended pregnancies and 29% of all pregnancies.^[1] Abortion has been legal in Vietnam since 1945, with the gestational limit extended to up to 22 weeks of pregnancy since the 1960s.^[2,3] Vietnam one of the countries with the highest abortion rates in the world, with a prevalence rate of 64/1000 women.^[4] However, potential barriers to accessing abortion services in Vietnam, especially among young people, include a lack of service information,^[2,5,6] limited knowledge about contraception^[6] and insufficient counseling from public service providers.^[7] Additionally, the stigma surrounding abortion can discourage women, especially sexually active unmarried Vietnamese, from seeking services.^[2,8,9] The absence of friendly and supportive attitudes from abortion providers, combined with concerns about confidentiality and privacy in public hospitals, further exacerbates the challenges faced by young unmarried women.^[2,6]

Vietnam’s open door policy since 1986 and its efforts to attract foreign investment have led to the creation of industrial zones (IZs) across the country.^[10,11] As of 2024, there were 304 operational IZs across the country, employing approximately 4.16 million workers. The majority of these works, around 60%, are women and many of whom have migrated from rural areas.^[12] While there is no precise national data on the proportion of these women who are of reproductive age or aged 18 to 29, available studies reported average ages of female workers in IZ ranges from 22.8 to 31.0 years.^[13,14] Notably, one 2021 study noted that two-thirds (66.8%) of female IZ workers were young, between 18 and 29 years old.^[15] While these zones offer job opportunities, they often lack avenues for growth, education, and adequate healthcare services, including sexual and reproductive health (SRH) services.^[16,17] As a result, women workers in these zones face increased risks related to unwanted pregnancies, sexually transmitted infections (STIs), and abortion due to persistent gender inequality, stereotypes, and workplace pressures.^[18]

Although there are significant numbers of unmarried women migrant workers in the IZs, official government programs for SRH services are lacking. While public SRH services are available through government programs near the IZ, many IZ workers are not permanent residents of the cities where the IZ is located. As a result, they are often ineligible for subsidized services and must pay full out-of-pocket costs, which significantly limits their access and discourages service utilization.^[17,19] Furthermore, the existing local reproductive health service network is not compatible with IZ workers’ schedules. Key accessibility barriers include services being too far from the IZs and operating hours limited to standard business days, which don’t accommodate workers’ needs. These structural issues significantly hinder workers’ ability to access and use reproductive health services.^[20] These structural barriers, combined with limited awareness of rights and entitlements, mean that many workers avoid or delay seeking care altogether. When SRH services are accessible, they are typically provided by non-governmental organizations or private clinics.^[21] This inaccessibility, coupled with employer disinterest in worker health and a lack of collaboration between health systems, significantly hinders these women’s ability to access critical SRH services.^[22] Studying the issue of abortion among migrant workers in Vietnamese IZs is crucial to understanding this vulnerability and to inform interventions that improve their sexual health outcomes.

A systematic review of SRH among female migrant workers in Southeast Asia, including Vietnam, demonstrated low awareness of SRH issues and limited understanding of STIs and contraception.^[21] This knowledge gap can increase the likelihood of unintended pregnancy, abortion, and STIs. Further, a study among migrant workers in Malaysia found that pregnancy, rather than STI prevention, is a core concern, that private providers often inadequately address. Abortions are usually seen as the only option for pregnant migrants.^[23] Another study among female factory workers in China documented a higher prevalence of unprotected sex (ranging from 36.8% to 51.2%) among rural-to-urban migrants working in the factories who also reported higher rates of abortion ranging from 15.5%^[24] to 41.2%.^[25] Research across Asia suggests that pregnant migrant workers in factories often resort to abortion as the sole option to maintain employment due to employer pressure or fear of job loss.^[23,26] Due to economic pressures, some migrant women turn to commercial sex to supplement their income, thereby increasing their exposure to the risks of STIs/human immunodeficiency virus (HIV), and unwanted pregnancy.^[27]

While research on abortion in the general population exists,^[9,28] much of it is outdated and and there’s a significant lack of current information regarding abortion among sexually active women migrant workers aged 18 to 29 working in the Vietnam’s IZs. This group faces heightened risks of unintended pregnancies and unsafe abortions but remains underrepresented in research and overlooked by public health programs. The lack of contemporary, targeted research creates a significant barrier to developing evidence-based policies and SRH interventions tailored to their needs. Addressing this gap is urgent, particularly given Vietnam’s rapid urbanization and industrial expansion, which continues to draw migrant women into IZs.

The study aimed to investigate the prevalence of induced abortion among female migrant workers in Vietnamese IZs and explore factors associated with induced abortion among these women. Based on ample evidence from other Asian countries^[21] and low-to-middle-income countries,^[29] we hypothesized that migrant women workers working in the IZ would have a higher prevalence of induced abortion compared to the general population; married women migrant workers would be more likely to have an induced abortion compared to single women.

2. Materials and methods

2.1. Study site and participants

This analysis used data from the parent study, “HIV Risk Among Young Women Migrant Workers in Industrial Zones of Vietnam,” which assessed sexual behaviors and HIV vulnerability. The parent study (n = 1063) included questions on pregnancy history and abortion, making it suitable for this secondary analysis on induced abortion. Of the total participants, 531 women reported a history of sexual activity (ever or currently) and comprised our analytical sample, as only sexually active individuals could experience pregnancy-related outcomes. This study was conducted from January 2020 to November 2021 in Thang Long Industrial Park in Hanoi, Vietnam.^[25] Thang Long Industrial Park is a major industrial center located on the outskirts of Hanoi. It is home to 106 companies, producing consumer goods, electronics, and automotive parts, and employs approximately 60,000 people. These factories primarily employ migrant workers who have moved from the rural northern provinces of Vietnam.^[30,31] Eligibility criteria for participation in the study included: female; between 18 and 29 years of age; single or married but living separately from husband or partner, or living alone (separated, divorced, or widowed); had 6 or more months of work experience in the IZ; and had migrated from a rural area or another province prior to IZ employment.

2.2. Sample size and recruitment

This study employed cluster sampling to recruit a total of 1061 participants from 419 clusters and 2 dormitories. The sample size was determined based on the cluster design and accounted for intra-class correlation within the primary sampling units, including rental clusters and dormitories. We calculated the sample size based on the effective sample size, adjusting for the intra-class correlation described by Killip et al to ensure sufficient statistical power.^[32] To facilitate recruitment, the research team collaborated with local authorities and former IZ women workers to identify and recruit potential participants in rent clusters. A comprehensive description of the sample size and recruitment process has been described in previous publications.^[33,34]

2.3. Data collection

Eligible female migrants were invited to attend an after-hours session at a nearby commune health center organized by the research team. During this session, they received comprehensive information about the study including its purpose, expected activities, survey topics, interview duration, their right to decline participation or withdraw at any time, and confidentiality procedures.

Those who agreed to participate provided written informed consent and underwent a 1-hour face-to-face anonymous interview using structured questionnaires, conducted by trained field researchers in a private setting. Interviewers were extensively trained in building rapport, maintaining confidentiality, and addressing participant questions sensitively. On average, the interview took approximately 1 hour to complete. Each participant received compensation of USD $3.00 for their time. Although participants were interviewed face to face by interviewers, participants were left to fill in the questions related to sexual risk and behaviors given the sensitivity of the sexual issues.

2.4. Measures

2.4.1. Outcome variables

The dependent variable included: “Have you ever had an abortion?” A binary response (yes, no) was utilized to measure the variable. Participants who answered “yes” were then asked to specify where the procedure was performed (e.g., private clinic, private hospital, community health center, public hospital/health center) and reasons for abortion (e.g., unwanted pregnancies, miscarriage/stillbirth). To ensure clarity, participants were provided with a clear definition of abortion as the intentional ending of a pregnancy, miscarriages (spontaneous pregnancy loss) and stillbirth in their responses.

2.4.2. Sociodemographic variables

These variables included age, marital status, education, ethnicity, income, and living conditions such as house status and working hours.

2.5. Sexual behavior

Participants were asked whether they had ever had sexual intercourse (yes/no). Those who answered affirmatively were further questioned about the age at their first sexual encounter, the identity of their partner (e.g., boyfriend, husband), and the location of their encounter (e.g., at the home village or IZ). Additional inquiries covered whether they had engaged in sexual activities during the last 6 months (yes/no), the number of sexual partners during this period, and condom use during their first sexual encounter and in the past 6 months preceding the interview (yes/no).

2.6. Statistical analysis

The data was summarized using descriptive statistics, which included frequency and percentages for categorical variables and mean and standard deviation for continuous variables. The analysis first evaluated the unadjusted relationships between having an induced abortion and other factors through bivariate analysis. Variables from the bivariate analysis with P-value <.25 were selected as the candidate variables for multivariable analysis. Multivariate logistic regression analysis identified factors associated with induced abortion controlling for the demographic factors (age, education, marital status, ethnicity, monthly income and place of residence) and time since first sexual intercourse. The monthly income variable was categorized based on the sample’s mean income of $297.6 as the threshold, allowing for a comparison between women earning above and below the average income. A P-value of <.05 was considered statistically significant.

3. Results

3.1. Participant characteristics

Table 1 presents the characteristics of 512 women migrant workers in the study with the mean age is 24.8 years (SD = 3.3). Most of the participants completed high school (70.9%), were of Kinh ethnicity (65.2%), lived in rental clusters (85.4%), worked 8 h/d (75.4%), and earned an average monthly income of $297.6. Regarding reproductive behavior, 77.7% used contraception at last sexual intercourse. The mean time since first sex was 3.7 years (SD = 2.9). The sample comprised 42% single and 58% married. Significant differences were observed across several variables among married and single women. Married women were older, with a mean age of 25.8 years compared to 23.5 years for single women (P < .001). Educational attainment also differed: 18.5% of married women had less than a high school education versus 13.0% of single women (P = .02). Regarding residence, 89.3% of single women lived in rental clusters, compared to 82.5% of married women (P = .03). Work duration showed notable variation, with 31.6% of single women having worked for 1 year or less, compared to only 9.8% of married women (P = .01). Married women had slightly higher monthly incomes ($302.0 vs $291.5, P = .04). Contraceptive use at last intercourse was more common among single women (85.6%) than among married women (72.1%; P < .001). Additionally, the time since first sex was significantly longer among married women (mean 4.5 years vs 2.5 years, P < .001). However, both groups shared similar characteristics in terms of ethnicity distribution (37.7% of single vs 32.7% of married women were from minority groups, P = .15) and working hours (26.0% of single vs 23.6% of married women worked more than 8 h/d, P = .21).

Table 1.

Sample characteristics of women migrant workers in an industrial zone in Vietnam, 2019 to 2020 (n = 512).

Variables	Total n = 512, n (%)	Single n = 215, 42.0%, n (%)	Married n = 297, 58.0%, n (%)	P-value
Age (yr), mean (SD)	24.8 (3.3)	23.5 (2.9)	25.8 (3.2)	<.001**
Education				.02*
Under high school	83 (16.2)	28 (13.0)	55 (18.5)
High school	363 (70.9)	160 (74.4)	203 (68.4)
Above high school	66 (12.9)	27 (12.6)	39 (13.1)
Ethnicity				.15
Kinh (majority)	334 (65.2)	134 (62.3)	200 (67.3)
Other minority	178 (34.8)	81 (37.7)	97 (32.7)
Residence				.03*
Rent cluster	437 (85.4)	192 (89.3)	245 (82.5)
Dormitory	75 (14.6)	23 (10.7)	52 (17.5)
Years working in the industrial zone				.01*
≤1 yr	97 (22.9)	68 (31.6)	29 (9.8)
2–5 yr	204 (48.2)	100 (46.5)	104 (35.0)
>5 yr	122 (28.8)	47 (21.9)	75 (25.2)
Working hours per day				.21
8 h	386 (75.4)	159 (74.0)	227 (76.4)
>8 h	126 (24.6)	56 (26.0)	70 (23.6)
Monthly income (USD), mean (SD)	297.6 (16.2)	290.1 (15.3)	301.1 (15.7)	.04*
Used any contraceptive method at last intercourse				<.001**
Yes	398 (77.7)	185 (85.6)	214 (72.1)
No	114 (22.3)	31 (14.4)	83 (27.9)
Time since first sex (yr), mean (SD)	3.7 (2.9)	0.5 (2.2)	4.5 (2.8)	<.001**

SD = standard deviation.

*P < .05, **P < .01.

3.2. Prevalence of induced abortion

Among 512 young women migrant workers (aged 18–29) who reported ever having sex, 55 (10.7%) reported having an abortion (Table 2). Married participants had a significantly higher prevalence of induced abortion compared to single participants (17.1% [95% confidence interval [CI]: 8–14%] vs 1.9% [95% CI: 2–7%], P < .001, respectively).

Table 2.

Prevalence of induced abortion among women migrant workers in an industrial zone, Vietnam, 2019 to 2020 (n = 512).

Characteristics	Total (n = 512, 100%)	Single (n = 215, 42.0%)	Married (n = 297, 58.0%)	P-value
Ever had an abortion
Yes	55 (10.4%)	4 (1.9%)	51 (17.1%)	<.001**
No	476 (89.6%)	211 (98.1%)	246 (82.8%)
Reasons for abortion				.73
Unwanted pregnancies	43 (76.4%)	4 (100.0%)	39 (76.4%)
Economic reasons*	6 (10.9%)	0 (0.0%)	6 (11.8%)
Being forced by a partner/husband	4 (7.3%)	0 (0.0%)	4 (7.9%)
Miscarriage/stillbirth	3 (5.4%)	0 (0.0%)	3 (5.9%)
Place where abortion occurred				.85
Private clinic	27 (41.7%)	2 (50.0%)	25 (49.0%)
Public hospital/health center	17 (36.1%)	2 (50.0%)	15 (29.4%)
Commune health center	6 (10.9%)	0 (0.0%)	6 (11.8%)
Private hospital	5 (9.1%)	0 (0.0%)	5 (9.9%)

^*Economic reasons: for example, not being able to afford to raise a baby.

^**P < .01.

3.3. Reasons for abortion

The primary reason for abortion was unwanted pregnancies, accounting for 76.4% of cases. A higher proportion of single women (100.0%) reported unwanted pregnancies as the reason for abortion, compared to married women (76.4%). Economic hardship, such as an inability to afford raising a child, contributed to 10.9% of abortions, while 7.3% were due to coercion from a partner or husband. Notably, miscarriages and stillbirths represented a small fraction at 5.4% (n = 3), occurring exclusively among married women. No single women reported terminating pregnancies due to economic reasons, partner coercion, or miscarriage/stillbirth. Nonetheless, the differences in reasons for abortion between single and married women were not statistically significant (P = .73).

3.4. Location where abortions were done

Abortions were most commonly performed at private clinics (41.7%), followed by public hospitals or health centers (36.1%), private hospitals (11.1%), and commune health centers (11.1%). The location of abortion services did not significantly differ by marital status (P = .68). While married women utilized a broader range of service providers, single women had abortions only at private clinics and public hospitals. No single women reported having an abortion at private hospitals or commune health centers.

3.5. Factors associated with induced abortion

Women who began sexual activity 4 or more years ago had over 4 times higher odds of having had an abortion compared to those with a shorter sexual history (aOR = 4.49, 95% CI: 1.78–11.36, P < .001). Married participants were significantly more likely to have had an abortion compared to single participants (aOR = 6.89, 95% CI: 2.06–22.98, P = .002). In addition, women from the Kinh ethnic group were nearly 3 times more likely to have had an abortion than women from other ethnic groups (aOR = 2.83, 95% CI: 1.50–5.50, P < .001). Conversely, women earning over $297/mo had significantly lower odds of having had an abortion compared to those earning less (aOR = 0.51, 95% CI: 0.26–0.99, P = .047; Table 3).

Table 3.

Multivariate logistic regression of factors associated with induced abortion among women migrant workers in an industrial zone in Vietnam, 2019 to 2020 (n = 512).

Characteristics	aOR	95% CI	P-value
Age	1.04	0.90–1.21	.559
Two levels of education
Under high school	1.00
High school and above	1.57	0.70–3.53	.278
Marital status
Single	1.00
Married	6.89	2.06–22.98	.002*
Ethnicity
Other	1.00
Kinh	2.83	1.50–5.50	<.001**
Monthly income (USD)
Low Income (<297)	1.00
High Income (≥297)	0.512	0.26–0.99	.047*
Time since first sex
<4 yr	1.00
At least 4 yr	4.49	1.78–11.36	.001*
Having sex in the last 6 mo
No	1.00
Yes	1.96	0.80–4.75	.139
Use contraception to prevent pregnancy last time
No	1.00
Yes	2.12	0.90–4.96	.084
Use of SRH/HIV since living in the IZ
No	1.00
Yes	1.001	0.49–2.04	.997

aOR = adjusted odd ratio, CI = confidence interval, IZ = industrial zone, SRH/HIV = sexual and reproductive health/human immunodeficiency virus.

^*P < .05.

^**P < .01.

4. Discussion

This study aimed to examine the prevalence and factors associated with induced abortion among sexually active young women migrant workers in the IZ in Vietnam. The results showed that a notable prevalence of induced abortion (10.9%), with significantly higher rates among married women (17.1%) than single participants (1.9%); multiple reasons for abortion, most commonly unwanted pregnancies and among married participants, experiences of coercion; varied sources of abortion care, with a predominance of private clinics; and several sociodemographic and reproductive factors significantly associated with the likelihood of abortion, including marital status, longer sexual history, ethnicity, and income. These results underscore the urgent need for effective interventions to reduce induced abortion rates among this vulnerable population, especially among married women.

The prevalence of abortion among married participants was 17.1%. This abortion prevalence among our study is much lower compared to prevalence rate of induced abortion among migrant workers was up to 41.6% migrant women in Guangzhou, China.^[35] One possible reason for this disparity is the differing age of the study populations. The Chinese study recruited women of childbearing age,^[18–49] whereas our study exclusively included participants aged 18 to 29. However, when divided prevalence of induced abortion among married women by age group, in our study among married women t women aged 20 to 25 years, 12.6% had an abortion, while the highest prevalence was observed in women aged 26 to 29 years, with 19.6% reporting abortion history. These findings align with a study by Luo et al, who found that abortion prevalence was highest among female migrants older than 25 years (24.8%) in China.^[24] This pattern suggests that older young women may face increased reproductive health risks or challenges, highlighting the need for age-specific reproductive health interventions. Futher, our study finding showed that abortion among married women significantly more likely to report having had an abortion compared to single women. This aligns with a recent analysis of cross-sectional, nationally representative household surveys from 36 low and middle-income countries between 2010 and 2018, which found that being married was strongly associated with pregnancy termination compared to unmarried women.^[36] This trend among married women may be due to less consistent use of contraceptives or their failure.^[37]

In contrast, the prevalence of abortion among unmarried participants in our study was 1.9%. This is notably lower than the 15.5% reported in a previous study on unmarried migrant workers in Shanghai, China.^[24] However, it’s important to consider that the Chinese study included a broader age range,^[18–35] which may account for the higher observed prevalence due to the older age of its participants. Another factor contributing to the low reported abortion rate among single participants in our study may be underreporting due to stigma. In Vietnam, social stigma surrounding premarital sex and pregnancy discourages women from disclosing abortions, even though previous research suggests that abortion among unmarried women might be common.^[6,9] A systematic review on abortion among migrants also indicated that for nonmarital participants, the social shame and stigma of nonmarital pregnancy could be avoided through a secret abortion.^[38] Given the potential for underreporting among unmarried individuals due to social stigma, further research is urgently needed to understand unplanned pregnancy and abortion among unmarried migrant workers.

The most common reason for abortion was unwanted pregnancy (76.4%) among both married and single participatns. In our study, single women cited only unwanted pregnancy as the reason for abortion. In contrast, married participants reported additional reasons beyond unwanted pregnancy, including economic hardship, partner/husband coercion and miscarriage or stillbirth. These findings are consistent with prior research, where unwanted pregnancy^[9] and economic hardship^[39] are major drivers of abortion decisions. Interestingly, while the reasons did not significantly differ by marital status, single women reported fewer diverse reasons, suggesting potentially different reproductive decision-making contexts. This underscores the need for targeted reproductive counseling and services that address both marital status and economic vulnerability.

Most abortions were performed at private clinics (41.7%), followed by public hospitals/health centers (36.1%). This pattern is consistent with findings from China, where migrants often use private clinics due to limited access to local health insurance and a preference for perceived confidentiality and shorter waiting times.^[35] The lack of significant differences in location of services by marital status may suggest similar access patterns among migrant women, regardless of relationship status. A significant concern is the potential for unsafe abortions among these migrant workers, as a large number of them (41.7%) have abortions at private clinics, likely due to a desire for better privacy^[7] and flexible hours, which are especially important for this time-constrained population. Public clinics, often open only from 7.30 am to 4.30 pm, Monday through Friday, are inaccessible for migrant workers employed in IZ factories during these hours. Consequently, private clinics offering evening and weekend services attract more visits from this group. However, the quality of services is often unregulated in Vietnam, raising concerns about their potential health risks,^[40,41] highlighting the need for stronger oversight of private providers in the context of safe abortion in Vietnam. In Vietnam, abortion services are legally and are provided at various levels of the health system, including central, provincial, and district public hospitals, as well as licensed private clinics.^[2] These services are regulated by the Ministry of Health under the National Guidelines on Provision of Reproductive Health Services,^[42] which outline standardized protocols for safe abortion, family planning, and maternal care. These guidelines are legally binding for all public healthcare facilities. However, private hospitals and clinics often operate with less oversight and weaker enforcement, which may lead to inconsistent adherence to these standards.^[43–45] This regulatory gap can result in variations in service quality, safety, and reporting practices between public and private providers. To better serve migrant women, who often work long hours and have limited flexibility, public hospitals and clinics should consider reviewing their working hours and service delivery models. Extending service hours into evenings or weekends, offering mobile SRH services near IZ, or implementing appointment-based systems could significantly improve access. These changes would address the needs of young female migrant workers, reducing health inequalities in Vietnam’s IZ.

A systematic review on abortion among migrants also indicated that for nonmarital participants, the social shame and stigma of nonmarital pregnancy could be avoided through a secret abortion.^[38] Globally, approximately 35 million abortions each year are considered unsafe, accounting for nearly half of all abortions worldwide, with 97% occurring in low- and middle-income countries.^[46] Although there is no official data on unsafe abortions in Vietnam, it has one of the highest abortion rates globally and ranks first in Southeast Asia,^[47] with an estimated 2,50,000 to 3,00,000 abortions performed annually according to official data. However, the actual number is likely much higher due to procedures conducted illegally at private or unregulated facilities.^[48] A significant proportion of these abortions are believed to take place in such settings, as young and unmarried women often seek privacy and confidentiality, which they may not find in public healthcare services.^[49] This highlights the potential risk of unsafe abortions in such settings and the need for stronger monitoring and regulation.

Regarding abortion location, both married and single women primarily sought services at private clinics (49.0% and 50.0%, respectively), with public hospitals or health centers being the next most common option. Interestingly, only married women reported using commune health centers or private hospitals. While the differences in abortion location between marital groups were not statistically significant (P = .68), the data suggest that married women may have broader access to various facility types. This could be attributed to factors such as their higher income or greater familiarity with healthcare systems, as the study found married participants’ incomes were significantly higher than those of single women.

The study fingdings further showed that lower income was significantly associated with abortion. Women with higher incomes were less likely to report having had an induced abortion, a pattern also observed among Chinese women aged 18 to 49.^[50] A large population-based study in 17 sub-Saharan African countries found that women from lower socioeconomic statuses often lack the financial resources to afford contraceptives. This can lead to a higher incidence of unintended pregnancies and, consequently, unsafe abortions.^[51]

Similar to previous study findings among factory female migrant workers in China,^[52] our study found that unwanted pregnancy (69%) was the major reason for induced abortions. This suggests a potential link to contraceptive failure, as reported by another study on internal female migrant workers in China.^[35] However, our study did not assess contraceptive adherence rates, which are essential for accurately interpreting failure rates. Additionally, we did not measure the overall contraceptive use rate among participants, which limits our ability to directly compare with previous studies or draw definitive conclusions about contraceptive failure. In Vietnam, through various channels, including public health facilities like commune health centers, over-the-counter sales at pharmacies, private clinics, and commercial outlets.^[53–56] However, female migrant workers face significant barriers to accessing these services. Long factory working hours often conflict with clinic schedules, and geographic distance from health facilities in industrial or remote areas restricts regular access.^[57–59] High out-of-pocket costs, limited health insurance coverage and low awareness^[60] further further deter contraceptive use. Our findings highlight the need for comprehensive interventions to prevent unwanted pregnancies among young female migrant workers. Implementing mobile health clinics at IZ during nonworking hours, subsidizing contraceptives through pharmacy partnerships, and delivering community-based education campaigns via factory networks can enhance access, increase awareness, and reduce social stigma, promoting higher contraceptive uptake.

Longer sexual history increased abortion odds, indicating that prolonged exposure to sexual activity heightens the risk of unintended pregnancies and subsequent abortions. Prior to Vietnam’s 2020–2025 National Action Plan, school-based programs often reduced sex education to theoretical biology lessons and often remained theoretical and superficial, failing to equip students with practical knowledge for their sexual health.^[9,61] The situation was even more restricted in the rural and remote areas that are the origin of most IZ migrant workers. Therefore, it is probable that many of these young women received limited or inconsistent sexuality education during their schooling years. These gaps likely contribute to low contraceptive knowledge among young migrant women, making them more vulnerable to unintended pregnancies. Expanding culturally appropriate, accessible sexual education programs targeting migrant populations, including contraception and reproductive health counseling, is critical to reducing abortion in this group.

The findings revealed that a small number of married women reported being coerced into abortions by their husbands. This highlights the intersection of gender-based violence and reproductive health. Similar patterns have been observed in previous studies in Vietnam, where a history of gender-based violence was associated with induced abortion among married women.^[8] While specific estimates are unavailable for Vietnam, a WHO multicountry analysis among 17,518 ever-partnered women found that experiencing intimate partner violence was associated with a 2.7-fold increase in the odds of abortion (AOR 2.68; 95% CI: 2.34–3.06).^[62] Addressing gender inequality and gender-based violence is crucial for ensuring safe abortion and providing access to SRH services for women migrant workers in the IZ, particularly those in vulnerable positions.

Further findings showed that Kinh women were nearly 3 times more likely to have had an abortion than women from other ethnic groups. This disparity highlights important differences in reproductive health access and outcomes between the 2 groups. While all IZ migrant workers face common barriers such as long factory hours, limited financial resources, and inadequate health insurance coverage,^[57] non-Kinh ethnic minority migrant workers may also experience additional ethnicity-specific challenges. These include significant language barriers, particularly when health information and services are primarily delivered in Vietnamese which may result in poorer understanding of contraceptive methods and abortion procedures.^[63,64] These communication barriers may partially explain the lower reported abortion rates among non-Kinh ethnic minority women in this population, as they may deter these women from seeking abortion services.

This study offers significant strengths. It directly addresses a critical evidence gap by focusing on young female migrant workers in Vietnamese IZ – a population often overlooked in reproductive health research. As the first study to examine abortion prevalence and associated factors specifically within this group, it provides unique and invaluable insights into their SRH challenges. Furthermore, with its relatively large sample size and the application of multivariate regression analysis, the study yields findings that are both statistically robust and potentially generalizable to similar migrant populations across Vietnam and Southeast Asia.

5. Limitations

This study has some limitations. First, participants were recruited from a single IZ, which may not be fully representative of all IZ across Vietnam. Therefore, caution should be exercised when generalizing these findings to other groups of women migrant workers. Additionally, while the subsample of 512 sexually active women was selected to align with the study’s focus on pregnancy and abortion, this criterion may exclude non-sexually active women migrant workers, potentially limiting representativeness of the broader target population. Second, due to the cross-sectional nature of the study, findings reflect associations rather than causal relationships and should be interpreted accordingly. Third, premarital abortion remains highly stigmatized in Vietnam, which may have led to underreporting of abortion experiences among unmarried women. To minimize social desirability bias and encourage honest responses, sensitive topics such as sexual history and abortion were collected via anonymous, self-administered questionnaires completed privately without interviewer supervision. Future research may benefit from using anonymized digital or audio-assisted self-interviews to further minimize reporting bias and ensure participant privacy. Fourth, the study did not collect the number of abortions done per woman, which limits our ability to assess the frequency of repeat abortions and may underestimate the overall burden of abortion experiences among participants. Finally, our study observed higher unintended pregnancy (76.4%) among married women, however, we did not collect data on whether married women with unwanted pregnancies were living with or apart from their partners. As a result, we were unable to analyze the proportion of unintended pregnancies by cohabitation status, which limits our ability to assess the potential impact of cohabitation on these outcomes.

6. Conclusions

This study reveals a notable prevalence of induced abortion (10.9%) among young female migrant workers in Vietnam’s IZ, with married women (17.1%) significantly more likely to report abortions than single women (1.9%), aligning with patterns observed in other low- and middle-income countries. Unwanted pregnancy was the predominant reason for abortion across all participants, while married women additionally cited economic hardship, partner/husband coercion, and miscarriage or stillbirth risks, consistent with broader research on reproductive decision-making. The high reliance on private clinics (41.7%) for abortion services, driven by desires for confidentiality and flexible hours convenient for workers’ schedules, highlights a critical concern regarding potential unregulated care and safety, even though abortion services are legal and well regulated in Vietnam. This suggests that public clinics should consider changing their hours and private clinics need better oversight and strong enforcement to keep women undergoing abortion safe. Furthermore, sociodemographic factors, including marital status, longer sexual history, lower income, and Kinh ethnicity, were significantly associated with abortion likelihood. The study also underscores the potential for underreporting of abortions, particularly among single women, due to pervasive social stigma. Collectively, these findings emphasize the urgent need for targeted and culturally sensitive interventions, such as adapting public clinic hours, implementing mobile health clinics, providing subsidized contraceptives, and expanding comprehensive, culturally appropriate sexual education programs, to address barriers, reduce unwanted pregnancies, and ensure equitable access to safe and high-quality reproductive health services for young female migrant workers in Vietnam.

7. Recommendations

To effectively improve reproductive health outcomes for IZ migrant workers, future research should explore contraceptive use patterns, the influence of cohabitation dynamics, and the actual rates of unsafe abortions, which are likely underreported in this population. Concurrently, interventions must focus on expanding access to affordable contraception, implementing culturally sensitive sexuality education programs, and strengthening regulation of private clinics to ensure safe abortion services. These research and intervention strategies work synergistically to address both the knowledge gaps and systemic barriers faced by this vulnerable group, ultimately leading to better reproductive health outcomes, especially a reduction in unsafe abortions within this population.

Acknowledgments

The authors are grateful to women migrant workers who agreed to participate in this study.

Author contributions

Conceptualization: Toan Ha, Nam Nguyen, Stephen L. Schensul.

Funding acquisition: Toan Ha, Stephen L. Schensul, Nam Nguyen.

Formal analysis: Thien Quy Pham.

Methodology: Toan Ha, Stephen L. Schensul, Nam Nguyen.

Investigation: Nam Nguyen, Stephen L. Schensul, Toan Ha.

Project administration: Nam Nguyen, Toan Ha.

Software: Thien Quy Pham.

Supervision: Toan Ha, Stephen L. Schensul.

Validation: Toan Ha.

Writing – original draft: Toan Ha.

Writing – review & editing: Toan Ha, Thien Quy Pham, Nam Nguyen, Roman Shrestha, Stephen L. Schensul.