Nguyen Van Thao opens a fridge and pulls out a bag of bloody foetuses to prepare for burial at a small Hanoi cemetery - a grim reminder that Vietnam has one of the highest abortion rates in the world.
Around 40 percent of pregnancies in the country end in abortion, according to a report by doctors from Hanoi's Central Obstetrics Hospital, the figure is double the rate given by official statistics.
AdvertisementA legacy of childbearing quotas, poor family planning advice for the young, and conflicting messages about sex have created a situation where some are relying on abortion as a form of contraception.
There are 83 abortions per 1000 women of childbearing age in Vietnam, compared to between 10 and 23 abortions per 1000 women in much of western Europe and the US, according to sexual health non-profit group, the Alan Guttmacher Institute.
"On our busiest ever day, we received 30 foetuses," said Thao, who for around a decade has led a team of mostly Catholic volunteers in collecting foetuses, normally disposed as medical waste, from abortion clinics across the capital.
"It's hard to count how many we've buried," said volunteer Nguyen Thi Quy, 62, who helps Thao shroud the foetuses before giving them a proper burial at the cemetery in Hanoi's Soc Son district.
For decades, communist Vietnam enforced a two-child policy, using a mix of administrative penalties and subsidised family planning to limit population growth. The scheme has since been scrapped, but its effects linger.
Abortions have never been socially taboo and the official rate of some 500,000 per 2.4 million pregnancies -- around one in five -- only counts procedures from state-run clinics.
"Sexually active young people have a problem... the public health system is not catering to (them)," said Hanoi-based United Nations Population Fund (UNFPA) representative Arthur Erken.
Sexual behaviour among young Vietnamese has radically transformed in the last few decades -- they have sex earlier and marry later -- but the state's old-fashioned family planning services offer little advice or suitable contraception to young, unmarried couples, experts say.
As a result they suspect that abortion -- permitted up to 22 weeks and widely available, particularly at legal but largely unregulated private clinics -- is being used to prevent unwanted pregnancies more often than in other countries.
"There is no systematic checking on private clinics. There could be another half million (officially unaccounted) abortions," said Erken.
He added this would put Vietnam's abortion rate at around one million for 2.4 million pregnancies and warned this figure "will increase unless we do something".
- Uninformed youth -
Abysmal sex education in schools, a general lack of information on reproductive health, and no access to free family planning services mean that for many young Vietnamese, unwanted pregnancies are a fact of life.
"I've done this three times," said Hoa, a fashionable looking 20-year-old, speaking to AFP after her third abortion at a private clinic in Hanoi.
"I was a bit scared the first time but now I'm used to it," said Hoa, adding she didn't understand why she kept becoming pregnant although she and her boyfriend had taken precautions.
Many young Vietnamese have no knowledge about contraception, said Le Ngoc Bao, country representative of family planning organisation Pathfinder International.
And while society has become more permissive, giving birth out of wedlock is still frowned upon.
"If they get (an) unwanted pregnancy... the only way (out) is to get an abortion," he said.
As many young people don't "fully understand the negative consequences of abortion" the immediate costs of buying condoms or pills might seem more significant than the abstract risks of not taking precautions, he said.
Moreover, Vietnam's high abortion rate comes even though statistics show widespread use of contraception -- a sign of poor family planning advice and counselling, Bao added.
In both private clinics and state-run facilities, even post-abortion counselling is limited, so some young women end up having repeated abortions.
Vietnam urgently needs to improve its provision of sexual education and contraception to young, unmarried women, Doctor Tran Ninh of the Vietnam Family Planning Association said.
- Pressure on fertility -
Vietnam's two-child policy, while not as draconian as China's notorious one-child limit, has long forced families to restrict the number of children.
"If they have three kids, it's a big problem for their career, they will not get a promotion or a salary raise," said Giang Dang, a development expert at the Center for Community Support and Development Studies.
Dang added that the idea of a two-child family became "ingrained" and suggested that although it's been officially scrapped, local officials may still tacitly encourage it as "for them what counts is population growth being controlled".
Cultural preferences for male children have also led to high rates of sex selective abortions in certain areas of the country.
In a bid to prevent this, Vietnam has made it illegal for medical staff to reveal the sex of a foetus before birth -- although experts say the law is hard to enforce and widely flouted.
As a result of the high abortion rate and decades of family planning aimed at limiting family size, Vietnam has one of the fastest ageing populations in the world, said UNFPA's Erken.
He explains: "The pressure that puts on society -- for pension reform, for example -- is phenomenal."