Why are births dense in highlands while urban areas are sparsely populated?

The report of the Department of Population on the occasion of Vietnam Population Day December 26 shows that the average fertility rate in the country in 2025 will reach 1.93 children per woman, slightly up from the historic low of 1.91 last year but still not reaching the replacement threshold. The differentiation is strong when 19 provinces and cities recorded a fertility rate of over 2.2 children, while 11 other localities dropped below 2.0. Regional disparities continue to widen as Ho Chi Minh City is in the lowest group in the country with 1.51 children per woman, while Dien Bien leads with 2.91 children. Northern mountainous provinces such as Lai Chau, Son La, Lao Cai, Gia Lai… have been in the group with high fertility rates for many years.

Explaining this reality, doctor Mai Xuan Phuong, former Deputy Director of the Department of Communication – Education, General Department of Population (now the Department of Population, Ministry of Health), said this is a consequence of the gap in economic development and access to social services. In economic regions based on agriculture and forestry such as the Northwest or Central Highlands, people consider children to be an important labor resource.

“Having 3-4 children helps the household have more people to work in the fields and is a support for security when parents get old. Unlike the pressure of expensive living costs in urban areas, raising children in the highlands does not create an immediate economic burden,” Mr. Phuong commented.

On the other hand, women’s education level directly impacts their fertility decisions. In localities with high fertility rates and low rates of women completing high school, child marriage still exists, causing their reproductive years to lengthen. On the contrary, women in developed cities like Ho Chi Minh City and Dong Nai often marry late, prioritize career and quality of life, so they proactively have fewer children or delay having children.

Besides economic factors, cultural barriers and medical infrastructure also keep fertility rates high. The ideology of “having many children brings many blessings”, “when there is a routine, there is a shortage” or the psychology of compensatory birth to prevent the risk of children getting sick or dying early is still deeply rooted in ethnic minority communities. The modern system of family planning services and contraceptives cannot widely reach remote villages, causing many women to give birth to many children due to lack of knowledge and tools to proactively control.

Experts warn that high fertility rates in disadvantaged areas, if not corrected promptly, will create a spiral of poverty and increase social inequality. Large families with many children cause investment resources for education to be fragmented, the quality of future labor is low, while the health care and basic education systems are under overloaded pressure.

Faced with this situation, Deputy Minister of Health Do Xuan Tuyen requested the population sector to shift to a flexible approach for each region. For areas with high fertility rates, the core solution is not to impose administrative measures or empty slogans, but to link population policy with hunger eradication and poverty reduction, improving people’s knowledge and women’s status. Mr. Tuyen emphasized the need to promote pre-marital counseling, eliminate child marriage and inbreeding to improve population quality from the beginning, instead of just chasing quantity.