How do ethnic minority women navigate family planning amid symbolic violence? A qualitative study among Kinh and Mong communities in the highlands of Vietnam

Background: In ethnic minority communities like in Vietnam, reproductive decision-making is shaped not only by access to services but by deeply rooted cultural and gender norms. A stark 'reproductive paradox' emerges, where high fertility is idealised yet unsafe abortion remains prevalent. Objectives: This study explores how women, men and healthcare workers in Son La province perceive family planning and gender-based violence (GBV), with attention to the structural and symbolic forces that shape the reproductive autonomy of the women in the region. Methods: A qualitative study was conducted in March 2022 in Son La province, using semistructured interviews and three group discussions with 18 participants, including mothers, fathers, pregnant women and healthcare workers from both Kinh and Mong ethnic groups. Data were analysed using Krippendorff's content analysis, framed by Social Constructionism and Symbolic Interactionism, to understand how cultural narratives shape Kinh and Mong women's reproductive autonomy. Results: Participants described how women's reproductive autonomy is constrained by structural and symbolic violence. Contraceptive choices were often controlled by husbands and mothers-in-law. Some women rejected intrauterine devices to avoid affecting male sexual comfort. 'Wife snatching' and early marriage were normalised as tradition. While both ethnic groups preferred large families, Kinh participants cited lineage expectations, whereas Mong participants emphasised ancestral blessings and land. Unsafe abortion, through herbal or informal methods, was common when women's choices conflicted with stigma or family control. Conclusions: Findings underscore how gendered and ethnic hierarchies restrict reproductive autonomy of Kinh and Mong women in the region. Interventions should integrate family planning and GBV services, promote cultural humility and engage local actors in codesigning solutions that respect both biomedical and indigenous reproductive logics.