A reproductive health needs assessment in Myanmar

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A Reproductive Health Needs Assessment in Myanmar (again excluding traditional birth attendants, the level of training of whom is unclear) in 1991, and 56 per cent in 1997. Birth spacing Birth spacing services have been available through the public sector only since 1991. The United Nations Population Fund (UNFPA), the United Nations Development Programme (UNDP) and Family Planning International Assistance (FPIA) are currently supporting public sector birth spacing services in 117 of Myanmar’s 320 townships (MOH 1997). The Myanmar Maternal and Child Welfare Association, a national non-governmental organization (NGO), also provides limited but critical services in some townships, distributing condoms and pills, and providing training courses in birth spacing education. Approximately 35 per cent of the population are believed to have no access to public sector primary health care services of any kind. Considering this background, it is not surprising that the largest provider of health services in Myanmar, including those related to birth spacing, is the private sector. Data concerning the specific content, quality and coverage of these services is extremely limited. Women in Myanmar have traditionally spaced their births primarily through the use of breastfeeding (Thein Thein Htay 1996), although many are now using modern contraceptive methods. The most easily procured, and therefore the most widely used methods, are injectable and oral hormonal contraceptives. There is limited use of long-term methods of contraception: sterilization is only available after approval from a board through a process that can take many months; and intrauterine device (IUD) use to date has been limited. The condom is the only method available in Myanmar for dual protection against pregnancy and sexually transmitted infections, and its access is highly limited. RTI/STDs The Department of Health’s STD control programme co-ordinates a network of 36 STD teams that operate in 25 townships throughout the country. In these townships the teams are responsible for STD surveillance, treatment, and contact tracing. Youth Although health education with a component on sexuality has been made available to some adolescents through “school based-curriculum” (i.e. optional) classes, few other interventions have been directed at unmarried adolescents who have sexual health needs related to preventing unwanted pregnancies or infections that are not being met by the current constellation of services. Current activities of international organisations and NGOs in Myanmar There are a number of international organizations and non-governmental organizations (NGOs) active in the area of reproductive health in Myanmar. Below is a brief description of their activities in this field. This is also presented in the three tables in Annexes I, II and III. United Nations Development Programme (UNDP) UNDP has a mandate to enact programmes that will have a grassroots level impact. Activities under the Human Development Initiative have been implemented since 1994. The 8
A Reproductive Health Needs Assessment in Myanmar primary health care component of the project is currently being undertaken in 36 townships in Myanmar. Activities in these townships include: IEC; the promotion of community participation; provision of essential drugs; and, the training of community health staff, in a number of areas of primary health care including birth spacing. UNDP is also active in the field of HIV/AIDS. Within the framework of UNAIDS, UNDP is undertaking a number of activities to address the increasing problem of HIV/AIDS in Myanmar. The primary objectives of these activities are to build the capacity of civil society organizations; to introduce inovative models to address both care and prevention of HIV/AIDS; to enhance the capacity of the National AIDS Programme; and, to co-ordinate HIV/AIDS activities within Myanmar. United Nations Children's Fund (UNICEF) UNICEF has activities addressing a number of different areas of reproductive health. The Women’s Health Project focuses on critical interventions for reducing maternal mortality, and involves the mobilization of women in maternal health related activities, the strengthening of community care, and the support for the decentralisation of planning and information activities. UNICEF’s HIV/AIDS activities focus on the promotion of reproductive health as a strategy to prevent the transmission of HIV among young people and women of reproductive age. Many national and international NGOs have been working closely with UNICEF to implement this programme. United Nations Population Fund (UNFPA) UNFPA has been supporting activities in Myanmar on an ad-hoc basis since 1988. UNFPA has supported a number of studies in population related areas, including the FRHS and a longitudinal study on maternal mortality. By 1996, UNFPA was supporting birth spacing projects in 72 townships. The activities within this project include: strengthening of institutional capacity of the Government’s birth spacing programme; direct support for township level provision of birth spacing services through training and provision of commodities; production of a training manual on birth spacing; strengthening of the IEC programme; providing community education materials; and setting up a management information system. World Health Organization (WHO) Within the current plan of action of WHO in Myanmar is a programme on reproductive health which is designed with the following objectives: to enhance capabilities for programme development; to increase technical knowledge and skills of staff; to increase public awareness and community involvement in reproductive health; and to improve access to reproductive health services for adolescents. In addition, WHO Geneva is supporting the Department of Medical Research with a long-term institutional grant to build their capacity for reproductive health research. WHO Geneva is also working with the Department of Health on a number of activities related to contraceptive introduction and quality of care in reproductive health services. WHO is also offering support for Myanmar nationals to undertake degree courses in HIV/STD epidemiology. 9
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ANNEX I Summary of Reproductive Hea
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Agency UNHCR Programme Local Reinte
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ANNEX III Summary Reproductive Heal
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Assuming that: (1) TFR in 1990 was
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