A reproductive health needs assessment in Myanmar

A Reproductive Health Needs Assessment in Myanmar
sub-centres on which antenatal care is provided, and midwives also conduct visits to the
homes of pregnant women.
The midwives interviewed by the assessment team reported that the typical content of
antenatal care at a health facility includes history-taking, weighing of the woman, blood
pressure measurement, a physical and abdominal examination, the administration of tetanus
toxoid, urine examination for albumin, and taking blood for a VDRL syphilis testing.
Pregnant women also receive information regarding the use of iron tablets, immunization
days, appropriate diet, breast care, exercise and personal hygiene, and are advised to come
back to the midwife if problems arise.
Women who receive antenatal care at home are provided with a more limited range of
services. Midwives report that care is restricted to a physical examination, including clinical
screening for anaemia and pedal oedema, and an abdominal examination, and advice on
nutrition. Thus, women who receive antenatal care at home do not have their weight
recorded, urine or haemoglobin examined, nor do they have their blood taken for a VDRL
test. Women receiving domiciliary care are advised to visit the antenatal care clinic in a
health facility three times during the pregnancy, but it is unclear how many women do so.
The quality of the antenatal care actually provided in the public sector is, however, highly
variable, both in terms of quantity and content of care. Health providers have been trained to
provide monthly visits up to the 28 th week of pregnancy, bimonthly from 29 to 36 weeks and
weekly visits thereafter. The Department of Health recommends that at least three antenatal
visits be conducted, one in each trimester. Antenatal care practice is reported to be somewhat
different, with the first visit/contact usually taking place at 20 weeks and visits may not be
spaced over trimesters. Some women do not realise the importance of antenatal visits, and
may have their first contact with a provider only near term.
Whilst VDRL testing is generally seen as an essential part of antenatal care, it is unclear what
is actually happening in this regard. The team observed that blood samples are being
collected in station hospitals and MCH centres and transported to the nearest STD team or
district or township hospital. It is not clear, however, whether the tests are actually being
done, and if they are, if the reports are getting back to the appropriate provider and being
acted upon. The VDRL testing is more systematic when women attend the district or
township hospital.
The only cost involved in routine antenatal services is for iron tablets, which have to be
purchased from the pharmacy or from the midwife at a nominal cost. There is no cost for
VDRL testing or tetanus immunization. The practice of prescribing vitamin injections
without any specific indication was noted, often at the request of the woman, and it is not
possible to say how widespread the practice is. The team wondered whether there may be a
cost rationale for this practice, since the midwives charge for the injection with a significant
profit margin involved.
Antenatal practices of traditional birth attendants
In addition to midwives, traditional birth attendants provide some women with antenatal care.
The team spoke with a number of traditional birth attendants, about the content of their
antenatal care practices. They say that they estimate the duration of pregnancy, give health
education, and “rearrange the abdomen” if a woman consults them for a tight feeling in the
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