A reproductive health needs assessment in Myanmar

More documents

Recommendations

Info

A Reproductive Health Needs Assessment in Myanmar abdomen or if the baby is in an abnormal position. This latter practice is believed to be common, as found in a study of traditional birth practices in a rural area of Myanmar, in which 90 per cent of women interviewed stated that it was necessary to “manipulate the uterus” and “rearrange the baby” (Win May et al. 1997). The content of health education was somewhat unclear, but one traditional birth attendant reported telling women to avoid lifting heavy weights, to avoid sex during pregnancy and up to 45 days postpartum, about diet during pregnancy, and about possible complications to the baby. Antenatal practices of general practitioners Some in-service personnel who carry out maternal and child health care activities provide antenatal care in their private practices. Antenatal care could be on a regular basis, involving assessment of anaemia, measurement of blood pressure and performing an obstetric examination. Prescription of vitamins, administration of tetanus toxoid and giving health education are also carried out. Sometimes patients will present because of a pregnancy complication, for example oedema of the legs or leakage of water, and are usually referred to the hospital. If elevated blood pressure is found on examination, the patient is also referred. ROUTINE DELIVERY CARE The majority of deliveries are performed at home. A couple of estimates put the figure at between 70 and 80 per cent (Ministry of Health 1996, Ministry of Health 1997a). Many women prefer to deliver at home for several reasons, including the availability of family support and the low costs. There is a general belief that it is perfectly safe to deliver at home, and therefore few women consider going to hospital. Nationally, it is generally recommended that all first births should be delivered in hospital, midwives, however, report that even when they counsel a woman to deliver in hospital, she usually chooses to stay at home. According to the preliminary findings of the FRHS (shown below in Table 3) 95 per cent of births were delivered by a doctor, nurse, midwife or TBA. It is unclear to what extent TBAs in Myanmar have had training. Most of those TBAs interviewed in Mon State and Mandalay Division reported having received some training in the past, although the Government has generally not provided such training in the past five years. Most TBAs appear to have learned their trade from their mothers and grandmothers. Table 3. Per cent of births being attended by various types of provider Doctor Nurse/ TBA Relative Herself No. of midwife /neighbour pregnancies Birth order 1 18.6 46.9 31.4 1.8 1.2 2676 2-3 12.8 45.6 37.0 2.4 2.2 4298 4-5 6.6 44.8 40.9 2.9 4.6 2360 6+ 4.1 40.4 47.2 3.0 5.3 1730 Residence Urban 38.7 48.5 12.5 0.1 0.4 2253 Rural 4.7 44.0 44.5 3.1 3.6 8811 Total 11.5 44.9 38.1 2.5 3.0 11064 Source: Ministry of Immigration and Population (1998) Fertility and Reproductive Health Survey (preliminary results). 18
A Reproductive Health Needs Assessment in Myanmar In villages where a midwife or an auxiliary midwife is resident, these people usually assist deliveries, although some women still prefer to be attended by a traditional birth attendant. In one study, 50 per cent of women residing in villages with auxiliary midwives had their deliveries conducted by them (Win May et al. 1997). It is not clear whether community preference is for the auxiliary midwife or the midwife when both are available in the same village. A number of different models of interaction between midwives and auxiliary midwives appear to exist in Myanmar. In some cases the auxiliary midwives assist the midwives with delivery. In others the auxiliary midwife attends the pregnant woman during labour and calls the midwife for the delivery. Alternatively, it may be that the auxiliary midwife would attend both the labour and the delivery. Due to the voluntary nature of the auxiliary midwife’s work, she may conduct deliveries only in the times of the year when she is not involved in farm work. In villages where neither a midwife nor an auxiliary midwife is resident, the community mainly relies on traditional birth attendants. If no midwife, auxiliary midwife or traditional birth attendant are present then an “experienced” woman will deliver the baby. People appear to have faith in the traditional birth attendant, although some women reported seeking assistance at delivery by the traditional birth attendant only because the midwife was not available. This availability is constrained by a number of factors including position vacancies, distance between her residence and that of the pregnant woman or her own absence from the community. Frequently mentioned by both community members and providers was the socio-economic differential. Those that can afford to pay will be attended by a private general practitioner or go to the hospital, whilst the poorer women will be attended by the TBA or midwife. Some women say that they prefer the traditional birth attendant because she will also do the housework and wash the clothes. Traditional birth attendants also tend to be cheaper than midwives. One midwife reported that it is the custom to give midwives and traditional birth attendants the reasonable amount of money or in kinds as presents in addition to the cost of gloves and materials used during delivery. Traditional birth attendants report conducting between two and five deliveries per month. They are usually called as soon as labour starts. At the start of labour they give offerings to the four mother spirits and pray for an uneventful delivery. They help the labour by giving the abdomen a gentle massage to keep the woman comfortable. The traditional birth attendants assess the progress of labour by monitoring the contractions and feeling the head through the abdomen. Some traditional birth attendants report calling the midwife, if there is one available, when the delivery is near, whilst others say that they only call the midwife if there are complications during the delivery. In most cases, the relationship between midwives and traditional birth attendants was reported to be good. The babies are usually delivered without the direct intervention of the traditional birth attendant. However, some traditional birth attendants reported the worrying practice of pushing on the abdomen with their hands or a bamboo or wooden stick. One traditional birth attendant said that she wore plastic gloves for delivery, which cost five kyats. Another said that she used rubber gloves, which she would wash and reuse. They reported that they were following the instructions of the midwives in this regard. Once the baby has been born, the TBA will tie the cord with knotted thread, then cut the cord with a blade that may have been cleaned with spirit or soaked in hot water. They massage the abdomen and deliver the placenta, which is then buried under the steps of the house or in the courtyard. After the delivery, the birth attendant usually massages the abdomen to ensure cessation of bleeding and clearing out of the womb. To induce sweating, the woman is seated over a pot of hot 19
Page 2 and 3: A Reproductive Health Needs Assessm
Page 70 and 71:
A Reproductive Health Needs Assessm
Page 72 and 73:
Page 74 and 75:
Page 76 and 77:
Page 78 and 79:
Page 80 and 81:
Page 82 and 83:
Page 84 and 85:
Page 86 and 87:
Page 88 and 89:
Page 90 and 91:
Page 92 and 93:
Page 94 and 95:
ANNEX I Summary of Reproductive Hea
Page 96 and 97:
Agency UNHCR Programme Local Reinte
Page 98 and 99:
ANNEX III Summary Reproductive Heal
Page 100:
Assuming that: (1) TFR in 1990 was
show all

A reproductive health needs assessment in Myanmar

Create successful ePaper yourself

Delete template?

Save as template?