A reproductive health needs assessment in Myanmar

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A Reproductive Health Needs Assessment in Myanmar who really cannot afford treatment. In one township the team observed that, in pharmacies attached to hospitals, the drug prices were set at ten per cent above the market price to cover establishment and running cost of the hospital. Since such outlets are convenient and ensure quality of the products, many service providers feel such costs are justified. Preparedness of the hospital Preparedness of the hospital to deal with complications and emergencies is an important aspect of quality of care related to pregnancy and childbirth. It was observed that the facilities for managing emergencies and complications are generally very basic. In one station hospital only one oxygen cylinder was available for the whole hospital, there was no refrigerator, a very limited number of instruments (retractors, scissors, clamps, speculums), and the labour room did not have an examination light. Although the district hospital at another location had this essential equipment and supplies, they were in poor condition. Facilities for general anaesthesia were generally unavailable in the hospitals visited and most procedures have to be conducted under spinal anaesthesia or ether and mask. Township and district hospitals were found to have limited resources for caesarean section and for the provision of blood. In none of the sites visited by the team were there fully functional blood banks at the station, township or district hospitals, and hospitals have to rely on live donors. Although donors are contacted from a list maintained at the township hospital when blood is needed, this process often introduces significant delays. State and divisional hospitals do have functioning blood banks. A 31 year old woman in her fourth pregnancy went into labour at home in a village. She had been in established labour since 10:00 pm and had not delivered by five o’clock the next morning. The midwife of the village was pregnant and so she was attended by the TBA, who advised that she should deliver in the hospital. The family went by horse cart to the town to get a car to take her to hospital. She arrived at the hospital between 9 and 10 o’clock. She continued to labour and the decision to do a caesarean section was made at 4:00 p.m. Her husband, however, had to look for a blood donor so she did not have the caesarean section until 8:00 p.m. Arranging for the transport and the donor took a total of approximately 8 hours in this case. The baby was 9 lbs 2oz and the mother required two units of blood. In the case described above facilities for HIV and hepatitis B testing were available and the woman received the blood after such screening. In some hospitals, however, blood is administered after cross matching without testing for HIV or hepatitis B. There is no charge reported for blood administration or for testing for HIV and hepatitis B. It was also noted during the assessment that some of the procedures and drugs used during the management of complications during pregnancy are not based on practices currently recommended internationally. For example, diazepam continue to be the drug of choice for management of eclampsia instead of magnesium sulphate, which is cheaper, more effective and recommended by WHO. The team found that quality of care was ultimately a function of the skills and motivation of individual service providers, which varied considerably. Even the availability of equipment was, to some extent, dependent on the initiative of the township medical officer to request supplies from the central medical store. 26
A Reproductive Health Needs Assessment in Myanmar Birth Spacing The Government of Myanmar started to provide birth spacing services in the public sector in 1991 with assistance from a number of international agencies. Public sector birth spacing programmes currently provide services in 117 of the country’s 320 townships, including 72 supported by UNFPA and 36 supported by UNDP. The majority of birth spacing products and services are, however, still provided by the private sector. UNMET NEED FOR BIRTH SPACING There are a number of indications that there is a significant unmet need for birth spacing in Myanmar. From the provisional results of the FRHS (MOIP 1998a) it was found that approximately 10 per cent of previous births were either not wanted at all (6.6 per cent) or not wanted at that time (3.3 per cent). These figures were slightly higher in rural than urban areas of Myanmar. The proportion of women reporting that they do not wish to have any more children rose from 46 to 58 per cent between 1991 and 1997 (MOIP 1995, MOIP 1998a). The difference between 1991 and 1997 was greatest amongst urban women and those with a higher level of education (see Table 5). Table 5. Per cent of currently married women wanting no more children 1991 1997 Education No schooling 52 63 l-4 standard 45 57 5-8 standard 41 56 9-10 standard 39 57 University 23 51 Residence Urban 47 63 Rural 46 57 Total 46 58 Source: Ministry of Immigration and Population (1998) Fertility and Reproductive Health Survey (preliminary results), and Ministry of Immigration and Population (1995) Myanmar Population Changes and Fertility Survey. In 1997, one quarter of the women reporting that they wanted no more children were found to not be currently amenorrhoeic, pregnant or abstaining, but not using a contraceptive method. Data were also collected for women who reported wanting to space their next birth for more than 24 months (18.9 per cent of currently married women). Of these women, nearly 30 per cent were not amenorrhoeic, pregnant or abstaining and not using contraception. From this calculation, a total of 20.6 per cent of the currently married women were found to be in need of contraception to either space their next birth, or to limit their family size. 27
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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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A reproductive health needs assessment in Myanmar

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