A reproductive health needs assessment in Myanmar

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A Reproductive Health Needs Assessment in Myanmar Table 6. Unmet need for birth spacing % Currently married women 100.0 + wanting to space or limit births 77.2 + not using contraception 42.7 + not currently pregnant, amenorrhoeic or abstaining 20.6 Source: Ministry of Immigration and Population (1998) Fertility and Reproductive Health Survey (preliminary results). SOCIAL ACCEPTABILITY OF BIRTH SPACING Community leaders were found, in general, to approval of the use of birth spacing. Many felt that this was a community necessity in “current times”, since economic considerations have become an important factor related to family size. Not everyone has this positive attitude towards the use of birth spacing, however, and the team heard about a number of people who were opposed to the idea. For instance, in one township, a general practitioner was reported to be advising women against the use of birth spacing. The FRHS found that 42.7 per cent of wives and 40.6 per cent of husbands disapproved of the use of contraception. Of those currently married women not using contraception, however, only 13.8 were not doing so because of opposition to use (either their own, their husbands, religious prohibition, or other opposition) (see Table 8). During the current assessment the team found that most of the women interviewed seemed to approve of birth spacing, and only a few of the men appeared to disapprove. A couple of the women interviewed said they did not tell their husband they were using injectables for a number of months because they thought that he would want to have more children. USER AND PROVIDER PERSPECTIVES ON BIRTH SPACING Almost all women that the team spoke to knew about the use of pills and injectables and many also knew about IUDs and sterilisation. Condoms, however, were rarely mentioned as a birth spacing method. The FRHS asked women about their knowledge of contraceptive methods, and from the table below it can be seen that a similar pattern emerged. Table 7. Per cent of ever married women who have heard of specific modern contraceptive methods 1991 PCFS 1997 FRHS Pill 75.1 88.3 Injecton 72.4 87.5 IUD 47.5 55.5 Condom 23.9 24.1 Female sterilisation 65.6 78.5 Male sterilisation 61.8 71.6 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. 28
A Reproductive Health Needs Assessment in Myanmar Despite knowing of a number of methods, the assessment team found that women’s knowledge is often superficial and is derived largely from their own or other women’s experiences of using the method. Provisional data from the recent FRHS show that the fear of side effects of modern contraception is a major reason why women do not use contraception. The FRHS found that, of 10,486 currently married women who weren’t using contraception at the time of the survey, 14 per cent were not doing so because of “health concerns”. This was the second most common reason after “desire to get pregnant” (see Table 8) Table 8. Reasons for non use of contraception Lack of knowledge Opposition to use Respondent’s opposition Husband’s opposition Others’ opposition Religious prohibition Fertility related reasons Menopausal Postpartum/breast feeding Infrequent sex Desire to get pregnant Pregnant Method related reasons Health concern Access/availability Costs too much Inconvenient to use Other 7.7 11.0 1.9 0.1 0.8 8.9 8.2 1.9 18.9 11.8 14.0 1.4 0.7 0.6 12.0 The team found that all hormonal methods are perceived to be associated with a number of common side-effects, although some women claim that pills are worse, and others that injectables are worse. For example one woman said that pills cause giddiness and vomiting, and that therefore women prefer injections, whilst another woman said that injectables are associated with irregular menstruation and that therefore pills were better. Becoming thin was another of the negative side-effects mentioned in relation to taking the pill. The choice between one-monthly and three-monthly injectables is also reported to be, in part, dependent on a woman’s attitude towards irregular menstruation. Method failure and the risk of infertility after extended use were also mentioned as problems with hormonal methods. Providers in particular attributed method failure to the woman not taking the pills regularly, or not returning at the right time for a re-injection. These side effects do not seem to be stopping women from using these methods, but many women report constantly changing between various hormonal methods in an attempt to avoid the negative consequences. Most providers and community members interviewed perceived the condom solely as a means to prevent sexually transmitted infection, and not as a birth spacing method. The condom is often perceived to be an inconvenient method to use, and disposal and storage problems were also mentioned as reasons for non-use of the method. 29
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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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