A reproductive health needs assessment in Myanmar

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A Reproductive Health Needs Assessment in Myanmar Despite the increase in the number of men having vasectomies discussed below, some fears about the method are still expressed in the community. It is often thought that vasectomy can lead to impotence and the inability to do heavy work, and is perceived to be only suitable for educated men because they do not have to do hard labour. This attitude was expressed more frequently in townships where vasectomy was reported to be uncommon. A number of fears were expressed in discussions about the potential use of the IUD. One woman said that she knew of a woman who had an IUD fitted and then died of renal failure. Another reported that after she had an IUD inserted the strings had got lost after eight months and that her menstruation stopped. When the IUD was pulled out, she had an abortion. It is also reported an IUD got “lost” inside the woman. Many women and service providers say that they know of women who have become pregnant while using the IUD. Many of these perceptions may be a result of past experience within the community with the Lippe’s Loop. BIRTH SPACING SERVICES In a number of townships with internationally supported birth spacing programmes, a broad range of contraceptive services are provided in the public sector. Two such townships were visited during the current assessment. The other four townships visited were without a public sector birth spacing programme. In the non-programme townships only female sterilisation is officially provided within the government system. In all townships, both programme and non-programme, a large percentage of contraceptive commodities and services are provided in the private sector. The private sector includes drug shops and private general practitioners as well as the private practice of government service staff. The MMCWA, a national NGO, also provides some birth spacing services. There are limited data available regarding the private sector and it is generally unknown what share of the birth spacing services are being provided in the private sector in programme townships. Public sector services As noted above, public sector birth spacing services are only available in a limited number of townships. Female sterilisation is, however, legally available at all township hospitals in Myanmar, but only after the woman has received the appropriate approval (see below). In townships where public sector birth spacing programmes are in effect, oral contraceptive pills, injectables and condoms are available down to the village level. IUDs are provided in township and station hospitals, and a few selected rural health centres. As in non-programme townships, sterilization is only performed in the township hospital. Drug shops Drug shops provide the majority of contraceptive commodities, but provide very little information to women and men. Most drug shops keep a broad range of birth spacing methods in stock, although the quality and price is highly variable between regions, between shops and between brands. Information regarding appropriate method choice and instructions for use are not spontaneously given and, if requested, may be extremely inaccurate. For example, one drug shop owner reported that the 3ml injectables could be divided into three 1ml doses, and be taken as a once-monthly injectable. The decision to accept a method is often more a factor of availability and cost than brand loyalty or method choice. When clients seek contraceptive commodities from commercial 30
A Reproductive Health Needs Assessment in Myanmar outlets they do not seem to distinguish different brands of a given contraceptive, e.g. oral contraceptive pills. They also appear to be relatively flexible regarding the specific type of contraceptive they receive. For example, a client seeking an injectable contraceptive may not mind accepting a pill if that is all that is available or affordable. Thus, brand-loyalty and method choice play a minor role in regard to drug shop purchases, where cost and the availability of commodities are major considerations. In major towns, better stocked drug shops can often provide a number of different injectable and oral contraceptives, condoms and IUD, and some were found to also have emergency contraception in stock. Private general practitioners The number of general practitioners in a town is a factor of the size of the town and the township. In larger towns, such as Taunggyi, there may be as many as 100 general practitioners. In smaller townships, five to ten general practitioners are generally found, usually concentrated in the central urban area. A few women seek birth spacing advice from private general practitioners, but the majority of women seem to consult with these providers only for the purpose of administering the method, primarily injections. Many women buy their contraceptive injection from the drug shops and take it to the private doctor to administer the injection. Information provided by general practitioners tends to be better than that given by pharmacists. They have generally not been trained in the provision of birth spacing, however, and did not tend to have detailed knowledge. The cost seems to vary significantly among general practitioners and regions. On average, the service and supply for an injection seems to cost between 150 and 250 kyats and an IUD between 350 and 700 kyats. During the course of the assessment there were also a number of reports of private general practitioners providing vasectomy and inserting IUDs. The reports of vasectomy costs at general practitioners varied widely, from 1,000 to 5,000 kyats. Public sector staff (in-service private practitioners) Public sector staff also provide birth spacing services in all townships as a part of their private practice. This is predominantly the lady health visitors and midwives, but some doctors and other medical staff also have a private practice. Even in non-programme townships, where public sector staff do not officially provide birth spacing services, most midwives and lady health visitors give information on contraception to women, and many administer the methods once women have bought them from the drug shop. Others will advise the woman to go to a general practitioner for this service. In some sites health staff report buying methods from the drug shops themselves and subsequently selling them to women in their local area. The Maternal and Child Welfare Association The Maternal and Child Welfare Association provides advice to women regarding birth spacing, and were reported to be helpful to women during the process of sterilisation application by supplying the forms and information for this application. In some townships visited by the team, the MCWA had also been active in the distribution of contraceptive pills 31
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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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