A reproductive health needs assessment in Myanmar

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A Reproductive Health Needs Assessment in Myanmar and condoms. They had received their supplies from the central level during a special activity, but the number they were provided with were not enough to make a serious impact. Despite the small number of condoms available for distribution, MCWA members still felt that it was difficult to give them away. This is probably a reflection of the population to which MCWA generally has access, and of the fact that many members were uncomfortable talking about condom use. The MCWA have also been actively involved in the 72 townships with UNFPA birth spacing projects. In these townships, five volunteers from MCWA have been trained as trainers on birth spacing and reproductive health. They, in turn, have provided training to an additional 20 health volunteers in each township. Social Marketing The condom social marketing activities began in mid-1995, with formative research being conducted with UNICEF support. This resulted in the development of an appropriate brand name, packaging design and motivational messages. Population Services International (PSI) then began to implement a condom social marketing project with its own funds. Beginning with one township in July 1996, the social marketing campaign has expanded to cover eight urban centres that represent the major population centres of central Myanmar. The social marketing project targets groups that are at high risk for HIV such as transport workers, migrant workers, commercial sex workers, intravenous drug users and their sex partners. In October 1997 a one-year UNAIDS-funded project was initiated, and during the 11 months of this project 2.54 million condoms were sold through a network of 878 retail outlets across 11 states and divisions (PSI 1998, Honeyman 1998). BIRTH SPACING PRACTICES During discussions with both community members and service providers it was mentioned that over the past few years the number of people using contraception has increased. One obstetrician/gynaecologist said that she thought that the contraceptive prevalence rate had increased from 20 to 60 per cent. Whilst this is likely to be a significant over-estimate, it indicates the perceived magnitude of the change in some communities. These anecdotal impressions corroborate the preliminary findings of the recent FRHS, which show that 32.7 per cent of the currently married women are using a method of birth spacing, and 28.4 per cent are using a modern method. These figures are in contrast to the 1991 PCFS in which the rates were found to be 16.8 and 13.6 per cent respectively (Table 9). Since the public sector birth spacing programme has only been in its infancy during this period, and covers only a small proportion of the country, it is hypothesised that this increase in contraceptive use is primarily through the private sector. From the team’s field visits and the FRHS, the most common methods were found to be the hormonal methods (pills and injections). The relative balance of these two, however, may be shifting, with more injectable users in recent years. Other methods available and used to some extent in Myanmar are sterilisation (both male and female), the condom and the IUD, as well as some traditional methods. 32
A Reproductive Health Needs Assessment in Myanmar Table 9. Per cent of currently married women of reproductive age who are currently using a birth spacing method (per cent of current contraceptive users who are using a specific birth spacing method) 1991 PCFS 1997 FRHS Pill 4.0 (23.8) 7.4 (22.8) Injecton 3.1 (18.5) 11.7 (36.0) I U D 0.9 (5.4) 1.3 (4.0) Condom 0.1 (0.6) 0.1 (0.3) Female sterilisation 3.7 (22.0) 5.5 (16.9) Male sterilisation 1.8 (10.7) 2.2 (6.8) Traditional methods 3.2 (19.0) 4.3 (13.2) Total 16.8 (100) 32.7 (100) 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. Hormonal methods The extent of the use of hormonal methods has been well documented in a number of recent studies (see Ministry of Health 1997a). The findings from the current assessment confirm much of what was already known, particularly that both pills and injectables are widely preferred throughout Myanmar. One new finding from this assessment is that the use of injectables appears to be increasing, and in many places they are now more popular than pills. This also corroborates the FRHS findings. There are many types and brands of injectables on the market and in use, including one-monthly Chinese injectables, two monthly (Noristerate) and three-monthly (DMPA) injections. Similarly, there are several brands of oral contraceptive pills available. From discussions with community members and service providers, the team found that there had been a considerable decrease in the use of two specific hormonal methods made in China, the once-a-month Chinese injectable and the once-a-month pill. During the WHO sponsored Assessment of the Contraceptive Method Mix conducted in 1996, the use of these methods was reportedly high, and was identified as a cause for concern (Ministry of Health 1997). Many providers during the current assessment seemed to be aware of the low efficacy and possible harmful effects of these methods. Providers reported, however, that some women use them because of their low cost. Female sterilisation As noted above, female sterilisation is the only method available in the public sector in townships without a birth spacing programme. In the 1997 FRHS 17 per cent of currently contracepting married women of reproductive age were found to rely on female sterilisation, representing 5.5 per cent of the total currently married women of reproductive age. One provider reported that the popularity of sterilisation was on the increase. In terms of per cent of currently married women, this appears to be true from the PCFS and FRHS data presented above (Table 9), but the relative prominence of this method in the overall method mix has somewhat decreased. The method is only available to women who have been given specific permission. Application for sterilisation involves the submission of a form signed by the woman, her 33
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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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