A reproductive health needs assessment in Myanmar

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A Reproductive Health Needs Assessment in Myanmar use of a number of methods. None of the contraceptive products available in Myanmar (other than condoms supplied by PSI) were found to have packaging in the Myanmar language. Many were found to provide no information at all, and others were written in English, Bengali, Thai, Chinese, and a number of other languages. Even the products provided in the public sector are not labelled in the Myanmar language, and although it appears to be true that most township level providers are competent in the English language, this is not true of the village level providers or the women themselves. 38
A Reproductive Health Needs Assessment in Myanmar Reproductive Tract Infections The term “reproductive tract infection” (RTI) is used to refer to a variety of infections that may occur in men and women. It includes the numerous sexually transmitted diseases (STDs), as well as iatrogenic and endogenous infections of the reproductive tract. The latter are most common among women and either result from genital tract procedures, such as IUD insertion and induced abortion (iatrogenic infection), or the disturbance of vaginal ecology, with an associated overgrowth of organisms normally present in the vagina (endogenous infection). Bacterial vaginosis and candida (yeast) infection are the common endogenous RTIs and together are responsible for the majority of vaginal discharge symptoms among women. STDs include genital ulcerative diseases (such as syphilis, chancroid, and herpes), gonorrhoea and chlamydia (the most common causes of urethral and cervical infection), and numerous viral infections. Viral pathogens include Human Papilloma Virus (HPV), which has been associated with the development of several genital tract cancers, and Human Immunodeficiency Virus (HIV), the cause of Acquired Immune Deficiency Syndrome (AIDS). Given the serious and well-described epidemic of HIV that emerged in neighbouring Thailand in 1989, great concern has been raised regarding the potential spread of HIV/AIDS within Myanmar over the past several years. Relatively less attention has been directed toward the broader category of STDs, although a vertical programme for the control of STDs has existed for many years. Endogenous RTIs have received very little attention and the need to address this category of infection has only been brought into focus by recent attempts to expand and integrate the provision of reproductive health services. As in most other countries, iatrogenic infections have remained almost entirely undocumented. OVERVIEW OF RTI PREVALENCE Ironically, the best prevalence data currently available concern the newest RTI pathogen, HIV. A national sentinel surveillance programme for HIV infection was established in March 1992. This programme involves the semi-annual (March and September) collection of anonymous, unlinked blood samples from a number of “sentinel” groups. The sentinel groups are designed to include a number of “at risk” groups (e.g., STD patients, sex workers, and injection drug users), as well as several groups more indicative of prevalence among the general population (e.g., pregnant women, blood donors, and new military recruits). Results from the September 1997 round of surveillance screening are summarised in Table 10 (March 1998 results were not available at the time of this report). Review of the site specific data reveal a considerable amount of geographic variation in the prevalence of HIV among the various sentinel populations, with rates generally higher in the eastern States and Divisions bordering Thailand, Laos, and southwestern China (Yunnan) (DOH 1997). A review of temporal trends (Table 11) indicates that rates of HIV infection are extremely high among injection drug users and are generally increasing among sex workers and STD clients (male and female). Of particular concern is the steady rise in seroprevalence rates among the “lower risk” sentinel groups (blood donors, pregnant women, and military recruits). This suggests that current efforts to reach “high risk” populations are ineffective and the epidemic is spreading further within the general population. The most recent HIV prevalence rates among antenatal clients range between 0.0 per cent in Yangon and Bago and 5.1 per cent in Kawthaung on the Myanmar-Thailand border. 39
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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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