A reproductive health needs assessment in Myanmar

More documents

Recommendations

Info

A Reproductive Health Needs Assessment in Myanmar interviewed believed that there is a considerable unmet need for reproductive health information and services among young people. The findings to date of an on-going UNFPA-supported maternal mortality survey (ENVIPRO 1998) indicate that 7.4 per cent of the maternal deaths were to women under the age of 20 years. The FRHS found contraceptive use among currently married women aged between 15 and 19 years to be 21.3 per cent, and that of women aged 20 to 24, 30.4 per cent. Regarding antenatal care, the survey found that women under 19 years are more likely to receive antenatal care from a traditional birth attendants or to receive no antenatal care, than those over 19 years (MOIP 1998a). Table 16. Provision of antenatal care by age of mother Doctor Nurse/midwife TBA Other None Number of pregnancies Age group 15-19 6.0 55.8 11.8 0.4 26.1 319 20-24 9.7 64.8 7.9 0.7 16.7 2165 24+ 12.0 60.4 7.1 0.3 16.2 12002 Total 11.5 64.3 7.3 0.4 16.5 14486 Source: Ministry of Immigration and Population (1998) Fertility and Reproductive Health Survey (preliminary results) ADOLESCENT SEXUAL BEHAVIOUR As the assessment team spoke with service providers, it became clear that they did not associate adolescence with reproductive health concerns. Whilst this lack of concern probably stems from the traditional assumption that unmarried people are not sexually active, both service providers and community members now believe that many boys are engaging in sexual activity before marriage. The practice of young unmarried men paying for sex with prostitutes appears to be quite common, and the team met with a number of young men who said that they themselves had visited prostitutes. The willingness of providers and youth to discuss men’s pre-marital sex with the assessment team varied between townships, and between rural and urban areas, but the team generally felt that it was much easier to discuss these issues that it had been just a few years previously. Pre-marital sex amongst girls is still said to be very rare. Providers and community members consistently say that it does not happen in their community. On the other hand, during discussions of induced abortion, one of the at-risk groups mentioned were young unmarried women. Attitudes of providers and older community members towards people who participate in pre-marital sex are generally negative and it is discussed as a “bad behaviour”. They tend to be less strong about condemning the actions of a young man who gets a STD from visiting a prostitute, however, than of an unmarried woman who gets pregnant. The experience of the assessment team in Tachileik was in contrast to that in the other townships visited. In Tachileik a number of different types of sexual exposure for young people were discussed very openly by both service providers and community members of all ages. As in other townships, young men were reported to be visiting sex workers. Their first exposure was often said to be in Thailand when they went there to seek work. Also of great concern is the reportedly common practice of young girls travelling to Thailand to find work, 52
A Reproductive Health Needs Assessment in Myanmar and ending up working as prostitutes. It is unclear whether or not they plan to work as prostitutes, or fall into this trade, but it appears that when they return to Myanmar they are sometimes admired for the amount of money they have managed to make. The HIV prevalence amongst this group of women is reported to be extremely high, and many return to Myanmar when they are in the final stages of the disease. Premarital sex was also reported to be increasingly common among couples who were soon planning to be married, especially in Tachileik. ADOLESCENTS KNOWLEDGE OF REPRODUCTIVE HEALTH ISSUES In many areas young girls and young boys have some information about HIV/AIDS and the use of condoms to prevent infection, but they have very limited knowledge of other STDs. The understanding that they do have about HIV/AIDS and STDs is misinformed and is probably not adequate for them to be able to protect themselves. For example, in one township the team visited, one adolescent boy, when asked about STDs, very innocently mentioned hydrocele as a STD. The same is true of contraception in terms of misinformation. Many have heard of a number of methods and sources of information, but do not know anything about the mode of use or the potential side-effects. Many said that they did not even like to talk about such things as STDs. There were a few exceptions, however, when a young person had exposure to information on health issues, particularly if their relatives were health personnel. Very limited information material is available which address the reproductive health concerns of young people specifically, and it appears that young people really do not have the information they need or want. For example, adolescent girls report that they did not know anything about menstruation and menstrual care before menarche, neither did they know about the relationship between menarche and fertility. The issue of menstrual irregularity is of particular concern for young girls, and was reported to be a much more common problem than other reproductive health concerns such as abnormal discharge. This was observed to be the case amongst both urban and rural girls alike. Many girls reported being emotionally upset by such menstrual problems. Mothers and elder women in their families generally acted as their confidantes when they experience irregular menstruation. Various brands of indigenous medicine were reported to be used in order to regulate menses, and if these do not work then some will consult doctors to receive an injection to regulate the menstrual flow (i.e. to induce withdrawal bleeding). ACCESS TO SERVICES It is reported to be easy for unmarried women to get contraceptive supplies. They are unlikely to go to public sector providers but can purchase methods from the drug shops in towns. They may also go to private general practitioners who are considered to be more confidential. There are also reports that young women can say that they are buying contraceptives “for my sister” or “to increase my weight” or “to regulate my menstruation”. We were unable to gain an understanding of the magnitude of contraceptive use among unmarried adolescent girls since the issues of pre-marital sex is still extremely taboo in many areas. In Taunggyi, where the public sector birth spacing programme is relatively new, the township medical officer told the assessment team that some of his basic health staff had been asking him what to do when unmarried women came to them for contraceptive methods. He says 53
Page 2 and 3:
A Reproductive Health Needs Assessm
Page 4 and 5: A Reproductive Health Needs Assessm
Page 94 and 95: ANNEX I Summary of Reproductive Hea
Page 96 and 97: Agency UNHCR Programme Local Reinte
Page 98 and 99: ANNEX III Summary Reproductive Heal
Page 100: Assuming that: (1) TFR in 1990 was
show all

A reproductive health needs assessment in Myanmar

Create successful ePaper yourself

Delete template?

Save as template?