A reproductive health needs assessment in Myanmar

A Reproductive Health Needs Assessment in Myanmar
that he encourages them to supply these young people with contraception, but finds it
difficult to account for this on his official reporting forms.
Despite the fact that many providers believe that all women want to get pregnant immediately
after marriage, there are indications that many women who marry young do wish to delay
their first birth and do have need of contraceptive services. Many community members
interviewed during the assessment made this point to the assessment team. It appears
however, that contraceptive use is not generally started until after the marriage itself, and the
first sexual exposure. The team spoke with one man whose wife had taken a three-month
injectable on the day after their wedding so that she wouldn’t get pregnant too soon.
Tachileik was an exception to this, where as noted previously the issue of pre-marital sex is
more openly discussed and accepted than in other areas. The contraceptive utilisation rate
among young woman, both married and unmarried, seems to be quite high. Most of these
contraceptives were purchased across the border in Thailand where it was reported that fewer
questions were asked, anonymity is maintained, and the quality of the products is perceived
to be higher. This is true of all reproductive health services despite the availability of formal
health services at all levels on the Myanmar side of the border. The team noted that, since
they were unable to visit any of the more remote areas of Tachileik township, this may not be
the case throughout the township.
Midwives appear to be judgmental when seeing unmarried adolescents with reproductive
health problems. They often have pre-formed ideas about the appropriate actions such
individuals should take. This partly influences young people’s decisions to go to private
providers or not to seek formal health care at all.
INFORMATION MATERIAL AND SOURCES
As noted above, very few information materials are available which address the reproductive
health concerns of young people specifically, and adolescents tend to have very limited
access to formal channels of health education. Both the youth themselves, as well as parents,
teachers and providers, report being reluctant to initiate discussions that involve sensitive
issues related to sexual behaviour. If provided with appropriate support, however, a number
of different groups of people were felt to be able to provide accurate information on
reproductive health to the young population, including teachers, parents, and health
personnel.
During the assessment, MCWA members who were working closely with the community
consistently mentioned that mothers were the best source of information for their daughters.
The major concern expressed with this strategy was the limited health literacy of many
mothers themselves. There was no similar suggestion that fathers would be a good source of
information for their sons. Most community members, including the adolescents, explained
that discussions of sexual and reproductive matters did not occur between people of different
sexes in a family.
The need for more health education in schools for adolescents on reproductive health issues
was expressed strongly by providers, parents and young people themselves, although the
young people thought that there may be objections from teachers and parents. They thought
that before any reproductive health education could be successfully provided in schools,
advocacy activities would need to be conducted with both parents and teachers to make them
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