A reproductive health needs assessment in Myanmar

A Reproductive Health Needs Assessment in Myanmar
A larger proportion of maternal health services are provided by the public sector. Almost all
antenatal care, many deliveries, and most treatment of obstetrical and abortion-related
complications are provided by the public sector. Even here, however, the role of the private
sector is expanding. The assessment team found that among those who can afford to pay,
some women prefer general practitioners for antenatal care. In large cities, some private
facilities now even have maternity beds and an instance of gynaecological surgeries being
performed in the private sector was reported. Traditional birth attendants continue to provide
assistance at a significant proportion of deliveries. It was reported that even when services
were delivered in the public sector, providers often receive gifts for their services.
Any reproductive health care programme therefore must build an effective partnership with
the private sector. UNICEF, for instance, has involved private general practitioners, through
the Myanmar Medical Association, in the development of its user-friendly STD clinics.
Partnership with the private sector needs to go beyond these initial attempts, however.
International experience shows that the private sector can significantly expand access and
availability, as it has already done in Myanmar. As with the public sector, however, there is a
need to ensure a better quality of services. As mentioned previously, quality of care is a
serious issue throughout the health sector in Myanmar. GPs are currently perceived as
offering a better quality of care than the public sector, however, we observed numerous
instances of poor quality services - particularly in regard to infection prevention and client
counselling. Innovative ways need to be found to involve private sector in efforts to ensure
the quality of care. These could include training, skills development and quality audits
through peers. Ideally, a partnership between public and private sectors should be forged for
improving the reproductive health status of men, women and young persons.
Cost as a barrier to improved reproductive health care
Community members repeatedly mentioned to the team that the cost of commodities and
services was a major consideration in whether to seek services, what services to seek, where
and from whom. In many cases concerns about cost were described as determining the
accessibility, availability and quality of care. For example, often women are reluctant to go
to hospital for delivery complications even when referred because they wish to avoid having
to spend money for transport and hospital costs. Delays in seeking emergency obstetrical
care result in avoidable morbidity and mortality. Other women reported switching to the
once-monthly injectable made in China because they did not have money to pay for DMPA.
Similarly, service providers often mentioned that they may not prescribe their first choice of
treatment if they felt that the client would not be able to afford it. To compensate, doctors
themselves often donate money for tests and drugs for very poor patients.
Gender issues
Although the situation of women has not been fully documented, the gender distinctions in
Myanmar are remarkably muted. Marital patterns also attest to a high degree of autonomy.
The challenge is to ensure that gender gaps do not arise as a consequence of rapid economic
and social change. Consequently, gender considerations need to be included in all aspects of
development activities.
While health care services include several services specifically for women, a full
understanding of women’s reproductive health risks is yet to develop both among the
community and the health system. Access to birth spacing still remains constrained and most
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