A reproductive health needs assessment in Myanmar

A Reproductive Health Needs Assessment in Myanmar
birth attendants had pushed with hands or sticks in attempts to facilitate delivery or used
other potentially harmful practices.
Priority should be given to filling vacant staff positions within the basic health
services responsible for maternal health care. In the meantime, training of traditional
birth attendants should be pursued as a means to bridge the gap until all women have
access to trained midwifery care. TBA training should focus on the content of
maternal care, including the avoidance of harmful practices, the observance of
aseptic measures during delivery, and the need for early recognition and referral of
complicated obstetrical cases. Linkages between the traditional birth attendants,
auxiliary midwives and midwives should be strengthened. The role of the TBA in
postpartum care, including birth spacing counselling, should be better defined.
Post-delivery care
Although current national guidelines stipulate that the midwife should visit the woman for up
to a week post-partum and then see her again at six weeks post-partum, midwives in most
townships reported that, while they routinely visit the woman every day for the first week,
they only see her again if she experiences problems. As a result, an important opportunity to
provide post-partum birth spacing counselling is missed.
Maternal health providers should be encouraged to follow national guidelines
regarding the schedule of post-partum visits, with special attention to follow-up at
five to six weeks. Training concerning the provision of post-partum birth spacing
counselling, including the use of progestin-only pills (where available) among
lactating women, should be provided to all maternal health providers.
Essential equipment for health providers and facilities
Adequately equipped health facilities are a pre-requisite to provision of quality maternity
care. Skilled service providers will be successful only if necessary equipment and supplies
are available at referral facilities as well as at the primary care level. For midwives, auxiliary
midwives, and traditional birth attendants, having an appropriate delivery kit and other
instruments for delivery care are as important as essential surgical equipment for the
hospitals. Since sepsis is one of the major causes of maternal mortality in Myanmar,
interventions to reduce the risk of sepsis are essential.
Given that most deliveries take place at home, the feasibility of providing a
disposable, clean delivery kit should be considered. Since most women currently pay
for all medical supplies used during their delivery anyway, women could be
encouraged to purchase such a kit in advance of their labour. Public sector services
could subsidise the provision of such delivery kits for women who could not afford to
purchase them.
A checklist of essential equipment and supplies should be developed for the first
referral level, including surgical instruments for Caesarean section, fluid volume
expanders, forceps, examination lamp, labour room table, suction machine, steriliser,
oxygen cylinder, refrigerator for essential drugs, etc. This checklist could be used to
strengthen logistic and supply systems to ensure that all referral facilities were
equipped to provide essential and comprehensive obstetrical care.
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