A reproductive health needs assessment in Myanmar
A reproductive health needs assessment in Myanmar
A reproductive health needs assessment in Myanmar
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A Reproductive Health Needs Assessment <strong>in</strong> <strong>Myanmar</strong><br />
counsell<strong>in</strong>g was found to be very <strong>in</strong>adequate. In most cases it <strong>in</strong>volved simply tell<strong>in</strong>g women<br />
<strong>in</strong> hospital with abortion-related complications to use birth spac<strong>in</strong>g without ensur<strong>in</strong>g access to<br />
<strong>in</strong>formation concern<strong>in</strong>g specific birth spac<strong>in</strong>g methods or referral to a source of contraceptive<br />
commodities. Some patients are actually scolded by providers because they have had an<br />
abortion (i.e. due, as one provider mentioned, “to anger aris<strong>in</strong>g out of compassion”). The<br />
providers also mentioned that they can give advice about sterilisation but follow-up is<br />
difficult. They also sometimes advise the use of an IUD, but few return for IUD <strong>in</strong>sertion.<br />
Clients seem to prefer hormonal <strong>in</strong>jections and oral contraceptives.<br />
The provision of birth spac<strong>in</strong>g counsell<strong>in</strong>g, <strong>in</strong>clud<strong>in</strong>g <strong>in</strong>formation concern<strong>in</strong>g a range<br />
of methods and referral to appropriate birth spac<strong>in</strong>g providers should become a<br />
rout<strong>in</strong>e component of post-abortion care, which should be provided <strong>in</strong> a nonjudgmental<br />
and friendly manner.<br />
Birth Spac<strong>in</strong>g<br />
Service provision<br />
General practitioners - The <strong>assessment</strong> team observed that the majority of birth spac<strong>in</strong>g<br />
services were provided by the private sector. Unfortunately, the quality of these services was<br />
highly variable and there seemed to be little awareness of the technical standards for<br />
provid<strong>in</strong>g specific contraceptive methods. In addition, clients currently receive very limited<br />
counsell<strong>in</strong>g and <strong>in</strong>formation material when they consult with a private general practitioner for<br />
birth spac<strong>in</strong>g methods. Consequently, there is a need to improve the quality of birth spac<strong>in</strong>g<br />
services provided by private general practitioners.<br />
Four particular issues regard<strong>in</strong>g the quality of birth spac<strong>in</strong>g services provided by<br />
private general practitioners need to be addressed: the quality of contraceptive<br />
commodities provided, the standardisation of technical skills, the need for tra<strong>in</strong><strong>in</strong>g,<br />
and the content of <strong>in</strong>formation provision. Consequently,<br />
The availability of high quality contraceptive commodities to private general<br />
practitioners at cost price should be facilitated.<br />
Appropriate technical guidel<strong>in</strong>es need to be developed and distributed to<br />
private general practitioners.<br />
Tra<strong>in</strong><strong>in</strong>g should be offered to improve the technical skills of general<br />
practitioners <strong>in</strong> the provision of birth spac<strong>in</strong>g services and counsell<strong>in</strong>g.<br />
High quality IEC materials need to be supplied to general practitioners for<br />
distribution to clients.<br />
Commodity supply, standards sett<strong>in</strong>g, tra<strong>in</strong><strong>in</strong>g, and <strong>in</strong>formation provision activities for<br />
general practitioners should focus on oral and <strong>in</strong>jectable hormonal contraceptives, as well as<br />
condoms. Similar efforts regard<strong>in</strong>g the IUD should be made for private obstetric and<br />
gynaecology specialists.<br />
It was noted that, while many private general practitioners provide some birth spac<strong>in</strong>g<br />
services, there is a large degree of variation <strong>in</strong> the number of clients served. Given that the<br />
organisation of tra<strong>in</strong><strong>in</strong>g programmes will take some time, some selection of which general<br />
practitioners to tra<strong>in</strong> first will need to be made.<br />
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