A reproductive health needs assessment in Myanmar

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A Reproductive Health Needs Assessment in Myanmar Priority for training and provision of materials should be given to GPs currently providing the highest volume of birth spacing services. Drug shops - Many women obtain contraceptive commodities directly from drug shops. For users of oral contraceptive pills this may be their only contact with a service provider. Users of injectable contraceptives may visit general practitioner or other health care providers to receive their injection, however, they have typically already purchased the injection, along with a needle and syringe, at a drug shop prior to seeing the health professional. Hence:, important decisions regarding which injectable contraceptive to buy have already been made by the time the client meets the GP. Consequently, drug shops play a major role in the provision of birth spacing services within Myanmar. Township medical officers should conduct a one-day training to improve the skills of drug shop staff in the provision of contraceptive methods. The focus of this training should be on oral and injectable hormonal contraceptives. This will require providing the township medical officers with training regarding the use of Curriculum on Birth Spacing recently adapted for use with drug shop dispensers. Recently oral contraceptive pills and injectable contraceptives have been placed on Myanmar’s essential drug list. This major policy decision allows these contraceptives to now be imported duty free. As a consequence, the supply of affordable and high quality contraceptive commodities in Myanmar should improve rapidly by allowing legally imported contraceptives to compete in price with inferior commodities currently brought across borders from neighbouring countries. The Food and Drug Supervisory Committee at township level should encourage drug shop owners to procure supplies from the most reliable sources. National NGOs - Given their extensive network of affiliates at township level, there is a potential for Myanmar Maternal Child Welfare Association to play a greater role in birth spacing activities. This includes expansion of their current sensitisation and community mobilisation activities, as well as the provision of selected birth spacing services, such as the community-based distribution of condoms and oral contraceptive pills. Other NGOs, such as the Red Cross, should also be sensitised to issues related to birth spacing. In order to achieve this potential, the MCWA will require both technical and IEC material support. The reproductive health training and multiplier training activities of the Maternal and Child Welfare Association should be expanded to reach all townships and, within townships, attention should be given to rural, as well as urban areas. All national NGOs should be provided with appropriate IEC materials for distribution to community members. Public sector - The assessment team noted that while birth spacing services are provided throughout Myamnar in the private sector, quality and price of commodities and services in this sector are often a barrier to access and appropriate use. Public sector services have been more effective in addressing these issues, to date, however, these services have only been provided in a limited number of townships. 66
A Reproductive Health Needs Assessment in Myanmar In order to improve access to quality services and commodities at an affordable price, efforts should be made to extend public sector birth spacing programme activities to all townships. It was evident from the fieldwork that levels of contraceptive use have increased significantly in all townships, including those with organized birth spacing programme efforts, as well as those without such programmes. This trend was corroborated by the recent national FRHS, which revealed a sharp increase in contraceptive prevalence compared to previous data from 1991. The team found that knowledge concerning the characteristics and side effects of various birth spacing methods was significantly greater in birth spacing programme townships. Given the increasing use of contraception throughout the country, it is important for all public sector health staff to receive training in the provision of birth spacing methods, emphasizing the need for appropriate client selection, information provision, counselling regarding potential side effects, and follow-up. Training efforts should be expanded to non-programme townships as soon as possible. Specific methods Female sterilisation - The current process for applying for sterilisation is generally long and cumbersome, although it is variably implemented. High cost was also a common reason for failure to access sterilisation procedures. In border areas, however, women reported travelling to Thailand to receive sterilisation, despite the high cost (approximately 6,000 kyats), rather than wait for approval from a state/division-level board. Women wishing to limit their fertility who do not have access to sterilisation or other long-term methods generally use alternative methods, which may have a higher failure rate. The occurrence of an unwanted pregnancy in an older woman was described as a common scenario leading to induced and unsafe abortion. A number of changes should be made to streamline the sterilisation approval process: The frequency of state/division-level sterilisation board meetings should be increased to reduce the current waiting time, Action should be taken to reduce relatively high costs associated with sterilisation procedures, Now that an obstetrics and gynaecology specialist has been posted to each district, consideration should be given to further decentralisation of the sterilisation board to the district level. Vasectomy - According to current laws, men can receive vasectomy procedures only if approved by a state/divisional sterilisation approval board. In general, the boards only grant approval for male sterilisation if the woman has a medical condition that prohibits her having a sterilisation procedure and she has already been approved to receive such a procedure. This two step process results in extremely long delays and contributes to the exceptionally low use of vasectomy in Myanmar. As with female sterilisation, men in border areas were reported to travel to Thailand for vasectomy procedures. 67
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