A reproductive health needs assessment in Myanmar

A Reproductive Health Needs Assessment in Myanmar
The legal status of vasectomy should be reviewed and the current approval criteria
for vasectomy should be streamlined. Ideally, the sterilisation approval process could
be reduced to one step, with approval applying to either the husband or the wife in the
event that the woman is medically unable to have a sterilisation procedure.
Intrauterine device (IUD) - In view of the long-term protection offered, its low cost and
reversibility, the IUD could be an important method of contraceptive use, especially for
couples who have completed the desired family size and do not want to have any more:
children in future. As noted previously, many of these women cannot currently access,
sterilisation services because of the cumbersome approval process. There is a need for
improving the access and availability of IUD services, however, there is a need to guarantee
the quality of care.
A pilot project should be designed to explore the most appropriate means of providing
the IUD in a variety of service settings while ensuring adequate quality of care.
Once-a-month injectable contraceptive - The assessment team was pleased to find that the use
of once-a-month injectable contraceptives of unproven safety and efficacy had decreased
substantially in comparison to a year and a half ago when the WHO-sponsored Assessment of
the Contraceptive method Mix in Myanmar was conducted. We found that the vast majority
of providers and most clients were aware that the Chinese once-a-month injectable had a
higher failure rate and should be avoided in preference of other methods. We did hear reports
of continued use, however, primarily by very poor women who could not afford other birth
spacing methods.
The use of the once-a-month injectable made in China should continue to be
discouraged in favour of more effective alternatives. Other once-a-month injectables
of unproven safety should also be discouraged. Removing these methods from the
method mix will depend ultimately upon lowering the cost of other birth spacing
methods and, following appropriate introductory research, the introduction of a safer
and more effective once-a-month injectable contraceptive such as Cyclofem or
Mesigyna.
Oral contraceptive pills - The team did find that reports of use of the once-a-month pill were
very uncommon, suggesting that the broader availability of other birth spacing methods had
succeeded in reducing demand for this marginally effective method of unproven safety.
Unfortunately, despite the fact that daily oral contraceptive pills are one of the two most
common methods used by women in Myanmar, awareness of the need to chose low dose
estrogen formulations in preference to higher oestrogen content pills was generally lacking
among both clients and providers. The high dose pills offer no benefits in terms of
effectiveness and have a higher rate of adverse effects.
The use of these high dose estrogen, pills should be discouraged in favour of lower
dose combined oral contraceptive pills.
Little progress has been made concerning the introduction of either progestin-only pills for
lactating women or emergency contraception. These methods are generally unavailable in
Myanmar, although Postinor is available in drug shops where it is sold as post-coital
contraception.
68