Family Planning in Asia and the Pacific - International Council on ...

IntroductionMyanmar has undergone considerable demographic,social, economic, environmental <strong>and</strong> political changes s<strong>in</strong>ce1994, when <strong>the</strong> United Nations hosted <strong>the</strong> <strong>International</strong>Conference on Population <strong>and</strong> Development (ICPD)<strong>in</strong> Cairo <strong>and</strong> adopted <strong>the</strong> Programme of Action. As adevelop<strong>in</strong>g country <strong>in</strong> South-East <strong>Asia</strong>, Myanmar hasmade considerable progress <strong>in</strong> recent years towards meet<strong>in</strong>g<strong>the</strong> ICPD goals <strong>and</strong> <strong>the</strong> Millennium Development Goals(MDGs), through its implementation of <strong>the</strong> Five-yearNational Strategic Plan for Reproductive Health (2004-2008) <strong>and</strong> <strong>the</strong> current plan (2009-2013). Implementationof those plans has resulted <strong>in</strong> improvements <strong>in</strong> <strong>the</strong> coverage<strong>and</strong> quality of maternal <strong>and</strong> child health (MCH) care <strong>and</strong>birth-spac<strong>in</strong>g services, as well as HIV/AIDS prevention,care <strong>and</strong> support. Despite <strong>the</strong> strong political commitment<strong>and</strong> cont<strong>in</strong>uous efforts by multiple partners, reproductivehealth (RH), birth spac<strong>in</strong>g <strong>and</strong> population development <strong>in</strong>Myanmar rema<strong>in</strong> a challenge, as <strong>the</strong> country is characterizedby a high maternal mortality ratio (MMR), high <strong>in</strong>fantmortality rate (IMR) <strong>and</strong> high burden of HIV <strong>in</strong>fection,all of which <strong>in</strong>dicate that, for successful implementationof <strong>the</strong> ICPD Programme of Action, much rema<strong>in</strong>s to beaccomplished.This report on Myanmar is based on primary <strong>and</strong> secondarydata collection <strong>and</strong> a major report 1 for <strong>the</strong> situation analysisconducted <strong>in</strong> <strong>the</strong> period 2009-2010 under <strong>the</strong> auspicesof <strong>the</strong> United Nations Population Fund (UNFPA). Thesituation analysis assessed <strong>the</strong> reproductive health situationaga<strong>in</strong>st <strong>the</strong> objectives <strong>and</strong> targets of <strong>the</strong> ICPD Programmeof Action <strong>and</strong> MDGs. The present report fur<strong>the</strong>r updatesthose data <strong>and</strong> furnishes an analysis us<strong>in</strong>g <strong>in</strong>terviews <strong>and</strong>self-adm<strong>in</strong>istered questionnaires distributed to <strong>the</strong> ma<strong>in</strong>stakeholders <strong>in</strong> <strong>the</strong> Department of Health, M<strong>in</strong>istry ofHealth, M<strong>in</strong>istry of Immigration <strong>and</strong> Population, UNFPA<strong>and</strong> <strong>in</strong>ternational non-governmental organizations(NGOs) work<strong>in</strong>g <strong>in</strong> <strong>the</strong> areas of RH <strong>and</strong> birth spac<strong>in</strong>g <strong>in</strong>Myanmar. The report also encompasses recommendationsfor giv<strong>in</strong>g direction <strong>and</strong> po<strong>in</strong>t<strong>in</strong>g to <strong>the</strong> way forward forMyanmar, with emphasis on birth spac<strong>in</strong>g.The reader will notice that <strong>the</strong> term “birth spac<strong>in</strong>g” isused throughout <strong>the</strong> report, as it is <strong>the</strong> policy of <strong>the</strong>Government of <strong>the</strong> Republic of <strong>the</strong> Union of Myanmar tohave <strong>the</strong> current population grow to a larger size; thus, <strong>the</strong>term “family plann<strong>in</strong>g” is not <strong>the</strong> preferred term. There isno separate family plann<strong>in</strong>g programme <strong>in</strong> Myanmar <strong>and</strong>birth spac<strong>in</strong>g is provided as part of <strong>the</strong> MCH programmeof <strong>the</strong> Department of Health, which uses an <strong>in</strong>tegratedapproach <strong>in</strong> implement<strong>in</strong>g birth spac<strong>in</strong>g.There are limitations <strong>in</strong> <strong>the</strong> present report as <strong>the</strong> availabledata <strong>and</strong> <strong>in</strong>formation are scarce; <strong>the</strong>refore, <strong>the</strong> sourcesheavily relied upon to prepare <strong>the</strong> report were fertility <strong>and</strong>reproductive health surveys, a nationwide cause-specificmaternal mortality survey, a family <strong>and</strong> youth survey <strong>in</strong> 2004<strong>and</strong> an RH basel<strong>in</strong>e survey <strong>in</strong> 2002. The views expressedhere are extracted from <strong>the</strong> responses to self-adm<strong>in</strong>isteredquestionnaires <strong>and</strong> <strong>in</strong>terviews with actors work<strong>in</strong>g <strong>in</strong> <strong>the</strong>area of RH <strong>and</strong> birth spac<strong>in</strong>g, plus <strong>the</strong> authors’ analyticalcomments. Where divergence exists, it is hoped that thisreport will be helpful <strong>in</strong> provid<strong>in</strong>g reflections from adifferent perspective with only one concern: <strong>the</strong> well-be<strong>in</strong>g<strong>and</strong> progress of <strong>the</strong> population of Myanmar.Population <strong>and</strong> reproductivehealth situation <strong>and</strong> pastachievementsPopulationThe population of Myanmar is estimated to have been59.13 million <strong>in</strong> 2009/10, with <strong>the</strong> annual growthrate be<strong>in</strong>g 1.29 per cent <strong>and</strong> <strong>the</strong> majority (70%) of <strong>the</strong>population liv<strong>in</strong>g <strong>in</strong> rural areas 2 .The population was expected to grow to about 60 millionby <strong>the</strong> end of 2010; 62.6 million by 2015; <strong>and</strong> 66 millionby 2020, tak<strong>in</strong>g <strong>in</strong>to consideration <strong>the</strong> current decreas<strong>in</strong>gtrend <strong>in</strong> <strong>the</strong> population growth rate.The United Nations estimated that <strong>the</strong> population was49.8 million <strong>in</strong> 2007, with <strong>the</strong> rate of natural <strong>in</strong>creasebe<strong>in</strong>g 0.9 per cent annually; <strong>the</strong> Population ReferenceBureau also projected that <strong>the</strong> population would growto 61.7 million by 2025 3 . O<strong>the</strong>r United Nations 4 <strong>and</strong><strong>in</strong>ternational 5 sources have estimated <strong>the</strong> population ofMyanmar to have been 50 million <strong>in</strong> 2009, with <strong>the</strong> rateof natural <strong>in</strong>crease be<strong>in</strong>g 0.9 to 1.1 per cent annually. Thepopulation of Myanmar is <strong>in</strong> <strong>the</strong> late transitional stage, withdecl<strong>in</strong><strong>in</strong>g fertility accompanied by moderate <strong>and</strong> decl<strong>in</strong><strong>in</strong>gmortality. In study<strong>in</strong>g past population trends, it may beobserved that <strong>the</strong> population has <strong>in</strong>creased steadily from10.7 million <strong>in</strong> 1901 to 28.9 million <strong>in</strong> 1973 (<strong>the</strong> pre-warcensus populations were estimated accord<strong>in</strong>g to <strong>the</strong> 1973census area) 6 . At <strong>the</strong> last census <strong>in</strong> 1983, <strong>the</strong> populationstood at 35.3 million. There is a vast difference between<strong>the</strong> United Nations estimates of population at 50 million<strong>in</strong> 2009 <strong>and</strong> <strong>the</strong> government’s estimate of 59.13 million,a situation which reflects <strong>the</strong> dire need for a populationcensus to be conducted.Regard<strong>in</strong>g spatial distribution, <strong>the</strong> population is unevenlydistributed among <strong>the</strong> regions of <strong>the</strong> country. TheM<strong>and</strong>alay <strong>and</strong> Ayeyarwady Regions are <strong>the</strong> most populous<strong>in</strong> Myanmar, each account<strong>in</strong>g for about 13.5 <strong>and</strong> 14 percent of <strong>the</strong> country’s population respectively. Kayah Stateprovides a stark contrast; it is <strong>the</strong> smallest region <strong>in</strong>263