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

NuptialityIn Myanmar nuptiality is <strong>in</strong> transition, with <strong>the</strong> proportionnever married (PNM) for both sexes hav<strong>in</strong>g been 39.6 percent <strong>in</strong> 1973, <strong>in</strong>creas<strong>in</strong>g over time to peak <strong>in</strong> 2001 at 55.7per cent <strong>and</strong> decreas<strong>in</strong>g <strong>the</strong>reafter to 54.1 per cent <strong>in</strong> 2006.However, <strong>the</strong> trend for PNM from 1973 to 2006 stillshowed an <strong>in</strong>crease. The proportion married was 51 percent <strong>in</strong> 1973, decreas<strong>in</strong>g cont<strong>in</strong>uously to 37.8 per cent <strong>in</strong>2001 – its lowest value, <strong>the</strong>n <strong>in</strong>creas<strong>in</strong>g slightly to 39.2 percent <strong>in</strong> 2006. Aga<strong>in</strong>, <strong>the</strong> net trend is a decl<strong>in</strong>e, although it<strong>in</strong>creased aga<strong>in</strong> <strong>in</strong> <strong>the</strong> period 2001-2006. The gender gapalso narrowed among <strong>the</strong> population “never married” <strong>and</strong>“married over time” (see Figure 3). It can be assumed thatPNM has leveled off at about 50 per cent <strong>and</strong> has nowstarted to stabilize.Mean ideal family size decl<strong>in</strong>ed slightly from 3.3 children<strong>in</strong> 1991 to 3.2 <strong>in</strong> 2006. About half of currently marriedwomen of reproductive age have no desire to have any morechildren. Age at marriage varies with rural-urban residence<strong>and</strong> educational atta<strong>in</strong>ment: persons <strong>in</strong> urban areas <strong>and</strong> <strong>the</strong>more highly educated tend to marry later 9 . Given that <strong>the</strong>age at marriage is <strong>in</strong>creas<strong>in</strong>g <strong>and</strong> a grow<strong>in</strong>g proportion of<strong>the</strong> population never marry, effective mechanisms need tobe developed to reach unmarried persons with appropriateRH <strong>in</strong>formation <strong>and</strong> contraceptive services.Myanmar’s population is <strong>in</strong> <strong>the</strong> last stages of demographictransition where <strong>the</strong>re is a decl<strong>in</strong>e <strong>in</strong> <strong>the</strong> proportion ofthose under age 15 <strong>and</strong> an <strong>in</strong>crease <strong>in</strong> <strong>the</strong> proportion <strong>in</strong> <strong>the</strong>work<strong>in</strong>g age population (15-59 years) <strong>and</strong> <strong>in</strong> <strong>the</strong> elderlypopulation (60 years <strong>and</strong> older). This pattern of decl<strong>in</strong>e <strong>in</strong>fertility below <strong>the</strong> replacement level, low dependency ratio<strong>and</strong> <strong>in</strong>crease <strong>in</strong> <strong>the</strong> work<strong>in</strong>g age group may be considereda “demographic w<strong>in</strong>dow of opportunity” or a “demographicdividend” for <strong>the</strong> country to make effective <strong>in</strong>vestments <strong>in</strong>job creation <strong>and</strong> <strong>in</strong> health <strong>and</strong> education, which <strong>in</strong> turnwill lead to susta<strong>in</strong>able economic growth.Maternal mortality ratioData on maternal mortality are not collected <strong>in</strong> mostsurveys because it is difficult to cover <strong>the</strong> required sizeof <strong>the</strong> population for direct calculation, as estimat<strong>in</strong>gMMR requires a large sample. MMR is typically difficultto measure for both conceptual <strong>and</strong> practical reasons, asmaternal deaths are difficult to identify with precision 10 .Only three large countrywide surveys, namely <strong>the</strong> 1997<strong>and</strong> 2007 FRHS, <strong>and</strong> <strong>the</strong> 1999 National Mortality Survey,<strong>in</strong>cluded questions concern<strong>in</strong>g maternal mortality. TheNationwide Cause-specific Maternal Mortality Survey(2004-2005) was specially designed to collect <strong>in</strong>formationon maternal mortality. Myanmar’s MMR was 283 per100,000 live births for <strong>the</strong> period 1986-1990. 11 Accord<strong>in</strong>gto <strong>the</strong> 1999 National Mortality Survey, it was 255 at <strong>the</strong>national level, 178 <strong>in</strong> urban areas <strong>and</strong> 281 <strong>in</strong> rural areas. 12The values varied widely among <strong>the</strong> regions of <strong>the</strong> country.It was as high as 500 or more <strong>in</strong> most of Shan State <strong>and</strong> aslow as 136 <strong>in</strong> Saga<strong>in</strong>g Division. The cause-specific surveyestimated MMR at <strong>the</strong> national level to be 316 (rang<strong>in</strong>gfrom 177 to 451) per 100,000 live births, 140 for urbanareas <strong>and</strong> 363 for rural areas <strong>in</strong> 2004-2005 13 . The HealthManagement Information System (HMIS) reportedMMR to be 150 per 100,000 live births <strong>in</strong> 2008, vary<strong>in</strong>gamong regions from 220 <strong>in</strong> Kayah State, Ch<strong>in</strong> State <strong>and</strong>Shan State to 110 <strong>in</strong> Bago (West) <strong>and</strong> Magway, <strong>and</strong> 90 <strong>in</strong>Yangon 14 . Vital statistics <strong>in</strong>dicate that MMR was 94 forurban areas <strong>and</strong> 136 for rural areas <strong>in</strong> 2007 15 .Approximately 1.3 million women give birth each year <strong>in</strong>Myanmar. 16 MMR, referr<strong>in</strong>g to <strong>the</strong> number of pregnancyrelatedmaternal deaths per 100,000 live births, rema<strong>in</strong>edelevated at an estimated 316 maternal deaths <strong>in</strong> 2004-2005 17 . Some researchers estimated MMR <strong>in</strong> Myanmar tobe 219 <strong>in</strong> 2008 18 , whereas <strong>the</strong> World Health Organization(WHO), United Nations Children’s Fund (UNICEF),UNFPA <strong>and</strong> <strong>the</strong> World Bank estimated it to be 240 per100,000 live births.Myanmar has made progress <strong>in</strong> br<strong>in</strong>g<strong>in</strong>g down maternalmortality <strong>and</strong> <strong>in</strong> work<strong>in</strong>g towards reach<strong>in</strong>g <strong>the</strong> nationaltarget of atta<strong>in</strong><strong>in</strong>g an MMR lower than 145 per 100,000live births by <strong>the</strong> year 2015 19 , but <strong>the</strong> effort rema<strong>in</strong>s anongo<strong>in</strong>g challenge. The fact that MMR estimates werehigher <strong>in</strong> 2005 than <strong>the</strong> estimated levels <strong>in</strong> 1994 <strong>and</strong> 1999(Figure 3) is suggestive of <strong>the</strong> compounded impact thateconomic <strong>and</strong> social factors have on women's health <strong>and</strong>survival <strong>and</strong> <strong>the</strong> <strong>in</strong>tense vulnerability of <strong>the</strong> health statusof women. The higher figures could also be due to betterreport<strong>in</strong>g of maternal deaths due to <strong>in</strong>creased awareness<strong>and</strong> improved data-collection methods 20 .The Nationwide Cause-specific Maternal Mortality Survey(2004-2005) depicted a wide range of MMR values thatdiffered accord<strong>in</strong>g to geographical location, age group,urban-rural residency <strong>and</strong> place of birth 21 . The lead<strong>in</strong>gdirect obstetric causes of maternal death are postpartumhemorrhage (31%), followed by hypertensive disordersof pregnancy, <strong>in</strong>clud<strong>in</strong>g eclampsia (17%) <strong>and</strong> abortionrelatedcauses (10%) There is evidence that wide use ofcontraceptives significantly lowers MMR. Thus, birthspac<strong>in</strong>g should be advocated for women who do not wantto get pregnant <strong>in</strong> order to reduce MMR <strong>and</strong> unwantedpregnancies.Birth spac<strong>in</strong>gPopulation density for <strong>the</strong> whole country is 87 persons persquare kilometer, rang<strong>in</strong>g from 683 per sq km <strong>in</strong> YangonDivision, which encompasses <strong>the</strong> city of Yangon, to 15 per266