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

Figureof contraceptive use. There are low rates of use for longtermmethods <strong>and</strong> it is common for mixed methods tobe used. Although four methods are be<strong>in</strong>g supported<strong>in</strong> Myanmar by UNFPA through <strong>the</strong> public sector, <strong>the</strong>use of IUDs <strong>and</strong> condoms for birth spac<strong>in</strong>g is very low.Implants are not widely available. Recently, PopulationServices <strong>International</strong> (PSI) has been provid<strong>in</strong>g specialists<strong>in</strong> obstetrics <strong>and</strong> gynaecology with implant supplies, but<strong>the</strong> cost of this method is too high for most communitiesto afford 29 .Female sterilization is available through <strong>the</strong> public sector<strong>in</strong> all townships, but is subject to official approval –permission must first be granted by a state/division-levelboard. Medical sterilization can be performed if officiallyapproved <strong>and</strong> under certa<strong>in</strong> conditions, such as multiparity,health complications <strong>and</strong> medical conditions. However,ow<strong>in</strong>g to <strong>the</strong> tedious paperwork <strong>in</strong>volved for patients toobta<strong>in</strong> formal clearance for sterilization from <strong>the</strong> state/division health department (3-5 months), permanentmethods are not <strong>the</strong> most widely used methods <strong>in</strong>Myanmar 30 . Male sterilization is restricted by law to menwhose wife had been approved for female sterilization butwas unable to undergo sterilization for medical reasons 31 .Common methods usedCommonly used methods of contraception are <strong>in</strong>jectables(3-month duration) (19.3percent), followed by dailycomb<strong>in</strong>ed oral pills (10.1 percent) (see Figure 5). Thereis negligible use of IUDs <strong>and</strong> male methods such ascondoms.Accord<strong>in</strong>g to <strong>the</strong> 2007 FRHS, over 95 per cent of <strong>the</strong>population has knowledge of at least 3 methods ofcontraception; 52 per cent of <strong>the</strong> respondents mentionedprivate sources <strong>and</strong> 42 per cent mentioned governmentoutlets as sources for contraceptive supplies. Mostrespondents (84.2% of females <strong>and</strong> 77.2% of males)mentioned that government facilities are <strong>the</strong> ma<strong>in</strong> source forsterilization <strong>and</strong> IUD <strong>in</strong>sertion, while private pharmaciesare known as <strong>the</strong> major source for contraceptive pills (over70%) <strong>and</strong> condoms (61.1%). However, with <strong>the</strong> <strong>in</strong>creasedsocial market<strong>in</strong>g of contraceptives by NGOs, trends havechanged over time <strong>and</strong> private health cl<strong>in</strong>ics are cited asa major source for <strong>in</strong>jectable contraceptives, followed bypublic nurses <strong>and</strong> midwives <strong>and</strong> private pharmacies.There are considerable differentials <strong>in</strong> <strong>the</strong> use ofcontraceptives, both among urban <strong>and</strong> rural groups, <strong>and</strong>rich <strong>and</strong> poor groups. Nearly 49 per cent of currentlymarried urban women are us<strong>in</strong>g any modern contraceptivemethods compared with only 34 per cent of rural womendo<strong>in</strong>g so. Among <strong>the</strong> regions, contraceptive use is <strong>the</strong>highest <strong>in</strong> Yangon Division (57%) followed by Bago (45%)<strong>and</strong> M<strong>and</strong>alay (42%); <strong>the</strong> lowest CPRs are <strong>in</strong> Ch<strong>in</strong> <strong>and</strong>Saga<strong>in</strong>g (28% each). The quality of service is better <strong>in</strong>DOH-UNFPA project townships than <strong>in</strong> non-projecttownships as <strong>the</strong> staff concerned did not receive tra<strong>in</strong><strong>in</strong>g.In project townships, women liv<strong>in</strong>g <strong>in</strong> rural areas haveaccess to birth-spac<strong>in</strong>g services, especially where <strong>the</strong>re isa midwife. Quality <strong>and</strong> cost depend on <strong>the</strong> availability<strong>and</strong> <strong>the</strong> price is fixed by Township Medical Officer.Contraceptive commodity security needs streng<strong>the</strong>n<strong>in</strong>gas, even <strong>in</strong> project townships <strong>the</strong>re are “stock-outs” (eventsthat cause <strong>in</strong>ventory to be exhausted) due to fund<strong>in</strong>g <strong>and</strong>transportation constra<strong>in</strong>ts, <strong>and</strong> weak logistical management<strong>and</strong> plann<strong>in</strong>g.Figure6Contraceptive method mix among currently married women, 1991-20072519912019.71997Percent151050410.18.67.40.91.3 1.8 1.83.111.714.80.1 0.1 0.3 0.75.54.7 4.43.7Pill IUD Injectables Condom FemaleSterilization1.82.21.5 1MaleSterilization20012007Cont racept ive met hodsSource: Fertility <strong>and</strong> Reproductive Health Survey, 2007269