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Scope of coverage <strong>and</strong>partnerships for birth-spac<strong>in</strong>gservicesHealth facilities under <strong>the</strong> M<strong>in</strong>istry ofHealth:Health centres of <strong>the</strong> Department of Health provide facilities<strong>and</strong> manpower for contraceptives provided by UNFPA atsubsidized rates <strong>in</strong> 132 of <strong>the</strong> country’s 325 townships.UNFPA also supports Marie Stopes <strong>International</strong> (MSI),Population Services <strong>International</strong> (PSI) <strong>and</strong> <strong>the</strong> MyanmarMedical Association (MMA) with contraceptives; thus,<strong>the</strong> total number of townships receiv<strong>in</strong>g birth-spac<strong>in</strong>gcommodities from UNFPA is about 225 townshipsout of <strong>the</strong> total 325 townships 32 . There is still a gap ofapproximately 100 townships, whereas <strong>in</strong> some townships<strong>the</strong>re are birth-spac<strong>in</strong>g services provided by <strong>the</strong> M<strong>in</strong>istry ofHealth, PSI, MSI, MMCWA <strong>in</strong> collaboration with IPPF<strong>and</strong> MMA. Currently, UNFPA supports <strong>the</strong> M<strong>in</strong>istrywith five contraceptive methods (oral contraceptive pills,3-monthly Depo-Provera <strong>in</strong>jections, IUDs, condoms <strong>and</strong>emergency contraceptive pills). Among <strong>the</strong>m, <strong>the</strong> IUD is<strong>the</strong> only long-term method. Use of IUDs is <strong>in</strong>creas<strong>in</strong>g butstill low at about 4 per cent of all methods, accord<strong>in</strong>g to<strong>the</strong> 2007 FRHS; however, <strong>the</strong> use of condoms for birthspac<strong>in</strong>g is even lower. UNFPA also supported <strong>the</strong> M<strong>in</strong>istryof Health with RH commodities <strong>and</strong> tra<strong>in</strong><strong>in</strong>g. <strong>in</strong> 132townships (<strong>in</strong>clud<strong>in</strong>g German-funded townships) up to2010. In 2011 <strong>and</strong> 2012, 10 more townships each year willbe exp<strong>and</strong>ed to UNFPA support with German bilateralfunds. There are low rates of use of long-term methods<strong>and</strong> it is common for mixed methods to be used 33 .Population Services <strong>International</strong>Partnerships <strong>in</strong> birth-spac<strong>in</strong>g programmes PSI/Myanmar signed a memor<strong>and</strong>um of underst<strong>and</strong><strong>in</strong>g with<strong>the</strong> government which allows PSI/Myanmar to work <strong>in</strong><strong>the</strong> field of RH. PSI/Myanmar now has <strong>the</strong> privilege ofhav<strong>in</strong>g a tax exemption <strong>and</strong> is allowed to procure highqualitycontraceptives <strong>in</strong>ternationally 34 . PSI/Myanmarconducts social market<strong>in</strong>g of contraceptives at highlysubsidized prices so that even low-<strong>in</strong>come women <strong>and</strong>men could afford <strong>the</strong>m. PSI has secured birth-spac<strong>in</strong>gcommodities until 2012 35 <strong>and</strong> operates an extensive socialmarket<strong>in</strong>g programme through franchised general practicecl<strong>in</strong>ics <strong>and</strong> primary providers (village volunteers) <strong>in</strong> 173townships. The major portion of <strong>the</strong> fund<strong>in</strong>g budget isspent on commodities. PSI conducts social market<strong>in</strong>g ofproducts at highly subsidized prices to Sun Quality HealthFranchise Cl<strong>in</strong>ics which <strong>in</strong> turn sell <strong>the</strong>m to women at anagreed price, with PSI/Myanmar mak<strong>in</strong>g a small profitwhich covers fees for services. However, <strong>the</strong> fee for IUD<strong>in</strong>sertion is 500 Kyats for <strong>the</strong> woman concerned, <strong>and</strong> PSI/Myanmar reimburses Sun providers 4,000 Kyats for <strong>the</strong>irIUD service.In 2010 UNFPA also supported PSI/Myanmar with 6contraceptive methods <strong>in</strong> 177 townships. Now PSI obta<strong>in</strong>sIUDs <strong>and</strong> implants (both long-term methods) from o<strong>the</strong>rdonor sources. Implants are available only for specialistswho are tra<strong>in</strong>ed specifically for <strong>in</strong>sert<strong>in</strong>g contraceptiveimplants which are still quite expensive compared witho<strong>the</strong>r contraceptive methods. Some clients practicemethod switch<strong>in</strong>g, chang<strong>in</strong>g from one contraceptivemethod to ano<strong>the</strong>r because of side effects, availability <strong>and</strong>affordability.In addition to UNFPA’s support, PSI/Myanmar providescontraceptives through social market<strong>in</strong>g strategies foreight contraceptive products, namely OK pills, OK onemonth<strong>in</strong>jectable, OK three-month <strong>in</strong>jectable, OK malecondoms, OK female condoms, OK IUDs, implants <strong>and</strong>emergency contraceptive pills through <strong>the</strong> Sun QualityHealth Franchise Cl<strong>in</strong>ics <strong>in</strong> 177 townships. In fact, PSI/Myanmar distributed 25 per cent of <strong>the</strong> market share ofcontraceptives <strong>in</strong> Myanmar <strong>in</strong> 2009.The target populations of PSI are <strong>the</strong> poor <strong>and</strong> o<strong>the</strong>rvulnerable groups. PSI/Myanmar procures RHcommodities directly from PSI/Wash<strong>in</strong>gton; its logisticsmanagement plan is <strong>in</strong> place to ensure that <strong>the</strong>re is noshortage of products <strong>in</strong> <strong>the</strong> programme 36 .Currently a total of 1,192 private doctors are tra<strong>in</strong>ed <strong>in</strong>RH <strong>and</strong> are conduct<strong>in</strong>g birth-spac<strong>in</strong>g services <strong>in</strong> 177townships of 13 states/divisions, <strong>and</strong> through socialmarket<strong>in</strong>g provide users with eight good-quality productsat highly subsidized prices so that women could select<strong>the</strong> birth-spac<strong>in</strong>g method of <strong>the</strong>ir own choice. Yearly RHconsultations <strong>in</strong> <strong>the</strong> Sun franchise network <strong>in</strong>creased from2,937 <strong>in</strong> 2001 to over 1 million consultations <strong>in</strong> 2009.Marie Stopes <strong>International</strong>MSI has a memor<strong>and</strong>um of underst<strong>and</strong><strong>in</strong>g with <strong>the</strong>Department of Health <strong>and</strong> is implement<strong>in</strong>g socialmarket<strong>in</strong>g of contraceptives <strong>in</strong> approximately 24 townships.MSI carries out capacity-build<strong>in</strong>g for youth through itsAdolescent <strong>and</strong> Sexual Reproductive Health (ASRH)tra<strong>in</strong><strong>in</strong>g programmes <strong>and</strong> reaches out to peri-urban youth<strong>in</strong> large cities, such as Yangon <strong>and</strong> M<strong>and</strong>alay 37 . MSI opensRH cl<strong>in</strong>ics <strong>and</strong> reaches communities us<strong>in</strong>g differentapproaches, work<strong>in</strong>g <strong>in</strong> collaboration with basic health staff<strong>and</strong> support<strong>in</strong>g tertiary hospitals with emergency obstetriccommodities. Sometimes overlapp<strong>in</strong>g of data collectionoccurs for <strong>the</strong> RH care provided <strong>and</strong> thus requires propermanagement <strong>and</strong> coord<strong>in</strong>ation between NGO <strong>and</strong> publichealth staff at <strong>the</strong> township level.270
Myanmar Medical AssociationMMA has well-established partnerships with <strong>the</strong> publicsector <strong>and</strong> private general practitioners. MMA tra<strong>in</strong>sprivate general practitioners <strong>in</strong> RH service skills, <strong>in</strong>clud<strong>in</strong>gbirth spac<strong>in</strong>g, <strong>and</strong> provides mobile health services. MMAalso focuses on work<strong>in</strong>g women <strong>in</strong> factories under <strong>the</strong>M<strong>in</strong>istry of Industry (2) provid<strong>in</strong>g factory workers withRH <strong>and</strong> birth-spac<strong>in</strong>g services <strong>and</strong> RH education, <strong>and</strong>supports pregnant women with antenatal care <strong>and</strong> birth<strong>in</strong>gkits.O<strong>the</strong>r NGOs, such as Medec<strong>in</strong>s du Monde (MDM),Adventist Multisectoral <strong>and</strong> Integrated DevelopmentServices (AMDA), Aide Médicale <strong>International</strong>e (AMI),Save <strong>the</strong> Children (SC) <strong>and</strong> Young Women’s ChristianAssociation (YWCA), provide antenatal care. Malteser<strong>International</strong> also has demonstrated <strong>the</strong> potential toimprove access to birth-spac<strong>in</strong>g commodities 38 , provid<strong>in</strong>gbirth-spac<strong>in</strong>g services through social market<strong>in</strong>g <strong>and</strong>subsidiz<strong>in</strong>g those commodities; however, only a few NGOsare provid<strong>in</strong>g services totally free of charge. With manyactors <strong>in</strong> <strong>the</strong> field of RH <strong>and</strong> Birth spac<strong>in</strong>g <strong>the</strong>re is a needfor better coord<strong>in</strong>ation leadership <strong>in</strong>itiated by M<strong>in</strong>istryof Health among <strong>the</strong> various partners so that tangibleimprovements <strong>in</strong> quality <strong>and</strong> coverage of RH <strong>and</strong> birthspac<strong>in</strong>gservices would be possible. The private commercialsector also imports contraceptives. The majority ofhouseholds <strong>and</strong> consumers have to pay for services <strong>and</strong>commodities offered by private cl<strong>in</strong>ics.As a rule, contraceptives are available <strong>in</strong> pharmacies;however, anecdotal evidence suggests that women oftenei<strong>the</strong>r get low-quality or imported counterfeit drugs or use<strong>the</strong> chosen method improperly. More evidence is neededto learn about <strong>the</strong> magnitude <strong>and</strong> consequences of <strong>the</strong> useof monthly contraceptive pills offered over <strong>the</strong> counter <strong>in</strong>private drug stores.Myanmar Maternal <strong>and</strong> Child WelfareAssociation(MMCWA) it is an NGO under <strong>the</strong> auspices of <strong>the</strong>MOH. The MMCWA was <strong>in</strong>itiated <strong>in</strong> April 1991, for<strong>the</strong> promotion of nation-wide maternal <strong>and</strong> child welfareactivities at central, township <strong>and</strong> ward/village levels. TheMMCWA is at present function<strong>in</strong>g with 324 townshipassociations, <strong>and</strong> 11,233 branch associations formed toundertake health <strong>and</strong> welfare activities nation-wide. TheMMCWA now has over 2,000,000 volunteers serv<strong>in</strong>g <strong>the</strong>community throughout Myanmar 39 . The <strong>International</strong>Planned Parenthood Federation (IPPF) has an MOUwith MMCWA <strong>and</strong> works <strong>in</strong> partnership for support ofRH <strong>and</strong> BS <strong>and</strong> counsell<strong>in</strong>g services through tra<strong>in</strong><strong>in</strong>gs <strong>and</strong>commodity support.South-South cooperationThis concept is relatively new <strong>in</strong> Myanmar as it only recentlystarted <strong>in</strong> this country; it <strong>in</strong>volves 13 develop<strong>in</strong>g countries<strong>in</strong> <strong>the</strong> sou<strong>the</strong>rn hemisphere that cooperate <strong>and</strong> supporteach o<strong>the</strong>r <strong>in</strong> RH <strong>and</strong> birth-spac<strong>in</strong>g programmes throughtechnology <strong>and</strong> <strong>in</strong>formation transfer 40 . Representativesfrom Myanmar attended <strong>the</strong> Global Consultation onSouth-South Cooperation, which was held <strong>in</strong> Bangkokfrom 27 to 29 July 2010. In <strong>the</strong> context of new aiddynamics, this emerg<strong>in</strong>g South-South paradigm exploreddifferent South-South modalities that are commonlyapplied to deliver technical cooperation <strong>and</strong> enhance <strong>the</strong>capacities of recipient partners. One of its objectives was topromote implement<strong>in</strong>g <strong>the</strong> ICPD Programme of Action<strong>and</strong> for capacity development to achieve MDGs 41 <strong>and</strong><strong>in</strong>troduce <strong>in</strong>novative ways of cooperation <strong>in</strong> addition toNorth-South cooperation strategies.The role of <strong>the</strong> South-South cooperation modalitycould be <strong>in</strong>itiated <strong>in</strong> <strong>the</strong> area of RH <strong>and</strong> birth-spac<strong>in</strong>gcommodity security through <strong>the</strong> shar<strong>in</strong>g of <strong>in</strong>ternationalbest practices, technology transfer <strong>and</strong> <strong>in</strong> plann<strong>in</strong>g for anew census (<strong>the</strong> most recent census hav<strong>in</strong>g been conducted<strong>in</strong> 1983). Gender statistics, study on <strong>in</strong>ternal migration<strong>and</strong> RH disability statistics are also doma<strong>in</strong>s that need tobe developed if Myanmar is to take forward South-Southcooperation.Contraceptive commoditysecurityUNFPA launched <strong>the</strong> Global Programme to EnhanceReproductive Health Commodity Security <strong>in</strong> Cairo <strong>in</strong>1994 as part of ICPD. The programme <strong>and</strong> all of <strong>the</strong>comb<strong>in</strong>ed efforts <strong>in</strong> <strong>the</strong> area of reproductive health supplieshave helped people to exercise <strong>the</strong>ir right to sexual <strong>and</strong>reproductive health.Promotion of family plann<strong>in</strong>g (FP) <strong>in</strong> develop<strong>in</strong>g countrieswith high birth rates has <strong>the</strong> potential to reduce poverty <strong>and</strong>hunger, <strong>and</strong> avert 25 to 35 per cent of all maternal deaths<strong>and</strong> nearly 10 per cent of childhood deaths. FP wouldalso contribute substantially to women’s empowerment,achievement of universal primary school<strong>in</strong>g <strong>and</strong> long-termenvironmental susta<strong>in</strong>ability 42 . Globally, fund<strong>in</strong>g shortagescont<strong>in</strong>ue to hamper <strong>the</strong> comb<strong>in</strong>ed efforts to ensure <strong>the</strong>adequate provision of contraceptives, condoms <strong>and</strong> o<strong>the</strong>rreproductive health supplies. However, <strong>the</strong> situation isgett<strong>in</strong>g worse 43 . In Myanmar, contraceptive commoditiesare supplied ma<strong>in</strong>ly by UNFPA, <strong>and</strong> <strong>the</strong> governmentstill needs to allot budget for purchas<strong>in</strong>g birth-spac<strong>in</strong>gcommodities. Although <strong>the</strong>re is a national-level committeefor RH commodity security, implementation actually islimited 44 .271
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Family Pla
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ForewordThe Asia <
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Part 1Part 1Asia <
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Ensuring that <str
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of methods for all, in</str
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and undertake <str
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Report on the Regi
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SESSION 1: Changin
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that improving <st
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at a hospital would be offered post
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Bounkoung Phichit, Deputy M
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medicines
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Thus, while knowledge of modern met
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Hon. Mr. Malakai Tabar, Chairman, P
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curricula. If the
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dialogue as well as regional <stron
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BackgroundGlobal development effort
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TableTable1EventNational policyYear
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A third observation is that reporte
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TableTable2Current Contraceptive Pr
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Figure(-1.2), Cook Island</
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FigureTableTable3Trends in<
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Nam. Nearly all economies i
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2008 2009% Bilateral % Multilateral
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family planning wi
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IntroductionFamily
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The advent of the
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FigureFigure1Oceania and</s
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next 25 years, however, TFR fluctua
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FigureFigureFigure2Total fertility
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family planning pr
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esponsible for the
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that estimates of CPR for earlier p
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Figuremarried at an older age compa
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As previously mentioned most <stron
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FigureFigure945Relationship between
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The concept of “unmet need” has
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TableTable8Percentage of th
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TableTable9Percentage of reasons fo
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family planning pr
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As far as the supp
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Socio-cultural challenges tofamily
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likely to use contraception than yo
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15 Tests of statistical significanc
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of the South <stro
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104
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Figurewill exceed the</stro
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in urban (67%) tha
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ased service delivery poin<
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Most FWAs who were recruited two to
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are considered, unmet need for effe
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Households pay the
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Effective public-private partnershi
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ConclusionThe Bangladesh Fa
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the Family
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National Institute for Population R
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IndiaIndiaFamily <
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IntroductionThe use of contraceptiv
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TableTable2Indicators of tra<strong
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FigureFigureFigure1Contraceptive pr
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TableTable5Indicators of contracept
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TableTable6Adjusted odds ratios for
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FigureFigure3Contraceptive prevalen
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TableTable7Adjusted and</st
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the north
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TableTable10Differences between nor
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TableTable11 Total fertility rate <
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End Note1The first camp was success
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152
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154
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Figure1980s and ex
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health care and ed
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assistance from UNFPA and</
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in CPR. Likewise,
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International supp
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in development has
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__________ (2007). Population <stro
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170
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TableTable2What has the</st
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174
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per cent of women reported us<stron
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is provider bias that such methods
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TableTable7skewed distribution of h
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TableTable8TableTable9182
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that of the nation
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TableTable12 7some policies that ex
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The system guides the</stro
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FigureFigure4Total donor expenditur
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FigureFigureagain
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Impact of family plannin</s
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marketing of contr
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United States Agency for In
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200
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acceptable. From an NGO perspective
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FigureThis trend of limited donor f
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Figureto have the
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FigureFigure5Percentage change <str
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FigureFigure6Desire to limit childb
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coordination betwe
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the 1980s
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Policy Management.__________ (n.d.,
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218
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Page 238 and 239: Figureeconomic growth durin
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Page 250 and 251: (Ministry of Healt
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Page 256 and 257: FigureTrends and p
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Page 262 and 263: TableTable8TableTable9Malaysia, abo
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Page 268 and 269: FigureFigure3TRF54.5Scatter plots o
Page 270 and 271: ReferencesAng, Eng Suan (2007). Stu
Page 272 and 273: Demographic data sheet: population
Page 274 and 275: population size, with just 336,000
Page 276 and 277: NuptialityIn Myanmar nuptiality is
Page 278 and 279: FigureIn Myanmar, birth-spac<strong
Page 282 and 283: FigureIn Myanmar, out of six select
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Page 288 and 289: Adolescent sexual and</stro
Page 290 and 291: FigureHIV/AIDS. An HIV-positive wom
Page 292 and 293: National Population PolicyMyanmar i
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Page 296 and 297: TableTable4Achievements of Myanmar
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Page 300 and 301: Nay Pyi Taw, 26 October 2010.53 Sit
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Page 306 and 307: TableTableA296
Page 308 and 309: dispense and adm<s
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Page 312 and 313: FigureFigureFigure3Use of modern co
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FigureFigureFigure18 Population <st
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National Statistics Office, <strong
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TableTable6TableTable7TableTable832
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TableTable11326
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TableTable14TableTable15TableTable1
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TableTable19Laws and</stron
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worker and hours w
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334
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336
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includin</
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TableTable1Contraceptive prevalence
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These results suggest that about 70
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2 The (period) TFR is the</
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346
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FigureThe existence of traditional
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Guinea case by <st
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The establishment of provin
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provide family plannin</str
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Figurelegal requirement nor a condi
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FigureTableTable5TableTable6Figure4
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modern method and
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married or in unio
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Figureolder. Both the</stro
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TableTable15The immediate past Nati
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out that the “ne
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Commodity securitySupply cha<strong
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is able to achieve. In Papua New Gu
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Qualitative assessments by a number
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increasin<
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service delivery poin</stro
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Population: Views from Men
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1545-1730Day 2: December 9Session 2
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Day 3, December 10Session 50830-100
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15Mr. Tong Sithen1
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54Ms. Shadiya IbrahimAssistant Repr
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93Mr. Melkie AntonProject OfficerUn
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131Dr. John P. SkibiakDirectorRepro
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International <str
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