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equirements. The M<strong>in</strong>istry of Health also discussedwith UNFPA, <strong>the</strong> major provider of birth-spac<strong>in</strong>gcommodities, to exp<strong>and</strong> its coverage of project townshipsas much as possible <strong>in</strong> order to exp<strong>and</strong> <strong>the</strong> coverage <strong>and</strong> toachieve universal access, even though it has not allocatedany budget for contraceptives 52 .In <strong>the</strong> public health facilities <strong>the</strong>re is a mechanism forbirth-spac<strong>in</strong>g commodity susta<strong>in</strong>ability by provid<strong>in</strong>gbirth-spac<strong>in</strong>g services through a cost-shar<strong>in</strong>g system,whereby <strong>the</strong> client pays a m<strong>in</strong>imal amount for birthspac<strong>in</strong>gcommodities. The funds thus generated areaccumulated <strong>in</strong> <strong>the</strong> Health Facility OA head<strong>in</strong>g account(OA-O<strong>the</strong>r Accounts) as a revolv<strong>in</strong>g fund, which is to beutilized if <strong>and</strong> when UNFPA funds are not available 53 .However, this system needs policy direction as to how <strong>the</strong>funds should be managed <strong>and</strong> utilized effectively, as <strong>the</strong>substantial amount of fund<strong>in</strong>g is accumulated without<strong>in</strong>terest <strong>in</strong> township banks.Relationship of <strong>the</strong> reproductivehealth <strong>and</strong> birth-spac<strong>in</strong>gprogrammes to health,communities <strong>and</strong> women’sempowermentCommunity volunteers such as Community supportgroups (CSG) <strong>and</strong> MCH promoters <strong>and</strong> Male frontl<strong>in</strong>ehealth promoters are tra<strong>in</strong>ed <strong>in</strong> selected townships toact as a bridge between health-care providers <strong>and</strong> people<strong>in</strong> communities. This programme is a jo<strong>in</strong>t <strong>in</strong>itiative<strong>in</strong>volv<strong>in</strong>g UNFPA, <strong>the</strong> Central Health Education Bureauof Department of Health, M<strong>in</strong>istry of Health <strong>and</strong> <strong>the</strong>Japanese Organization for <strong>International</strong> Cooperation<strong>in</strong> <strong>Family</strong> <strong>Plann<strong>in</strong>g</strong> ( JOICFP) 54 . The ma<strong>in</strong> aims ofcommunity volunteers are to dissem<strong>in</strong>ate RH knowledge<strong>and</strong> birth spac<strong>in</strong>g <strong>and</strong> to support <strong>the</strong> community <strong>in</strong><strong>the</strong> behavioural change process for healthy liv<strong>in</strong>g. Theobjectives of mobiliz<strong>in</strong>g community volunteers are todissem<strong>in</strong>ate RH knowledge to <strong>the</strong> relevant population <strong>in</strong>townships <strong>and</strong> provide means of transport <strong>and</strong> referrals tohospital <strong>in</strong> times of obstetrical emergencies so that proper<strong>and</strong> timely referral could be provided.Start<strong>in</strong>g <strong>in</strong> 2002 members of CSG were selected from eachcommunity by <strong>the</strong> local midwife <strong>and</strong> <strong>the</strong> village healthcommittee, accord<strong>in</strong>g to criteria for selection: persons<strong>in</strong>terested <strong>in</strong> <strong>the</strong> health <strong>and</strong> welfare of <strong>the</strong> community,<strong>and</strong> active males <strong>and</strong> females between 18 <strong>and</strong> 50 years ofage. Each CSG member is given tra<strong>in</strong><strong>in</strong>g on reproductivehealth, is given a record booklet <strong>and</strong> is put <strong>in</strong> charge of30 households. The CSG members give health educationto <strong>the</strong>ir assigned households, provide help <strong>and</strong> supportwith transport when a person needs to be referred to adistant hospital or health-care provider, raise funds from<strong>the</strong> community if <strong>the</strong>re is a need <strong>in</strong> emergency situations,<strong>and</strong> assist midwives or health-care providers <strong>in</strong> healthactivities. CSGs work very closely with village healthcommittee members <strong>and</strong> basic health staff; <strong>the</strong>y havebeen successful <strong>in</strong> provid<strong>in</strong>g timely referral <strong>and</strong> support <strong>in</strong>obstetric emergencies.CSG was implemented as a model project <strong>in</strong> DalahTownship <strong>in</strong> Yangon Division, <strong>and</strong> Sarmalauk village <strong>in</strong>Nyaung Done Township. When <strong>the</strong> model communityRH project was assessed, it was found that CPR roseby 50 per cent over exist<strong>in</strong>g levels <strong>and</strong> that awareness ofreproductive tract <strong>in</strong>fections, sexually transmitted diseases<strong>and</strong> HIV/AIDS had <strong>in</strong>creased by about 50 per cent.CPR <strong>in</strong> Sarmalauk raised from 31 per cent <strong>in</strong> 2001 to42.6 per cent <strong>in</strong> 2003 55 , <strong>and</strong> was later exp<strong>and</strong>ed to reach64 townships by <strong>the</strong> end of 2010 56 . The Situation AnalysisTeam members also observed success stories dur<strong>in</strong>g <strong>the</strong>irvisits to rural health centres <strong>and</strong> felt that this programmehad <strong>the</strong> potential to br<strong>in</strong>g about better RH outcomes <strong>in</strong>rural areas 57 .PSI/Myanmar’s mission is to serve <strong>the</strong> poor <strong>and</strong>vulnerable groups <strong>in</strong> <strong>the</strong> country, <strong>and</strong> all programme<strong>and</strong> service deliveries are targeted towards <strong>the</strong>se groups.All Sun providers have been tra<strong>in</strong>ed <strong>in</strong> counsel<strong>in</strong>g skills.Women are empowered to select a method of <strong>the</strong>ir choice<strong>and</strong> considerable progress has been made <strong>in</strong> reach<strong>in</strong>gcommunities nationwide.Role of youth volunteers <strong>and</strong>Youth Information Centres 58UNFPA-supported youth programmes <strong>in</strong> collaborationwith <strong>the</strong> MSI, AFXB, MMA, DOH <strong>and</strong> DHP are successstories with regard to reproductive <strong>and</strong> sexual heal<strong>the</strong>ducation <strong>and</strong> services through youth programmes. YouthInformation Centres (YIC) have become a good modelfor young people to learn about ASRH; <strong>the</strong>y furnisha socially friendly environment for behavioural changecommunication <strong>and</strong> for <strong>the</strong> adoption of positive habitstowards safe sex <strong>and</strong> abst<strong>in</strong>ence from <strong>the</strong> tobacco, alcohol<strong>and</strong> betel-chew<strong>in</strong>g habits. The “Leadership development<strong>and</strong> healthy happy adolescent life programme” had muchsuccess <strong>in</strong> engag<strong>in</strong>g youth to adopt healthy behaviouralchanges. The YIC programme, which is supported byMMA, AFXB <strong>and</strong> <strong>the</strong> Central Health Education Bureau-JIOCFP, has been successful <strong>in</strong> engag<strong>in</strong>g youth but willneed fur<strong>the</strong>r expansion <strong>and</strong> quality assurance whenfranchised. It is not enough simply to furnish young peoplewith <strong>in</strong>formation on health; youth also need support for<strong>the</strong>ir personal <strong>and</strong> professional development <strong>in</strong> order toachieve holistic growth 59 .274
Most of <strong>the</strong> youth volunteers are <strong>in</strong>formed about youthprogrammes <strong>and</strong> youth centres by <strong>the</strong>ir friends <strong>and</strong>through HIV knowledge fairs. They attend youth tra<strong>in</strong><strong>in</strong>gsto <strong>in</strong>crease <strong>the</strong>ir level of knowledge about reproductive<strong>and</strong> sexual health <strong>and</strong> share it with o<strong>the</strong>r friends so that<strong>the</strong>y too could avoid risky behaviour <strong>and</strong> diseases. InYangon, MMA has a comprehensive tra<strong>in</strong><strong>in</strong>g programmefor personal <strong>and</strong> leadership development for youth. Forsuburban youth, AFXB has youth centres where practicalvocational tra<strong>in</strong><strong>in</strong>g opens young people to job opportunitieswere <strong>the</strong>y can ga<strong>the</strong>r toge<strong>the</strong>r for peer educator tra<strong>in</strong><strong>in</strong>gs.In rural areas, some youth are now peer educators for youth<strong>in</strong> <strong>the</strong>ir villages <strong>and</strong> conduct outreach activities, provid<strong>in</strong>go<strong>the</strong>r youth <strong>in</strong> <strong>the</strong> village with health education sessions.The community <strong>and</strong> <strong>the</strong> families of <strong>the</strong> youth appreciate<strong>the</strong>se activities because of <strong>the</strong> many positive changes <strong>the</strong>yhave observed <strong>in</strong> youth: <strong>in</strong>creased awareness about health,changes <strong>in</strong> lifestyle <strong>and</strong> behaviour <strong>and</strong> participation <strong>in</strong>social work with parents. Fur<strong>the</strong>rmore <strong>the</strong> youth becomegood leaders <strong>in</strong> <strong>the</strong> community <strong>and</strong> organize many o<strong>the</strong>ryouth to jo<strong>in</strong> <strong>in</strong> <strong>the</strong>se activities.The constra<strong>in</strong>ts to <strong>the</strong> outreach activities are that work<strong>in</strong>gyouth face difficulties <strong>in</strong> committ<strong>in</strong>g <strong>the</strong>ir free timeto engage <strong>in</strong> group activities <strong>in</strong> <strong>the</strong> community; alsosometimes <strong>the</strong>y cannot answers questions that peers mightask dur<strong>in</strong>g peer sessions. In Mawlamya<strong>in</strong>g <strong>and</strong> Thahtonedistricts, <strong>the</strong>re has been migration of community youthpeer educators <strong>and</strong> tra<strong>in</strong>ed volunteers, which served to<strong>in</strong>crease <strong>the</strong> attrition rate of peer educators for socioeconomicreasons. This programme needs to be exp<strong>and</strong>edto reach o<strong>the</strong>r youth <strong>in</strong> <strong>the</strong> nation.There is a need to produce IEC about sexually transmitted<strong>in</strong>fections (STIs) <strong>and</strong> to provide <strong>the</strong> peer educationprogramme <strong>and</strong> tra<strong>in</strong><strong>in</strong>g sessions at universities; alsomonitor<strong>in</strong>g guidel<strong>in</strong>es are needed for peer educators, <strong>and</strong>more volunteer peer educators are needed to substitute fordropouts. There is a need to develop books of frequentlyasked questions compiled from such sessions <strong>and</strong> distribute<strong>the</strong>m to peer educators for <strong>the</strong> purpose of <strong>the</strong> shar<strong>in</strong>gprecise, correct messages with <strong>the</strong> community.In l<strong>in</strong>e with <strong>the</strong> low economic conditions that prevail <strong>the</strong>reis a need to exp<strong>and</strong> vocational tra<strong>in</strong><strong>in</strong>g for out-of-schoolyouth who are unemployed. More advocacy is neededto exp<strong>and</strong> youth centres so that youth who are highlyvulnerable would be able to participate. For outreachactivities, peer educators need to be provided with moneyto pay for transport (bicycles or trawlagy- motorized, locallyassembled-open-top vehicle). Accord<strong>in</strong>g to <strong>the</strong> workplan forscheduled outreach activities, regular tra<strong>in</strong><strong>in</strong>g is neededfor <strong>the</strong> recruitment of new peer educators <strong>and</strong> refreshertra<strong>in</strong><strong>in</strong>g to update <strong>in</strong>formation about reproductive health<strong>and</strong> o<strong>the</strong>r health-related issues. A forum is neededto enable <strong>the</strong> shar<strong>in</strong>g of experiences among youth <strong>in</strong>different townships; <strong>in</strong> addition supplies of IEC materials<strong>and</strong> condoms are needed cont<strong>in</strong>uously <strong>and</strong> <strong>in</strong> adequatequantities 60 .These young peer educators can be resources for l<strong>in</strong>k<strong>in</strong>g <strong>the</strong>prevention of HIV/STIs to birth-spac<strong>in</strong>g services. Theycan advocate birth spac<strong>in</strong>g <strong>and</strong> emergency contraceptionto reduce un<strong>in</strong>tended pregnancies among young people.More youth-friendly spaces need to be developed whereyouth peer educators can <strong>in</strong>teract with o<strong>the</strong>r village youthsfor ARSH education.Government, religious <strong>and</strong>public support for RH <strong>and</strong> birthspac<strong>in</strong>gprogrammesThere are nei<strong>the</strong>r significant restrictions on nor oppositionto birth spac<strong>in</strong>g <strong>in</strong> Myanmar <strong>in</strong> terms of religious beliefsor cultural concepts, except <strong>the</strong> government’s propensitytowards a pronatalist population policy <strong>and</strong> caution <strong>in</strong>exp<strong>and</strong><strong>in</strong>g contraception <strong>and</strong> control over <strong>the</strong> population 61 .Politically, <strong>the</strong> government has been becom<strong>in</strong>g morepositive towards birth spac<strong>in</strong>g, especially <strong>in</strong> <strong>the</strong> later partof 2010 62 . This may be due to <strong>the</strong> publication by UNFPA<strong>in</strong> 2010 of <strong>the</strong> Report on Situation Analysis of Population<strong>and</strong> Development, Reproductive Health <strong>and</strong> Gender <strong>in</strong>Myanmar, which highlighted birth-spac<strong>in</strong>g gaps <strong>and</strong> maderecommendations for birth-spac<strong>in</strong>g commodity securityfor a better RH outcome. PSI/Myanmar has been askedby <strong>the</strong> Department of Health to support IUD tra<strong>in</strong><strong>in</strong>gs fortownship medical officers <strong>and</strong> has been requested to allowmidwives to refer IUD clients to Sun cl<strong>in</strong>ics 63 . This is seenas a major shift for <strong>the</strong> Department which <strong>in</strong> past yearspersistently discouraged PSI/Myanmar’s IUD activities<strong>and</strong> rem<strong>in</strong>ded <strong>the</strong> NGO repeatedly to work passively<strong>and</strong> for each Sun cl<strong>in</strong>ic not to carry out more than five<strong>in</strong>sertions a day 64 .About 90 per cent of <strong>the</strong> population of Myanmar isBuddhist. Buddhism welcomes large families <strong>and</strong> regards<strong>the</strong>m as a bless<strong>in</strong>g. Christians <strong>and</strong> Muslims comprise about5 <strong>and</strong> 4 per cent of <strong>the</strong> population, respectively, <strong>and</strong> o<strong>the</strong>rreligions toge<strong>the</strong>r comprise about 1 per cent 65 . The peopleof Myanmar are made up of 135 national races belong<strong>in</strong>gto eight major groups: Kach<strong>in</strong>, Kayah, Kay<strong>in</strong>, Ch<strong>in</strong>,Bamar, Mon, Rakh<strong>in</strong>e <strong>and</strong> Shan. There are more than 100languages <strong>and</strong> dialects spoken across <strong>the</strong> country.One of <strong>the</strong> m<strong>in</strong>ority religions <strong>in</strong> Myanmar is Christianity.Catholics do have reservations about <strong>the</strong> use ofcontraception, which may affect a m<strong>in</strong>or proportion of <strong>the</strong>population. All citizens of Myanmar have equality <strong>in</strong> accessto education <strong>and</strong> health, <strong>and</strong> enjoy freedom of worship275
Page 1:
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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Population Activities (UNFPA) for a
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where family plannin</stron
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Page 238 and 239: Figureeconomic growth durin
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Page 246 and 247: than in ensur<stro
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Page 250 and 251: (Ministry of Healt
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Page 256 and 257: FigureTrends and p
Page 258 and 259: TableTable3Unmet need for contracep
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Page 262 and 263: TableTable8TableTable9Malaysia, abo
Page 264 and 265: previously mentioned is based on fo
Page 266 and 267: TableTable16births and</str
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 280 and 281: Scope of coverage and</stro
Page 282 and 283: FigureIn Myanmar, out of six select
Page 286 and 287: according to <stro
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
Page 294 and 295: Linkages with o<st
Page 296 and 297: TableTable4Achievements of Myanmar
Page 298 and 299: monitoring <strong
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
Page 310 and 311: (1) I am against a
Page 312 and 313: FigureFigureFigure3Use of modern co
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Page 316 and 317: Figureprojection, and</stro
Page 318 and 319: Figure 11 summarizes the</s
Page 320 and 321: correlating <stron
Page 322 and 323: Figurethe use of c
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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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