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accord<strong>in</strong>g to <strong>the</strong> Constitution of <strong>the</strong> Republic of <strong>the</strong>Union of Myanmar. The majority of people <strong>in</strong> Nor<strong>the</strong>rnRakh<strong>in</strong>e State (NRS) are Muslim; <strong>the</strong>y speak a dialectof Bengali that is spoken <strong>in</strong> sou<strong>the</strong>rn Bangladesh <strong>and</strong> isl<strong>in</strong>guistically different from <strong>the</strong> native Rakh<strong>in</strong>e. Most of<strong>the</strong>m are given temporary registration cards (TRC) issuedby <strong>the</strong> government 66 .That population group needs permission to marry <strong>and</strong> totravel. Socio-cultural concepts compounded with <strong>the</strong>selimitations have had a significant impact on <strong>the</strong> status ofwomen <strong>and</strong> adolescent females <strong>in</strong> NRS. After pubertywomen are conf<strong>in</strong>ed to <strong>the</strong> house <strong>and</strong> permitted to goout only <strong>in</strong> <strong>the</strong> company of a male family member. As aresult some Muslim girls <strong>in</strong> NRS, if <strong>the</strong>y are attend<strong>in</strong>gschool, withdraw after <strong>the</strong> fourth grade. This could be oneof <strong>the</strong> contributory factors for a low literacy rate amongfemales, lead<strong>in</strong>g to disempowerment 67 . Because of suchrestrictions, delays <strong>in</strong> <strong>the</strong> decision to seek assistance <strong>and</strong>ga<strong>in</strong> access to health care have had a major negative impacton <strong>the</strong> reproductive health of women <strong>in</strong> NRS. Currently,more attention has been given by <strong>the</strong> government to NRSensur<strong>in</strong>g better social support.Major socio-cultural <strong>and</strong>economic issues of relevancewith regard to birth spac<strong>in</strong>gConservative <strong>and</strong> religious cultural norms can sometimescause limitations on birth spac<strong>in</strong>g. Myths <strong>and</strong> beliefs,such as hav<strong>in</strong>g an IUD (a foreign body) <strong>in</strong> <strong>the</strong> uterus,are harmful. Weak public <strong>in</strong>formation, education <strong>and</strong>services related to family plann<strong>in</strong>g with little or noknowledge about <strong>the</strong> different birth-spac<strong>in</strong>g methods alsoare deleterious. Opposition by husb<strong>and</strong>s <strong>and</strong> <strong>the</strong> wrong<strong>in</strong>fluence of elderly people, especially gr<strong>and</strong>mo<strong>the</strong>rs <strong>and</strong>mo<strong>the</strong>rs-<strong>in</strong>-law who believe that knowledge about sex <strong>and</strong>FP is for married women <strong>and</strong> talk<strong>in</strong>g about <strong>the</strong>m is seenas improper conduct, also are detrimental to RH. Mostunmarried women do not seek RH services from publicsuppliers. Official permission is needed even for marriedwomen to obta<strong>in</strong> sterilization, which takes a long timefor local health authorities to process; when <strong>the</strong> womangets <strong>the</strong> official permission, she may already be pregnant 68 .Traditionally, big families are considered a bless<strong>in</strong>g <strong>in</strong>Myanmar. Although this culture is chang<strong>in</strong>g <strong>in</strong> urbanitesas a country whose economy is based on agriculture,farmers <strong>in</strong> rural areas still want to have a large family towork <strong>the</strong> l<strong>and</strong> 69 .Factors contribut<strong>in</strong>g to successThe birth-spac<strong>in</strong>g <strong>and</strong> RH programmes have ga<strong>in</strong>edmomentum despite <strong>the</strong>se challenges, as ev<strong>in</strong>ced by <strong>the</strong>decrease <strong>in</strong> TFR, <strong>the</strong> <strong>in</strong>crease <strong>in</strong> CPR <strong>and</strong> <strong>the</strong> decrease<strong>in</strong> unmet need for contraception. The ma<strong>in</strong> reasons forsuccess are as follows:(a) Strong political commitment of <strong>the</strong> M<strong>in</strong>istry ofHealth, work<strong>in</strong>g toge<strong>the</strong>r with UNFPA, WHO <strong>and</strong><strong>in</strong>ternational NGOs, with a high level of <strong>in</strong>volvement <strong>in</strong>coord<strong>in</strong>at<strong>in</strong>g commodity security. Given <strong>the</strong> significantunmet need for FP, much rema<strong>in</strong>s to be done to reachreproductive health commodity security.(b) Increased knowledge of contraceptives <strong>and</strong> accessibility<strong>and</strong> affordability of different methods both <strong>in</strong> <strong>the</strong>public <strong>and</strong> private sectors.(c) Improved access to high-quality RH services byenhanc<strong>in</strong>g <strong>the</strong> knowledge <strong>and</strong> skills of providersabout birth spac<strong>in</strong>g through tra<strong>in</strong><strong>in</strong>g <strong>in</strong> sexual <strong>and</strong>reproductive health. Access is also enhanced by giv<strong>in</strong>gwomen <strong>the</strong> chance to select <strong>the</strong> method of <strong>the</strong>ir choiceus<strong>in</strong>g social market<strong>in</strong>g of high-quality products whichare attractively packaged, <strong>and</strong> social market<strong>in</strong>g by PSIconta<strong>in</strong><strong>in</strong>g <strong>in</strong>formation for both clients <strong>and</strong> generalpractitioners. Such <strong>in</strong>formation enables <strong>the</strong>m tochoose/recommend different contraceptive methods<strong>and</strong> compare prices so that <strong>the</strong>y have freedom tochoose accord<strong>in</strong>g to <strong>in</strong>dividual affordability 70 .(d) The birth-spac<strong>in</strong>g programme is not a st<strong>and</strong>-aloneprogramme; it is supported by <strong>the</strong> national reproductivehealth behaviour change communication activitieswhich create greater dem<strong>and</strong> for birth spac<strong>in</strong>g 71 .(e) Community empowerment contributed to success <strong>in</strong>selected townships where CSGs form a l<strong>in</strong>k between<strong>the</strong> community <strong>and</strong> health-service providers at <strong>the</strong>grass-roots level.Current issues of concernAdolescent sexual <strong>and</strong> reproductivehealth <strong>and</strong> vulnerabilitiesYoung people (15-24 years) represent <strong>the</strong> future of everysociety <strong>and</strong> comprise a great resource of a nation. InMyanmar <strong>the</strong>y constitute one fifth of <strong>the</strong> total population 72 .Of <strong>the</strong> estimated population of 57.5 million 73 , <strong>the</strong>proportion of young people has decl<strong>in</strong>ed to 19.2 per centfrom 20 per cent <strong>in</strong> 2001. The trend <strong>in</strong> <strong>the</strong> age-specificfertility rate for <strong>the</strong> age group 15-19 is decl<strong>in</strong><strong>in</strong>g (see Figure276
Figure3.12). The proportion of TFR attributed to <strong>the</strong> age group15-19 years was 3.37 per cent <strong>in</strong> 2002 74 <strong>and</strong> was less than4-5 per cent <strong>in</strong> 2007 75 . Accord<strong>in</strong>g to <strong>the</strong> 2007 FRHS only1.9 per cent of females had <strong>the</strong>ir first birth before age 15,<strong>and</strong> slightly over 25 per cent had <strong>the</strong>ir first birth before age20. However, <strong>the</strong>re are regional differentials, with Rakh<strong>in</strong>eState hav<strong>in</strong>g <strong>the</strong> lowest age at first birth.Usually adolescents do not use contraception <strong>and</strong> maybe prone to unsafe abortion <strong>in</strong> <strong>the</strong> case of unwantedpregnancy. With regard to pre-marital sex, 16 per cent ofyouth approved it for boys while only 7 per cent of youthapproved of it for girls 76 . Young people perceived thatsocioculturally Myanmar youth should not be <strong>in</strong>volved <strong>in</strong>pre-marital sex; however, <strong>the</strong> majority expressed <strong>the</strong> viewthat <strong>the</strong>re are <strong>in</strong>creased numbers of young people engaged<strong>in</strong> pre-marital sex 77 .Accord<strong>in</strong>g to <strong>the</strong> 2007 FRHS, 11.4 per cent of pregnancies<strong>in</strong> women aged 15-19 ended <strong>in</strong> abortion. The 2004<strong>Family</strong> <strong>and</strong> Youth Survey conducted by <strong>the</strong> Departmentof Population, M<strong>in</strong>istry of Immigration <strong>and</strong> Population,<strong>and</strong> UNFPA 78 reported that 78 per cent of <strong>the</strong> youth<strong>in</strong>terviewed <strong>in</strong>dicated that <strong>the</strong> home of tra<strong>in</strong>ed birthassistants was <strong>the</strong> place where abortions could be done;home (40%) <strong>and</strong> private cl<strong>in</strong>ic (36%) were o<strong>the</strong>r oftencitedplaces. In addition, young people make up a segmentof <strong>the</strong> population that is particularly vulnerable to HIV<strong>in</strong>fection ow<strong>in</strong>g to several specific factors, such as lack ofknowledge about HIV/AIDS, lack of education <strong>and</strong> lifeskills, poor access to health services <strong>and</strong> commodities,early sexual debut, sexual coercion, sexual violence,traffick<strong>in</strong>g <strong>and</strong> grow<strong>in</strong>g up without parents or o<strong>the</strong>r formsof protection from exploitation <strong>and</strong> abuse. As <strong>the</strong>y are<strong>in</strong>fluenced by socio-economic factors, contemporary socialnorms <strong>and</strong> lifestyles, young adults tend to acquire riskysexual behaviours.Accord<strong>in</strong>g to Behavioural Sent<strong>in</strong>el Surveillance, 2008, forout-of-school youth 79 per cent have complete <strong>and</strong> accurateknowledge of HIV/AIDS <strong>and</strong> about half of <strong>the</strong>m did notuse condoms dur<strong>in</strong>g <strong>the</strong>ir last sexual encounter with causalpartners, although 90 per cent of <strong>the</strong>m used condoms <strong>the</strong>last time <strong>the</strong>y had sex with sex workers. Anecdotal evidencesuggests that an <strong>in</strong>crease <strong>in</strong> number of men who have sexwith men (MSM) is associated with new registrations atPSI youth drop-<strong>in</strong> centres of young men below 19 years ofage 80 . While adolescents do have a high level of awarenessabout STIs/HIV (75% for STIs <strong>and</strong> 91% for reproductivetract <strong>in</strong>fections) 81 , detailed knowledge on RH <strong>and</strong> STIsis limited. The school dropout rate is highest at grade 11(55.4%). The percentage of youth with a high school orhigher level of education is almost 60 per cent for bothsexes <strong>in</strong> urban areas, whereas it is less than 25 per cent<strong>in</strong> rural areas. Employment opportunities for out-ofschoolyouth are very limited; an estimated 90 per cent areunemployed.Traffick<strong>in</strong>g is <strong>the</strong> crim<strong>in</strong>al <strong>and</strong> illegal trad<strong>in</strong>g of humanbe<strong>in</strong>gs for <strong>the</strong> purpose of exploit<strong>in</strong>g <strong>the</strong>ir labour. Youngpeople are more likely to be <strong>the</strong> victims of traffick<strong>in</strong>g thanadults. While <strong>the</strong>re are no national-level data on traffick<strong>in</strong>g,<strong>the</strong> 2004 <strong>Family</strong> <strong>and</strong> Youth Survey, 2004, reported that 87per cent of youth had ever heard about <strong>the</strong> term traffick<strong>in</strong>g<strong>and</strong>, of <strong>the</strong>m, 71 per cent suggested that <strong>the</strong> 15-19 agegroup was <strong>the</strong> most likely target for traffick<strong>in</strong>g <strong>and</strong> ano<strong>the</strong>r20 per cent suggested that <strong>the</strong> age group 20-24 was. Girlsare especially vulnerable <strong>and</strong> are likely to be <strong>in</strong>fluenced byfalse job offers, promises of marriage <strong>and</strong> a better life.Figure9Trend <strong>in</strong> age-specific fertility rate per 1,000 among females aged 15-19 years, (1971-2001)504040ASFR3020102922.701971 1996 2001yearSource: For <strong>the</strong> years 1971 <strong>and</strong> 1996, World Fertility Report 2003 (United Nations publication, Sales No. E.04.XIII.10); for 2001:Myanmar Fertility <strong>and</strong> Reproductive Health Survey 2001, M<strong>in</strong>istry of Immigration <strong>and</strong> Population, Yangon, 2003.277
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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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Population Activities (UNFPA) for a
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where family plannin</stron
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Thus an objective assessment of <st
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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
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Page 282 and 283: FigureIn Myanmar, out of six select
Page 284 and 285: equirements. The Min</stron
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 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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Page 316 and 317: Figureprojection, and</stro
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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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