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

Adolescent sexual <strong>and</strong> reproductivehealth educationReproductive health services <strong>and</strong> <strong>in</strong>formation can improve<strong>the</strong> health status of adolescents <strong>and</strong> help <strong>the</strong>m atta<strong>in</strong> <strong>the</strong>level of underst<strong>and</strong><strong>in</strong>g required to make responsibledecisions. Participation of young people <strong>in</strong> plann<strong>in</strong>g,implementation <strong>and</strong> monitor<strong>in</strong>g of services could ensureadolescent-friendly health services. Adequate supportfrom <strong>the</strong> education sector <strong>and</strong> <strong>the</strong> community should beencouraged to support <strong>the</strong> <strong>in</strong>itiative.PSI/Myanmar <strong>and</strong> its Sun network members are tra<strong>in</strong>ed<strong>in</strong> adolescent reproductive health (ARH) <strong>and</strong> specialcommunication materials have been developed for <strong>the</strong>m.One million copies of an ARH booklet were distributedto young people dur<strong>in</strong>g <strong>the</strong> period 2006-2009 82 . This wasfunded by UNFPA; <strong>the</strong> production of <strong>the</strong> booklet wasjo<strong>in</strong>tly done by PSI/Myanmar <strong>and</strong> MMA youth teammembers.UNICEF <strong>and</strong> <strong>the</strong> M<strong>in</strong>istry of Education <strong>in</strong>troduced<strong>the</strong> School-based Healthy Liv<strong>in</strong>g <strong>and</strong> AIDS PreventionEducation programme (SHAPE) <strong>in</strong>to school curriculastart<strong>in</strong>g <strong>in</strong> 1997. The National Strategic Plan forAdolescent Health <strong>and</strong> Development (2008-2012)addresses general issues of adolescent health <strong>and</strong> def<strong>in</strong>esstrategies for adolescents’ reproductive health <strong>in</strong> particularby support<strong>in</strong>g adolescent-friendly health services 83 .The latter <strong>in</strong>cludes, among o<strong>the</strong>r th<strong>in</strong>gs, provision ofdiagnosis <strong>and</strong> treatment of STIs, provision of voluntarycounsel<strong>in</strong>g <strong>and</strong> test<strong>in</strong>g for HIV, provision of counsel<strong>in</strong>g<strong>and</strong> contraceptive services, antenatal, delivery, postnatal<strong>and</strong> post-abortion care.Un<strong>in</strong>tended pregnanciesAccord<strong>in</strong>g to <strong>the</strong> 2007 FRHS, almost 5 per cent of allpregnancies end <strong>in</strong> abortion. The abortion rate was highest<strong>in</strong> <strong>the</strong> age group 15-19 years <strong>and</strong> university-educatedyouth, with 11.39 per cent <strong>and</strong> 9.07 per cent of <strong>the</strong> totalrespectively 84 .Induced abortion is illegal <strong>in</strong> Myanmar. Accord<strong>in</strong>g to <strong>the</strong>2004 <strong>Family</strong> <strong>and</strong> Youth Survey, 78 per cent of <strong>in</strong>terviewedyouth expressed <strong>the</strong> view that homes of traditional birthattendants constituted <strong>the</strong> ma<strong>in</strong> place where abortionswere performed. The majority of <strong>the</strong>se procedures arelikely to be unsafe. Abortion is <strong>the</strong> third most commoncause of maternal death <strong>and</strong>, with <strong>the</strong> grow<strong>in</strong>g proportionof never married <strong>and</strong> high abortion rate of youth, sexual<strong>and</strong> reproductive health education <strong>and</strong> contraceptiveservices should cover not only married women but also betargeted towards youth, adolescents <strong>and</strong> <strong>the</strong> unmarried.Some patients with complications from <strong>in</strong>duced abortionpresent at hospitals; thus, <strong>in</strong> addition to FRHS <strong>and</strong> <strong>the</strong><strong>Family</strong> <strong>and</strong> Youth Survey, hospital statistics can also reflect<strong>the</strong> abortion rate <strong>in</strong> Myanmar. Hospital statistics revealedthat septic abortion contributed to 53 per cent of allmaternal deaths 85 .A hospital-based cross-sectional descriptive study on<strong>the</strong> sociodemographic determ<strong>in</strong>ants of abortion <strong>and</strong>assessment of contraception knowledge showed that, for100 patients admitted for abortion, <strong>the</strong> determ<strong>in</strong>ants ofrepeated abortion were very early age of marriage, longduration of marriage, <strong>in</strong>creas<strong>in</strong>g number of children alive<strong>and</strong> multiparity. Determ<strong>in</strong>ants of <strong>in</strong>duced abortion wereduration of marriage, desire not to have more children,unplanned or chance pregnancy <strong>and</strong> poor practice ofbirth-spac<strong>in</strong>g methods. From <strong>the</strong>se f<strong>in</strong>d<strong>in</strong>gs <strong>in</strong>formation,education <strong>and</strong> communication activities were essential toprevent abortion <strong>and</strong> its complications 86 .Antenatal care coverage improved from 63.1 per cent<strong>in</strong> 2005 to 64.6 per cent <strong>in</strong> 2007. The proportion ofbirths delivered by a traditional birth attendant droppedmarg<strong>in</strong>ally from 8.8 per cent <strong>in</strong> 2005 to 8.6 per cent <strong>in</strong>2007. The proportion of deliveries attended by skilled birthattendants (doctors, nurses <strong>and</strong> midwives) reached 64 percent <strong>in</strong> 2007, compared with 57 per cent <strong>in</strong> 2001. Theproportions of births attended by skilled birth attendantswas highest <strong>in</strong> <strong>the</strong> age group 45-49 years old, followed byfemales <strong>in</strong> <strong>the</strong> age group 15-19 years old. Most (76.4%)deliveries occurred at home, 16.6 per cent at governmentfacilities <strong>and</strong> <strong>the</strong> rest at private cl<strong>in</strong>ics.L<strong>in</strong>kages <strong>and</strong> timely referralThe majority (62%) of maternal deaths occurred at home.Only 38 per cent of women with complications werereferred to a hospital <strong>and</strong> only 24 per cent reached <strong>the</strong>hospital for proper management, while 14 per cent died on<strong>the</strong> way due to late referral <strong>and</strong> delays <strong>in</strong> transportation 87 .Quality of reproductive health careThis is one of <strong>the</strong> greatest barriers <strong>in</strong> <strong>the</strong> midwifery services<strong>and</strong> is augmented by <strong>in</strong>adequate supplies of essentialdrugs, non-adherence to established st<strong>and</strong>ards due to lackof knowledge <strong>and</strong> skills, unavailability of supplies <strong>and</strong> nonavailabilityof authorization of midwives to perform lifesav<strong>in</strong>g <strong>in</strong>terventions 88 .Health workforceAccord<strong>in</strong>g to WHO estimates, 23 health-care providers(doctors, nurses <strong>and</strong> midwives) per 10,000 people is<strong>the</strong> threshold to achieve 80 per cent coverage for skilledattendance dur<strong>in</strong>g deliveries. Countries with fewer than278