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

condom use were met with some resistance <strong>in</strong> Nor<strong>the</strong>rnRakh<strong>in</strong>e state thoughRH services <strong>and</strong> family plann<strong>in</strong>g,can reduce prenatal mortality <strong>and</strong> improved maternal<strong>and</strong> child health. The work of Médec<strong>in</strong>s Sans Frontières(MSF), <strong>and</strong> Malteser, play a vital role <strong>in</strong> RH <strong>in</strong> Nor<strong>the</strong>rnRakh<strong>in</strong>e State. It was critical to ga<strong>in</strong> trust <strong>and</strong> tra<strong>in</strong> <strong>the</strong>mullahs (Muslim men educated <strong>in</strong> Islamic <strong>the</strong>ology whoare religious leaders of <strong>the</strong> community) to help <strong>in</strong> foster<strong>in</strong>ghealth education activities. The local mullahs were veryresponsive <strong>and</strong> glad that MSF had come to discuss <strong>the</strong>seideas <strong>and</strong> issues with <strong>the</strong>m 102 . UNFPA <strong>in</strong> collaborationwith Department of Health implement RH program <strong>in</strong>Buditaung <strong>and</strong> Maungdaw townships <strong>and</strong> <strong>in</strong> Re<strong>the</strong>taungUNFPA works with MMA <strong>in</strong> NRS.Poverty <strong>and</strong> birth spac<strong>in</strong>gThe <strong>in</strong>cidence of poverty <strong>in</strong> Myanmar was 23 per cent <strong>in</strong>2001, while <strong>the</strong> poverty headcount <strong>in</strong>dex at <strong>the</strong> nationallevel was 32 per cent. About 10 per cent of Myanmar peoplefall under <strong>the</strong> food poverty l<strong>in</strong>e. The l<strong>and</strong>less rate of peoplework<strong>in</strong>g <strong>in</strong> agriculture is 25.7 per cent at <strong>the</strong> national level<strong>and</strong> 31.8 per cent among poor <strong>in</strong>dividuals. These numbershelp to illustrate <strong>the</strong> struggles of <strong>the</strong> l<strong>and</strong>less poor <strong>and</strong>small-scale farmers who are at <strong>the</strong> mercy of high-<strong>in</strong>terestmoneylenders. Typically, <strong>the</strong>y require capital for loans tobuy seeds <strong>and</strong> fertilizer <strong>in</strong> order to break out of <strong>the</strong> viciouscycle of poverty. It is this proportion of <strong>the</strong> population thatrequires essential RH care <strong>and</strong> birth-spac<strong>in</strong>g commodities,which should be made available at affordable prices or evenfree of cost <strong>and</strong> be easily accessible.Status of reproductive rights <strong>in</strong>national law <strong>and</strong> policiesThe description below organizes <strong>the</strong> discussion arounddata describ<strong>in</strong>g <strong>the</strong> status of <strong>the</strong> above-mentioned variables<strong>in</strong> 1990, 2000 <strong>and</strong> 2010:Law perta<strong>in</strong><strong>in</strong>g to <strong>in</strong>duced abortionThe Union of Myanmar Penal Code section 312 statesthat“whoever voluntarily causes a womanwith child to miscarry shall, if suchmiscarriage be not caused <strong>in</strong> good faithfor <strong>the</strong> purpose of sav<strong>in</strong>g <strong>the</strong> life of <strong>the</strong>woman, be punished with imprisonmentof ei<strong>the</strong>r description for a term whichmay extend to three years, or withf<strong>in</strong>e, or with both; <strong>and</strong> if <strong>the</strong> woman bequick with child, shall be punished withimprisonment of ei<strong>the</strong>r description for aterm which may extend to seven years<strong>and</strong> shall be liable to f<strong>in</strong>e”.This law is still <strong>in</strong> force. As <strong>in</strong> o<strong>the</strong>r countries women withan un<strong>in</strong>tended pregnancy f<strong>in</strong>d it difficult to seek skilledhelp at health facilities.The fact is that <strong>the</strong>re is a high unmet need for birth-spac<strong>in</strong>gservices <strong>and</strong> a significant number of unwanted pregnancieswhich result <strong>in</strong> a large number of <strong>in</strong>duced abortions underunsafe conditions 103 , lead<strong>in</strong>g to complications, maternalmorbidity <strong>and</strong> mortality. Accord<strong>in</strong>g to hospital statistics,<strong>the</strong> number of abortions per 100 deliveries decl<strong>in</strong>ed slightlyfrom 27 <strong>in</strong> 2005 to 24.7 <strong>in</strong> 2007 104 . Evidence suggests thatwomen undergo abortion under unsafe conditions <strong>and</strong> tendto approach health-care providers late for management ofcomplications. Provision of services for management ofcomplicated abortions, post-abortion counsel<strong>in</strong>g <strong>and</strong> postabortionbirth-spac<strong>in</strong>g services have improved slightly.However, <strong>the</strong>se factors still pose a challenge.Adolescent un<strong>in</strong>tended pregnanciesAdolescent pregnancies <strong>in</strong> 1998 accounted for 2.9 per centof total pregnancies <strong>in</strong> Yangon 105 . One of <strong>the</strong> outst<strong>and</strong><strong>in</strong>gchallenges of adolescents with an unwanted pregnancy isunsafe <strong>in</strong>duced abortion. When asked about un<strong>in</strong>tendedpregnancies all of <strong>the</strong> young people at <strong>the</strong> MMA YangonYouth Centre expressed <strong>the</strong> view that term<strong>in</strong>ation ofpregnancy should not be an option; both partners shouldtake responsibility <strong>and</strong> jo<strong>in</strong>t decision-mak<strong>in</strong>g should beencouraged so that <strong>the</strong>y both face <strong>the</strong> consequences. Theyknew at least six methods of contraception, as mentioned<strong>in</strong> <strong>the</strong> situation analysis with regard to HIV <strong>and</strong> STIs, <strong>and</strong>young people are aware of <strong>the</strong> mode of transmission <strong>and</strong>prevention of HIV <strong>and</strong> STIs. Social norms have changed<strong>and</strong> universities located <strong>in</strong> <strong>the</strong> outskirts of cities haveproblems <strong>in</strong> respect of pre-marital sex lead<strong>in</strong>g to unwantedpregnancies <strong>and</strong> complications due to unsafe abortions,which <strong>in</strong> some cases might lead to maternal mortality 106 .When asked about <strong>the</strong>ir greatest needs, adolescents saidthat <strong>the</strong>re is no sufficient service tailored for adolescents’sexual <strong>and</strong> reproductive health <strong>and</strong> for unmarried girls/young women, as <strong>the</strong> current RH programme <strong>in</strong> Myanmargenerally caters to <strong>the</strong> needs of married women 107 .UNFPA <strong>in</strong>itiated a project with assistance from Germany(2009-2011) for reduction of MMR <strong>and</strong> prevention ofHIV/AIDS <strong>in</strong> five townships us<strong>in</strong>g <strong>the</strong> MCH communitypromoter modality to improve RH knowledge throughbehavioural change communication <strong>in</strong>terventions amongcommunity adolescents 108 .281