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National Population PolicyMyanmar is relatively sparsely populated <strong>and</strong>, with its richnatural resources, particularly its broad agricultural base, itcan support a far larger population than <strong>the</strong> current size 109 .Hence <strong>the</strong> government has ma<strong>in</strong>ta<strong>in</strong>ed a pronatalist policy.Among its several reasons for do<strong>in</strong>g so, <strong>the</strong> most importantones are:(a) The country is considered to be under populated,compared with o<strong>the</strong>r countries <strong>in</strong> <strong>the</strong> region;(b) The abundant availability of natural resources, arablel<strong>and</strong>, forests <strong>and</strong> mar<strong>in</strong>e resources;(c) The country’s currently low population density;(d) The perception that population growth is an asset fornational development.The draft National Population Policy was developed<strong>in</strong> 1992 under <strong>the</strong> guidance of <strong>the</strong> National HealthCommittee, discussed <strong>and</strong> deliberated at different levels of<strong>the</strong> government departments concerned. The draft policyhighlighted <strong>the</strong> need for birth spac<strong>in</strong>g as an importantissue for a "Happy Healthy <strong>Family</strong>" on health grounds.The draft policy recognized <strong>the</strong> fact that “<strong>the</strong> improvement<strong>in</strong> <strong>the</strong> quality of life would <strong>in</strong>evitably come from reducedpopulation growth”, so it was aimed at improv<strong>in</strong>g <strong>the</strong> healthstatus of women <strong>and</strong> children by ensur<strong>in</strong>g <strong>the</strong> availability<strong>and</strong> accessibility of birth-spac<strong>in</strong>g services among allmarried couples that voluntarily seek such services 110 .It is envisaged that revision <strong>and</strong> <strong>the</strong> formal adoption of<strong>the</strong> draft Population Policy-1992 would enhance <strong>the</strong>implementation of <strong>the</strong> ICPD Programme of Action, aswell as programmes for achiev<strong>in</strong>g MDGs by 2015 <strong>and</strong> <strong>in</strong>promot<strong>in</strong>g population <strong>and</strong> development concerns.NGO activities with regard to birth-spac<strong>in</strong>g servicesallowed with caution <strong>in</strong> 2001; health authorities endorsed<strong>the</strong> use of <strong>the</strong> term birth spac<strong>in</strong>g <strong>in</strong>stead of FP. In general,UNFPA <strong>and</strong> its implement<strong>in</strong>g partners had to be flexiblewith its birth-spac<strong>in</strong>g plans <strong>and</strong> activities <strong>and</strong> move along<strong>the</strong> directions set by <strong>the</strong> Department of Health <strong>and</strong> <strong>the</strong>M<strong>in</strong>istry of Health <strong>and</strong> not exp<strong>and</strong> on meet<strong>in</strong>g <strong>the</strong> dem<strong>and</strong>for <strong>in</strong>novative FP activities 111 .Cultural sensitivity still prevails <strong>in</strong> Myanmar with regard to<strong>the</strong> topic of pre-marital sexual activities <strong>and</strong> <strong>the</strong> utilizationof contraceptives by unmarried adults <strong>and</strong> young people.At <strong>the</strong> level of policymak<strong>in</strong>g, <strong>the</strong> fact that an <strong>in</strong>creas<strong>in</strong>gproportion of adolescents <strong>and</strong> never married persons maybe sexually active <strong>and</strong> need contraceptives to be preventun<strong>in</strong>tended pregnancies was not addressed effectively.Current challenges for birthspac<strong>in</strong>g(1) Availability of contraceptives at affordable prices,accessible for <strong>the</strong> whle population.(2) Accessibility of <strong>the</strong> commodities <strong>and</strong> services by remotevillages <strong>and</strong> ethnic m<strong>in</strong>orities, <strong>the</strong> poor, migrants, <strong>and</strong>vulnerable <strong>and</strong> mobile people.(3) Involvement of adolescents at all levels of plann<strong>in</strong>g<strong>and</strong> implementation of <strong>the</strong> programme.(4) For those unmarried, <strong>the</strong>re are barriers, such as culturalsensitivity <strong>and</strong> judgmental attitude of community <strong>and</strong>health care providers (although UNFPA-supportedRH tra<strong>in</strong><strong>in</strong>gs clearly <strong>in</strong>dicate <strong>the</strong> need for equalaccess).The age group 14-49 years, which comprises <strong>the</strong> largestproportion of reproductive-age women, is at risk. Unsafeabortion is one of <strong>the</strong> major causes of high MMR <strong>in</strong>Myanmar. Accord<strong>in</strong>g to <strong>the</strong> 2007 FRHS, abortion ishighest <strong>in</strong> <strong>the</strong> age group 15-19 years, account<strong>in</strong>g for 11.4per cent of <strong>the</strong> total pregnancies <strong>in</strong> that age group. Womenseek unsafe abortion because <strong>the</strong>y cannot afford to br<strong>in</strong>gup a new addition to <strong>the</strong> family <strong>in</strong> addition to us<strong>in</strong>g it asa method for birth spac<strong>in</strong>g. If this practice cont<strong>in</strong>ues <strong>and</strong>if women <strong>and</strong> adolescents cont<strong>in</strong>ue to face limitations dueto f<strong>in</strong>ancial, logistical or sociocultural barriers <strong>in</strong> access<strong>in</strong>gbirth-spac<strong>in</strong>g services, <strong>the</strong> Millennium DevelopmentGoals will be hard to reach.L<strong>in</strong>kages between <strong>the</strong> Maternal<strong>and</strong> Child Health Programme<strong>and</strong> HIV/AIDS <strong>and</strong> sexuallytransmitted disease servicedeliveryNational levelIn Myanmar <strong>the</strong> Department of Health (DOH) under<strong>the</strong> M<strong>in</strong>istry of Health (MOH) is headed by a Director-General <strong>and</strong> provides comprehensive health care for <strong>the</strong>whole country. The Maternal <strong>and</strong> Child Health (MCH),Women <strong>and</strong> Child Development (WCHD), PrimaryHealth Care, <strong>and</strong> Tra<strong>in</strong><strong>in</strong>g of Basic Health Staff (BHS) areunder DOH <strong>and</strong> each is headed by a Deputy Director 112 .The MCH division is responsible for <strong>the</strong> RH <strong>and</strong> birthspac<strong>in</strong>gprogrammes <strong>and</strong> works <strong>in</strong> collaboration withUNFPA , WHO <strong>and</strong> <strong>in</strong>ternational NGO partners,whereas WCHD emphasizes care of <strong>the</strong> newborn <strong>and</strong>282
women development activities, <strong>and</strong> works with UNICEF<strong>and</strong> NGOs. Safe mo<strong>the</strong>rhood <strong>and</strong> child survival <strong>in</strong>itiativesare <strong>in</strong>tegrated under <strong>the</strong> WCHD programme, as is <strong>the</strong>Prevention of Mo<strong>the</strong>r-to-Child Transmission (PMCT)programme, with <strong>the</strong> National AIDS Programme.Complementarity is encouraged, to avoid overlaps, atdifferent levels of <strong>the</strong> programme.L<strong>in</strong>kage with School Health TeamsIn towns with a population over 10,000, <strong>in</strong> addition toMCH centres <strong>the</strong>re are School Health Teams (featur<strong>in</strong>gdoctors, nurses, dental surgeons, medical social workers,pharmacists <strong>and</strong> clerical staff ) tak<strong>in</strong>g charge of <strong>the</strong> MCHactivities, as well as school health work. There are 80 suchteams operat<strong>in</strong>g <strong>in</strong> 51 towns across <strong>the</strong> country. MOH<strong>in</strong>cluded school health programme activities with<strong>in</strong> ARH<strong>in</strong> its 2001-2006 National Health Plan. Dur<strong>in</strong>g this time,MOH collaborated with o<strong>the</strong>r m<strong>in</strong>istries, such as M<strong>in</strong>istryof Education, M<strong>in</strong>istry of Sports <strong>and</strong> Physical Education,M<strong>in</strong>istry of Immigration <strong>and</strong> Population <strong>and</strong> M<strong>in</strong>istry ofInformation. To <strong>in</strong>tegrate school health <strong>and</strong> adolescentsexual <strong>and</strong> reproductive health, <strong>the</strong> national five-yearAdolescent Health <strong>and</strong> Development Strategic Plan(2009-2013) 113 was developed to address priority issuesaffect<strong>in</strong>g <strong>the</strong> health of young people across <strong>the</strong> nation.L<strong>in</strong>kages at primary health-care levelRural Health CentresRHCs are each responsible for a population of about26,000 <strong>in</strong> 7-14 villages (national average) 114 . The typicalRHC consists of 1 health assistant as team leader, 1 ladyhealth visitor, 5 midwives <strong>and</strong> 1-5 public health supervisors(Grade II – multipurpose health worker) <strong>and</strong> 1 watchman.MCH care <strong>and</strong> birth-spac<strong>in</strong>g services are provided at <strong>the</strong>RHC level <strong>and</strong> urban MCH by <strong>the</strong> lady health visitors<strong>and</strong> midwives. There are 1,481 RHCs throughout <strong>the</strong>country 115 . More than 18,000 basic health service providersat <strong>the</strong> township level were given tra<strong>in</strong><strong>in</strong>gs on maternal,newborn <strong>and</strong> child health care dur<strong>in</strong>g 2009 116 .Sub-centresUnder each RHC, <strong>the</strong>re are usually five sub-RHCs <strong>and</strong>each midwife is given charge of one to three village tractswith a population rang<strong>in</strong>g from 2,000 to 4,000. Thus, <strong>the</strong>four midwives at <strong>the</strong> periphery of <strong>the</strong> ma<strong>in</strong> RHC workthrough four Rural Health Sub-centres, which functionallyserve as MCH centres. There are 5,824 117 such sub-centres<strong>in</strong> Myanmar.Auxiliary midwivesAMWs are selected from underserved villages, tra<strong>in</strong>ed forthree months <strong>in</strong> <strong>the</strong> hospital <strong>and</strong> <strong>the</strong>n for three monthsserve <strong>in</strong> <strong>the</strong> nearest RHC. While AMWs are not regardedas skilled birth attendants, <strong>the</strong>re is a heavy reliance on<strong>the</strong>m <strong>in</strong> Myanmar <strong>in</strong> <strong>the</strong> absence of o<strong>the</strong>r health personnel<strong>in</strong> rural remote villages. Work<strong>in</strong>g under <strong>the</strong> supervisionof <strong>the</strong> midwife <strong>and</strong> Village Health Committee, <strong>the</strong> ma<strong>in</strong>activities of AMWs <strong>in</strong>volve serv<strong>in</strong>g as volunteers <strong>in</strong> fill<strong>in</strong>g<strong>the</strong> gap <strong>in</strong> <strong>the</strong> provision of MCH <strong>and</strong> birth-spac<strong>in</strong>gservices <strong>in</strong> hard-to-reach areas. AMW recruitment wasup to 31,787 for a total of 64,910 villages; <strong>the</strong> AMW-tovillageratio is almost 1:2 118 .It is <strong>the</strong> above-mentioned basic health workers who,dur<strong>in</strong>g <strong>the</strong>ir field visits, provide antenatal care, assist <strong>in</strong>deliveries, provide postnatal care <strong>and</strong> conduct weigh<strong>in</strong>g <strong>and</strong>immunization of children under three years of age. Theyalso provide health education regard<strong>in</strong>g safe mo<strong>the</strong>rhood<strong>and</strong> nutrition, <strong>and</strong> promote breast-feed<strong>in</strong>g <strong>and</strong> birthspac<strong>in</strong>geducation <strong>and</strong> provision. These multi-purposeworkers conduct RH, as well as birth-spac<strong>in</strong>g <strong>and</strong> HIV-STI prevention activities; however, <strong>the</strong>re is no tra<strong>in</strong><strong>in</strong>g oradvocacy for <strong>the</strong> dual use of condoms for <strong>the</strong> preventionof STIs <strong>and</strong> birth spac<strong>in</strong>g. L<strong>in</strong>kages between RH, birthspac<strong>in</strong>g <strong>and</strong> HIV-STI care are present, as township medicalofficers arrange for lady health volunteers or midwives toprovide cont<strong>in</strong>u<strong>in</strong>g education <strong>and</strong> supervision to update<strong>the</strong> knowledge of AMWs <strong>and</strong> upgrade <strong>the</strong>ir skills.National AIDS ProgrammeNAP is responsible for HIV/AIDS activities, whereas <strong>the</strong>Director (Disease Control), headed by a Deputy Director<strong>in</strong> Nay Pyi Taw, is responsible for STI activities. NAPfields 46 AIDS/STD teams nationwide, <strong>in</strong>clud<strong>in</strong>g 6 at <strong>the</strong>State <strong>and</strong> Divisional levels, where <strong>the</strong> prevalence of AIDS/STDs is high, or if <strong>the</strong> townships are vulnerable. Each of <strong>the</strong>AIDS/STD teams has a staff of 3-15 members, <strong>in</strong>clud<strong>in</strong>ga medical doctor (team leader), nurses, counselors,<strong>in</strong>vestigator/outreach workers, laboratory technicians <strong>and</strong>support staff.The AIDS/STD teams implement projects at <strong>the</strong> locallevel <strong>in</strong> harmony with national public health strategies.Medical officers are <strong>in</strong> charge of <strong>the</strong> team <strong>and</strong> providecounsel<strong>in</strong>g, management of STIs, <strong>and</strong> with <strong>the</strong> help ofnurses some basic HIV/AIDS treatment <strong>and</strong> care. Theteams refer to physicians people liv<strong>in</strong>g with HIV who needantiretroviral <strong>the</strong>rapy, <strong>and</strong> <strong>the</strong>y also perform monitor<strong>in</strong>g,supervision <strong>and</strong> report<strong>in</strong>g as necessary. Investigators <strong>and</strong>outreach workers provide contact trac<strong>in</strong>g for STI cases<strong>and</strong> people liv<strong>in</strong>g with HIV, <strong>and</strong> <strong>the</strong>y support outreachactivities. Laboratory technicians carry out tests related toSTIs <strong>and</strong> HIV. In townships without AIDS/STD teams,HIV/AIDS <strong>in</strong>terventions are implemented by o<strong>the</strong>rresponsible officers, notably <strong>the</strong> township medical officer.Township hospitals provide basic services on HIV/AIDScl<strong>in</strong>ical management to outpatients where AIDS/STDteams are not present <strong>and</strong> to patients with advanced HIV<strong>and</strong> AIDS.283
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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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226
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Figureeconomic growth durin
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TableTable1TableTable2For spac<stro
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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 286 and 287: according to <stro
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Page 290 and 291: FigureHIV/AIDS. An HIV-positive wom
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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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Page 316 and 317: Figureprojection, and</stro
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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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