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L<strong>in</strong>kages with o<strong>the</strong>r departments <strong>and</strong>at <strong>the</strong> programme levelNAP is l<strong>in</strong>ked with <strong>the</strong> Division of Public Health,<strong>in</strong>clud<strong>in</strong>g <strong>the</strong> Maternal <strong>and</strong> Child Health section, <strong>the</strong>Reproductive Health section for PMCT, State/Divisionhealth committees, health laboratories at each level to carryout its programmes. In addition o<strong>the</strong>r related m<strong>in</strong>istries,United Nations agencies, NGOs <strong>and</strong> community-basedorganization are concerned with provid<strong>in</strong>g HIV prevention<strong>and</strong> care services <strong>in</strong> collaboration with NAP. While <strong>the</strong>NAP <strong>and</strong> MCH programmes are <strong>in</strong> place, with verticalorganizational mechanisms, separate fund<strong>in</strong>g <strong>and</strong> budgetl<strong>in</strong>es, all are under DOH. This makes communication <strong>and</strong>coord<strong>in</strong>ation easier now that all sectors <strong>in</strong> <strong>the</strong> capital cityNay Pyi Taw. However, at <strong>the</strong> programme level, advocacyfor <strong>the</strong> use of condoms as a dual protection contraceptive<strong>and</strong> <strong>in</strong>tervention for <strong>the</strong> prevention of HIV <strong>and</strong> STIs is nota common practice 119 . As for NGO staff, PSI claims thatall Sun providers are tra<strong>in</strong>ed <strong>in</strong> SRH, HIV <strong>and</strong> STIs.Studies on birth-spac<strong>in</strong>g activitiesIn-depth studies on population <strong>and</strong> birth-spac<strong>in</strong>g at <strong>the</strong>national level <strong>in</strong>clude <strong>the</strong> Fertility <strong>and</strong> Reproductive HealthSurveys conducted by <strong>the</strong> Department of Population <strong>and</strong>UNFPA. DOH conducts <strong>the</strong> Contraceptive MethodMix study <strong>and</strong> prepares small-scale research paperson contraceptive method choice <strong>and</strong> adolescent peerpregnancies 120 . UNFPA conducts regular programmeevaluations <strong>and</strong> midterm reviews of country programmeassistance.Reference to <strong>the</strong> <strong>International</strong>Conference on Population<strong>and</strong> Development <strong>and</strong> <strong>the</strong>Millennium Development GoalsPr<strong>in</strong>ciple 8 of ICPD states that “everyone has <strong>the</strong> rightto <strong>the</strong> enjoyment of <strong>the</strong> highest atta<strong>in</strong>able st<strong>and</strong>ard ofphysical <strong>and</strong> mental health”. ICPD also encouraged “Statesshould take all appropriate measures to ensure, on a basisof equality of men <strong>and</strong> women, universal access to healthcareservices, <strong>in</strong>clud<strong>in</strong>g those related to reproductive healthcare, which <strong>in</strong>cludes family plann<strong>in</strong>g <strong>and</strong> sexual health”. Inthis regard Myanmar as a develop<strong>in</strong>g country is committedto fulfill <strong>the</strong> basis of this pr<strong>in</strong>ciple <strong>and</strong> has mechanisms <strong>in</strong>place <strong>and</strong> is implement<strong>in</strong>g its second Five-Year NationalStrategic Plan for Reproductive Health (2009-2013).Reproductive health-care programmes are provided at<strong>the</strong> level of a basic essential package. However, <strong>the</strong>y havenot reached <strong>the</strong> stage of universal coverage, especially <strong>in</strong>regions where transportation is difficult <strong>and</strong> geographicterra<strong>in</strong> prevents easy access to health care. There is no formof coercion <strong>in</strong> provid<strong>in</strong>g <strong>the</strong> wide range of services with<strong>in</strong>Myanmar’s economic <strong>and</strong> cultural context with regard tobirth spac<strong>in</strong>g, which is <strong>in</strong> l<strong>in</strong>e with pr<strong>in</strong>ciple 8. All couples<strong>and</strong> <strong>in</strong>dividuals do have <strong>the</strong> basic right to decide freely <strong>and</strong>responsibly <strong>the</strong> number <strong>and</strong> spac<strong>in</strong>g of <strong>the</strong>ir children <strong>and</strong><strong>the</strong>y do have <strong>the</strong> <strong>in</strong>formation <strong>and</strong> education, to a certa<strong>in</strong>extent, to do so but <strong>the</strong>se need fur<strong>the</strong>r streng<strong>the</strong>n<strong>in</strong>g.The table 3 below shows Myanmar’s progress towardsachiev<strong>in</strong>g selected ICPD Programme of Action <strong>in</strong>dicatorsas analyzed by various issues of <strong>the</strong> UNFPA State of WorldPopulation reports to enable comparison <strong>in</strong> relation to<strong>in</strong>dicators from national sources as well as United Nationssources <strong>in</strong> relation to progress towards achiev<strong>in</strong>g <strong>the</strong> ICPDProgramme of Action goals <strong>and</strong> MDGs.Millennium Development Goal5 121 : Improv<strong>in</strong>g maternal healthTarget B of Goal 5 is to "achieve, by <strong>the</strong> year 2015, universalaccess to reproductive health". This <strong>and</strong> <strong>the</strong> related<strong>in</strong>dicators under MDG5 (see table below) recognize <strong>the</strong>centrality of reproductive health <strong>and</strong> reproductive rights<strong>in</strong> improv<strong>in</strong>g maternal <strong>and</strong> <strong>in</strong>fant health <strong>and</strong> <strong>in</strong> reduc<strong>in</strong>gpoverty. To promote universal access to comprehensivereproductive health services, <strong>the</strong> M<strong>in</strong>istry of Health ofMyanmar toge<strong>the</strong>r with its United Nations <strong>and</strong> NGOpartners implemented its first Five-year National RHStrategic Plan (2004-2008). The implementation of <strong>the</strong>plan had a shortfall of approximately 75 per cent aga<strong>in</strong>st<strong>the</strong> planned budget of US$ 30.1 million 122 . Thus, some of<strong>the</strong> components of <strong>the</strong> plan were ei<strong>the</strong>r not implementedor implemented on a very limited scale. Thus, progresstowards achiev<strong>in</strong>g <strong>the</strong> ICPD goals <strong>and</strong> MDG5 (Target5A) of reduc<strong>in</strong>g maternal mortality has proven to be slow<strong>and</strong> unequal among population groups. The ma<strong>in</strong> strategyof <strong>the</strong> second Five-year National RH Strategic Plan (2009-2013) is to scale-up <strong>the</strong> essential package of reproductivehealth services with improved coord<strong>in</strong>ation <strong>and</strong> resourcepool<strong>in</strong>g. The second such plan set <strong>the</strong> national targets tomonitor implementation aga<strong>in</strong>st <strong>the</strong> MDG5 <strong>in</strong>dicators.MMR, one of <strong>the</strong> important <strong>in</strong>dicators, is targeted todecl<strong>in</strong>e to 145 per 100,000 births <strong>in</strong> 2015, which willrequire aggressive <strong>in</strong>puts <strong>in</strong>to emergency obstetric care <strong>and</strong>support if universal access to birth spac<strong>in</strong>g <strong>and</strong> RH careis to be provided. The target for <strong>the</strong> proportion of birthsattended by skilled health personnel is currently 64 percent, which is a long way from <strong>the</strong> target of 80 per centby 2015.284
TableTable3Myanmar’s progress towards selected Programme of Action <strong>in</strong>dicators, as analyzed by UNFPAReproductive HealthProportion of births withskilled attendantInfant mortality, total per1,000 live birthsState of WorldPopulation 2000State of WorldPopulation 2002State of WorldPopulation 200957 - 57State of WorldPopulation 201079 87 72 70Life expectancy (M/F) 58.5 / 61.8 53.8 / 58.8 59.9 / 64.4 60.5 / 65.0Maternal mortality ratio 230 170 380Births per 1,000 women,ages 15-19Contraceptive prevalence(any method)Contraceptive prevalence(modern methods)HIV prevalence rate (%)ages 15-49*2009 estimation workshop, Myanmar.(240: UnitedNations) 38026 29 18 1817 33 37 3714 28 33 33- -0.7 (2007) 0.61(2009)*0.7Gender-based violenceThis occurs more frequently where poverty <strong>and</strong> social<strong>in</strong>stability are prevalent – for <strong>in</strong>stance, <strong>in</strong> emergencysituation <strong>and</strong> early recovery situations 124 . Gender-basedviolence reflects <strong>and</strong> re<strong>in</strong>forces gender <strong>and</strong> social <strong>in</strong>equities<strong>and</strong> compromises <strong>the</strong> health, security, autonomy <strong>and</strong>dignity of its victims. At least one out of every threewomen around <strong>the</strong> world has been beaten, coerced <strong>in</strong>tosex, or o<strong>the</strong>rwise abused <strong>in</strong> her lifetime. The abuser isusually someone known to her.In Myanmar, ow<strong>in</strong>g to <strong>the</strong> fact that <strong>the</strong>re are no officialnational-level data on gender-based violence <strong>and</strong> that <strong>in</strong>general women <strong>and</strong> girls do not experience many of <strong>the</strong>extreme manifestations of discrim<strong>in</strong>ation <strong>and</strong> seclusion, ithas become normal for many gender gaps <strong>and</strong> <strong>in</strong>equalitiesto be often overlooked by both national <strong>and</strong> <strong>in</strong>ternationalorganizations work<strong>in</strong>g <strong>in</strong> Myanmar’s development sector.A study carried out by <strong>the</strong> Myanmar Women’s AffairsFederation (MWAF) on reported cases of sexual assaultrevealed that, <strong>in</strong> 17 states <strong>and</strong> divisions of Myanmar, <strong>the</strong>rewere 209 such cases <strong>in</strong> 2001 <strong>and</strong> 338 cases <strong>in</strong> 2004. Astudy on marital violence aga<strong>in</strong>st women revealed that <strong>the</strong>most common causes were f<strong>in</strong>ancial difficulties, alcoholconsumption <strong>and</strong> <strong>in</strong>compatibility with <strong>in</strong>-laws 125 .Programmatic measures taken by MWAF to elim<strong>in</strong>ateviolence aga<strong>in</strong>st women <strong>in</strong>clude:(a) Counsel<strong>in</strong>g centres set up to help women ga<strong>the</strong>rtoge<strong>the</strong>r <strong>and</strong> solve <strong>the</strong>ir own problems;(b) Tra<strong>in</strong><strong>in</strong>g for service providers on violence aga<strong>in</strong>stwomen <strong>in</strong> all states <strong>and</strong> divisions.Natural disasters destabilize <strong>the</strong> social <strong>in</strong>frastructure,leav<strong>in</strong>g many young people, particularly young women,vulnerable to sexual violence, exploitative labour <strong>and</strong>traffick<strong>in</strong>g. M<strong>in</strong>imal services <strong>and</strong> support are availableto gender-based violence survivors <strong>and</strong> <strong>the</strong> limited lawenforcement available can result <strong>in</strong> impunity for <strong>the</strong>perpetrators. The Women’s Protection Sub-cluster ofCyclone Nargis reported that, as is common <strong>in</strong> many o<strong>the</strong>rcountries, many women present at cl<strong>in</strong>ics with symptomsconsistent with gender-based violence but report that<strong>the</strong>y have had an accident, ra<strong>the</strong>r than been victims ofabuse126. This makes creat<strong>in</strong>g a gender-based violenceresponse mechanism particularly challeng<strong>in</strong>g. Presumablythis is due to <strong>the</strong> reluctance of women <strong>and</strong> girls to reportviolence to <strong>the</strong> authorities. A major po<strong>in</strong>t of concern is <strong>the</strong>legal h<strong>and</strong>l<strong>in</strong>g of such cases: when a victim reports to acl<strong>in</strong>ic, <strong>the</strong> medical service provider is required to report<strong>the</strong> case to <strong>the</strong> police before treat<strong>in</strong>g <strong>the</strong> survivor. Thus,most survivors are reluctant to make a report <strong>in</strong> order toga<strong>in</strong> access to health care. In addition, young people arealso at a formative stage <strong>in</strong> <strong>the</strong>ir transition to adulthoodwhen harmful experiences can have long-last<strong>in</strong>g physical,psychological <strong>and</strong> social effects.285
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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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eflect a provider bias (e.g., <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 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
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Page 286 and 287: according to <stro
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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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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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