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Reproductive Health/Gynaecology, Obstetrics

Websites/Multiple Documents

Title: Burma Children Medical Fund
Description/subject: "The Burma Children Medical Fund (BCMF) is a program dedicated to raising money for children from Burma with serious medical problems who are disadvantaged as a result of the political turmoil in Burma. On this website you will find a brief introduction to the situation along the Thai-Burma border and at the Mae Tao Clinic; see pictures of children you can help; read about the medical conditions that BCMF funds treatment for and see how donations are managed and used. BCMF is currently expanding its program to include special adult and women’s cases. Please see Burma Adult Medical Fund (BAMF) and Women’s Gynaecological Surgery Fund (WGSF) for more information.
Language: English
Source/publisher: Burma Children Medical Fund
Format/size: html
Alternate URLs: http://www.burmachildren.net/our-cases/women/
Date of entry/update: 26 December 2012

Title: Community Partners International
Description/subject: A merger of Foundation for the People of Burma and GHAP (Global Health Access Program).....Our Mission: "We work with local partners to improve health and education through community-driven development led by and for the people of Burma/Myanmar. Partnership with local community-based organizations (CBOs) in Burma and along its borders is the core of our work. Together with local partners, we listen to local voices, build local capacity and support basic needs. Our long-term relationships develop the trust and experience vital to positive lasting change, and our extensive network encompasses diverse ethnicities, religions and languages. We believe in community driven development. We provide resources and technical support tailored to specific needs in villages, slums, migrant worker enclaves and refugee encampments, and our projects include an array of health and education initiatives. In addition to improving quality of life at home, many of our partners generate scientifically rigorous documentation to inform and influence public health and education policy globally and locally. No matter what the project, we focus on building the capacity of community leaders to assess their own needs and resources; manage, monitor and evaluate their own projects; and seek and exchange skills and resources with others. We believe this model promotes independence, strengthens communities from within and provides a unique local-global platform to develop long-term civil society in Burma.... HEALTH: We believe that healthy families build strong communities. Our support of community-based public health and clinical care in Burma and along its borders reaches more than one million people — many of them displaced and living in unstable conflict-affected zones with no other health care available. We focus on evidence-based public health and clinical care initiatives through innovative training and partnership with local health clinics, backpack medics and village-based health workers. Using a train-the-trainers model, we have partnered with more than 60 community-based organizations on malaria, tuberculosis, filariasis (elephantiasis), reproductive health, trauma care, health systems strengthening, childhood immunizations and child nutrition in a country where 1 in 3 children are malnourished. Through our health branch, the Global Health Access Program, we provide training, technical support and resources to help our partners implement a broad array of initiatives, including clean births and emergency obstetric care for mothers living in remote villages; malaria screening, treatment and prevention for villagers living in a country with the highest number of malaria deaths in Southeast Asia; trauma management in a country with one of the highest number of landmine injuries and deaths in the world; Vitamin A distribution to prevent blindness and help children survive and thrive; health systems strengthening to improve community-based infrastructure and assessment of health needs and services. EDUCATION Education goes far beyond the classroom for millions from Burma who are vulnerable because they’re illiterate, uprooted, marginalized and poor. Two-thirds of children in our project areas drop out of primary and middle school because books and fees are beyond their reach. Teenagers in places like remote Shan State have few options for their future because their villages don’t have high schools. With solid skills, people have a chance to find jobs, feed families, avoid abuse and rebuild communities. That’s why we invest in education, partnering with 62 local organizations to support more than 1,200 schools, 5,200 teachers and classrooms for more than 115,600 students. In remote villages and peri-urban slums, we support community-led programs that take children off the streets; counsel and retrain trafficked women and girls; train ethnic-minority villagers to farm organically and leverage group savings; teach migrant workers to calculate wages and advocate for rights; train leaders to assess and respond to community needs. Starting with preschools, our education outreach continues through primary school, middle school, high school, post-high school and includes an array of vocational and skills training opportunities for adults—including many who’ve never had formal schooling. We believe education is the cornerstone of civil society. In conflict and natural disaster zones, our local partners’ extensive network of schools offer uprooted villagers stability, hope and a chance to regroup."
Language: English
Source/publisher: Community Partners International
Format/size: html
Date of entry/update: 24 November 2011

Title: Reproductive Health (various studies)
Description/subject: "Women in Myanmar's ethnic border and underserved central regions face enormous risks in having children. In eastern Myanmar the vast majority are anemic and deliver their babies without trained assistance or access to emergency obstetric services. Nearly 1% of pregnancies result in maternal death, mostly from bleeding after delivery or infection — one of the highest rates of maternal mortality in the world. Community Partners International's focus on training, technical support and resources for local organizations has achieved community-based delivery of antenatal care, family planning and emergency obstetric services to 135,000 women and men who would otherwise have gone without. In addition to implementing life-saving health initiatives, our local partners — with technical support and in-depth mentoring from CPI — have conducted the only peer-reviewed surveys in these largely inaccessible regions... For reproductive health-related articles and reports, see links at right"
Language: English
Source/publisher: Community Partners International
Format/size: html
Date of entry/update: 20 August 2014

Individual Documents

Title: Breastfeeding Promotion and Protection for Maternal, Infant and Childhood Health and Nutrition in Myanmar
Date of publication: 26 August 2015
Description/subject: "The Government of Myanmar has demonstrated their interest and commitment to promoting and protecting breast feeding and to improve Maternal, Infant and Child Health and Nutrition with the launching of Scaling Up Nutrition(SUN) Movement in 2013 and the adoption of a new Food Law “The Order of Marketing of Formulated Food for infant and Young Child” (OMFFIYC) in 2014. The SUN Movement is a global movement founded on the principle that all people have a right to food and good nutrition and it unites people from government, civil society, United Nations, donors, businesses and researchers in a collective effort to improve nutrition and eradicate malnutrition. In February, 2014, the SUN Movement partnered with the Civil Society Alliance (CSA), a sectorial network of NGO’s and CBO’s, for addressing food security and nutrition and to confirm active engagement of executive level political leadership. With of the adoption of the new National Food Law (OMFFIYC), the Government of Myanmar is striving: (1) to support and protect breastfeeding for infants and young children (2) to ensure appropriate use of breast-­‐milk substitutes, if necessary and to introduce proper complementary foods at the right time to infants and (3) to publish correct and adequate information and to monitor the marketing of formulated breast milk substitutes and complementary foods.".....Paper delivered at the International Conference on Burma/Myanmar Studies: Burma/Myanmar in Transition: Connectivity, Changes and Challenges: University Academic Service Centre (UNISERV), Chiang Mai University, Thailand, 24-­26 July 2015.
Author/creator: Thelma Tun Thein
Language: Burmese (ျမန္မာဘာသာ)
Source/publisher: International Conference on Burma/Myanmar Studies: Burma/Myanmar in Transition: Connectivity, Changes and Challenges: University Academic Service Centre (UNISERV), Chiang Mai University, Thailand, 24-­26 July 2015
Format/size: pdf (128K)
Alternate URLs: http://rcsd.soc.cmu.ac.th/web/Burma/home.php#
Date of entry/update: 19 August 2015

Date of publication: 2015
Description/subject: "A Consultant Obstetrician and Gynaecologist, Dr Khin Win Kyu has been volunteering much of her time for the last 17 years at the Muslim Free Hospital in Yangon, a hospital that treats poorer communities without charge, regardless of race, religion or ethnicity. Earlier Dr Khin Win Kyu worked in the government service for 22 years. Established in the 1930s, the hospital is a microcosm of what an ideal Myanmar society could be like, where people from all faiths work together to treat the less fortunate, irrespective of their religion, ethnicity or race."
Author/creator: Kannan Arunasalam
Language: Burmese (ျမန္မာဘာသာ) - English sub-titles
Source/publisher: Centre for Peace and Conflict Studies (CPCS),
Format/size: Adobe Flash
Date of entry/update: 21 February 2016

Title: A Book for Midwives
Date of publication: 2014
Description/subject: "...Midwives need accurate information to help them protect the health and well-being of women, babies, and families. They need strategies to fight poverty and the unequal treatment of women, and for working together and with other health workers towards health for all. We revised A Book for Midwives with these needs in mind. In this edition of A Book for Midwives, you will find: * information needed to care for women and their babies during pregnancy, labor, birth, and in the weeks following birth, because this is the primary work of most midwives. * skills for protecting a woman’s reproductive health throughout her life, because a woman’s health needs are important whether or not she is having a baby, and because a woman’s health when she is not pregnant affects how healthy and safe her pregnancies and births will be. * safe, effective methods from both traditional midwifery and modern, Western-based medicine, because good health care in labor and birth uses the best from both Western medicine and the traditions of midwifery. discussion of the ways that poverty and the denial of women’s needs affect women’s health, and how midwives can work to improve these conditions, because changing these conditions can make a lasting improvement in health. * suggestions for how midwives can and must work with each other, with other health workers, and with the larger community, because working together strengthens everyone’s knowledge and makes action to improve women’s health more effective..."
Language: English
Source/publisher: Hesperian Health Guides
Format/size: html, pdf
Date of entry/update: 20 August 2014

Title: Five-Year Strategic Plan for Reproductive Health
Date of publication: 2013
Description/subject: Executive Summary: "Myanmar is committed to the 1994 International Conference on Population and Development (ICPD). Following the ICPD Programme of Action and the 2000 Millennium Declaration, the implementation of programs for improving reproductive health and well-being is a Government priority. It is in this context that the Strategic Plan for Reproductive Health (RH) shall,provide guidance in achieving the goals set in the National RH Policy. The first Strategic Plan for Reproductive Health 2004-2008 is seen as a major response to address RH needs and challenges in Myanmar for achieving the Millennium Development Goal (MDG) 4 of reducing child mortality and (MDG)5 of improving maternal health. The maternal mortality in Myanmar was estimated at 580 deaths per 100,000 live births in 19901 and 316 deaths per 100,000 live births in 20052 . Unless more focused attention is given to implementing effective interventions, the MDG 5 target of reducing maternal mortality ratio to 145 per 100,000 live births by the year 2015 is not likely to be achieved. Intimately tied with maternal health status, infant and neonatal deaths contributed to about 73% and 24% of under-five deaths respectively3. Hence achieving MDG 4 target of reducing the under-five mortality to 28 per 1,000 live births by 2015 requires halving of neonatal mortality. The challenges to overcome are inadequate access to maternal and neonatal services and other reproductive health services, as well as limited resource allocation for reproductive health. A second five-year national strategic plan for reproductive health has been developed to ensure coordinated response to the reproductive health needs of women, men, adolescents a~d youth in Myanmar. The overall goal of the strategic plan is to attain a better quality of life of the people of the Union of Myanmar by contributing to the improved reproductive health status of women, men, adolescents and youth. The strategy provides a review of the reproductive health situation and services in Myanmar and· sets objectives under the following core elements: • Improving antenatal, delivery, post-partum and newborn care; • Providing quality services for birth spacing and prevention and management of unsafe . abortions; • Preventing and reducing reproductive tract infections (RTIs); sexually-transmitted infections (STIs), including HIV; cervical cancer and other gynecological morbidities; • Promoting sexual health; including adolescent reproductive health and male involvement. The strategy recognizes the centrality of reproductive health and rights in improving maternal and newborn health and achieving internationally agreed Millennium Development Goals. To attain reproductive health targets, the strategy calls for actions in the following priority areas: • Setting enabling environment; • Improving information base for decision making; • Strengthening health systems and capacity for delivery of quality reproductive health services; • Improving community and family practices. The above actions will be led by the Ministry of Health and supported by the National Working Committee for Reproductive Health to oversee the implementation of the Strategic Plan, to coordinate the partners' contributions and to advocate for increased resource mobilization."
Language: English
Source/publisher: Ministry of Health
Format/size: pdf (2.3MB)
Date of entry/update: 26 June 2015

Title: Separated by Borders: United By Need, An Assessment of Reproductive Health on the Thai-Burma Border (English)
Date of publication: 06 February 2012
Description/subject: A needs assessment of reproductive health on the Thailand-Burma border...According to Dr. Angel Foster, DPhil, MD, of Ibis Reproductive Health and the University of Ottawa, “Our report finds that millions of Burmese and ethnic minorities both inside Burma and along the Thai border have limited or no access to family planning, safe abortion, and general reproductive health care. The toll on women has been particularly severe. Negative effects include high numbers of unplanned pregnancies — and, consequently, high rates of maternal mortality and unsafe abortions. In fact, post-partum hemorrhage and unsafe abortion are the leading causes of maternal death and injury.” The absence of health care infrastructure inside eastern Burma, as well as for those Burmese living illegally as migrants in Thailand, has produced a kind of reproductive health “perfect storm.” Notes Foster, “Since denial of health care has been an official policy of the Burmese military in ethnic areas, women and men, especially adolescents, know little about family planning practices and voluntary sterilization.” Other key findings: Despite the fact that rape and sexual violence are extensive problems within both the conflict zones of eastern Burma and in migrant communities in Thailand, the few health workers that do exist generally lack the knowledge and supplies to dispense critical medicines like emergency contraceptive pills (ECPs), which can prevent pregnancy after sexual assault. Even within refugee camps inside Thailand, leaders and organizations working there often adopt policies that prevent unmarried people from accessing family planning information or supplies. Finally, abortion is illegal in Burma unless a woman’s life is at risk and restricted in Thailand. Lack of legal access combined with a lack of trained providers are fundamental causes of morbidity and mortality from abortion. “Our hope is that the new Burmese government will someday make it possible for more organizations to provide aid and resources to the people in eastern Burma where outside groups are currently banned,” said Cari Sietstra, JD, a consultant at Ibis. “The time has come to rebuild the health and human rights of the millions of men, women, and children affected by this conflict.”... Due to an ongoing sixty-year civil war that has subjected civilian populations to forced labor, extrajudicial killings, rape, displacement, imprisonment, denial of health care and education, and destruction of food supplies, the reproductive health of Burmese populations on both sides of the Thai-Burma border is marked by high levels of unmet needs. Reproductive health indicators throughout the region demonstrate a lack of access to family planning resources, including sexual and reproductive health information, low levels of contraceptive access, and high rates of unplanned pregnancy, maternal mortality, and harm from unsafe abortion. Unsafe abortion is a leading cause of maternal mortality for Burmese populations on both sides the Thailand-Burma border.
Language: English (full text); Karen, Burmese, Thai (summary and findings)
Source/publisher: Ibis Reproductive Health (Ibis), Global Health Access Program (GHAP)
Format/size: pdf (2.8MB - OBL version; 4.15MB - original)
Alternate URLs: http://ibisreproductivehealth.org/work/other/thaiburmaborder.cfm (Summary and findings in Thai, Burmese, Karen and English)
Date of entry/update: 15 February 2012

Title: Forced Migration and Adolescent Reproductive Health
Date of publication: December 2011
Description/subject: "This article combines findings from a study on reproductive health in three populations along the Thailand-Burma border and research conducted on adolescent pregnancy in camps for Burmese refugees in Thailand. The data show that adolescents in three populations—communities in eastern Burma (isolated rural villages, conflict-affected areas, and internally displaced person (IDP) areas in eastern Burma), migrant communities and refugee camps in Thailand—face difficulties in gaining access to reproductive health information and services. One key reason for gaps in service is community attitudes towards adolescent sexual health and reproduction. The impact of community attitudes on access to care is most striking in refugee camps, where populations may access camp-based clinics for reproductive health services, and arguably face the fewest structural barriers to access (for example, barriers to access that exist as part of one’s external environment, such as security and freedom of movement)..."
Language: English
Source/publisher: "Gender Perspectives" (Vol. 3, Issue 2, December 2011) INSTITUTE OF SOUTHEAST ASIAN STUDIES (ISEAS)
Format/size: pdf (596K)
Date of entry/update: 23 February 2012

Title: Against the Odds: Helping Mothers and Babies Survive in Eastern Burma
Date of publication: November 2011
Description/subject: Technical support provided by the Global Health Access Program (the health branch of Community Partners International), and the Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health....."Over the last decade, militarization and the destruction of community infrastructure have escalated in eastern Burma. The government does not provide health care for the displaced population, which is targeted for abuse, with food and health facilities, documents and supplies destroyed. We have a high prevalence of malaria in eastern Burma, which causes low birth weight, and sometimes miscarriage. If not properly cared for, pregnant women suffer high maternal, and high neo-­‐natal death. There is high mortality in children under age five. And there is a lack of family planning services. Before the Mobile Obstetric Maternal Health Workers (MOM) Project, our community-­‐based organizations utilized every opportunity to improve access to maternal and child health care and education for these vulnerable displaced populations. There were many successes, but it was far from enough. We needed to increase health worker capacity, improve access and the referral system, and most of all, to address the shortage in life-­‐saving emergency care. What the MOM Project brought was a focus on mobile health care, a way to address obstetric emergencies and training of local health workers, even in displaced populations. Through the MOM Project, we helped empower individuals and the community. The MOM Project could not get rid of maternal, or neonatal and infant death. But by equipping people and communities with knowledge and skills, it has saved countless lives. Significantly, the MOM Project played a role in fulfilling the basic right to reproductive health and building a human rights-­‐based approach to health in eastern Burma. Health and human rights cannot be separated. People have the right to access health information and essential health services. Families have the right to stay together and organize as a community. A rights-­‐based approach encourages looking at the bigger picture, at integrating health into the broader system of civil society. This is the critical issue — strengthening our civic foundation to save the lives of mothers and children, and build healthy families and communities." - Dr. Cynthia Maung
Language: English
Source/publisher: The Mobile Obstetric Maternal Health Workers (MOM)
Format/size: pdf (2.5MB) 32 pages
Alternate URLs: http://cpintl.org/sites/default/files/bookPdf/CPI%20RH%20report%20web_0.pdf
Date of entry/update: 15 February 2012

Title: Myanmar: Monitoring the situation of children and women
Date of publication: October 2011
Description/subject: Multiple Indicator Cluster Survey 2009-2010.....Contents: Summary Table of Findings i Contents iii List of Tables v List of Figures vii List of Abbreviations viii Acknowledgements ix Executive Summary xi I. Introduction 1 Background 1 Survey Objectives 3 II. Sample and Survey Methodology 4 Sample Design 4 Questionnaires 4 Training and Fieldwork 5 Data Processing 7 III. Sample Coverage and the Characteristics of Households and Respondents 8 Sample Coverage 8 Characteristics of Households 8 Characteristics of Respondents 10 IV. Child Mortality 11 V. Nutrition 14 Nutritional Status 14 Breastfeeding 16 Vitamin A Supplements 20 Low Birth Weight 21 VI. Child Health 24 Immunization 24 Tetanus Toxoid 26 Oral Rehydration Treatment 27 Care Seeking and Antibiotic Treatment of Pneumonia 29 Solid Fuel Use 31 VII. Environment 32 Water and Sanitation 32 VIII. Reproductive Health 36 Contraception 36 Antenatal Care 36 Assistance at Delivery 38 Myanmar Multiple Indicator Cluster Survey 2009 - 2010 iv IX. Child Development 40 X. Education 42 Pre-School Attendance and School Readiness 42 Primary and Secondary School Participation 43 Young Female Literacy 47 XI. Child Protection 48 Birth Registration 48 Early Marriage 49 Orphans and Children's Living Arrangements 50 XII. HIV/AIDS 52 Knowledge of HIV Transmission 52 List of References 56 Appendix A. Sample Design 124 Appendix B. List of Personnel Involved in the Survey 130 Appendix C. Estimates of Sampling Errors 134 Appendix D. Data Quality Tables 176 Appendix E. MICS Indicators: Numerators and Denominators 183 Appendix F. Questionnaires
Source/publisher: Ministry of National Planning and Economic Development; Ministry of Health; United Nations Children's Fund (UNICEF)
Format/size: pdf (5.7MB)
Date of entry/update: 27 December 2013

Title: Report on Situation Analysis of Population and Development, Reproductive Health and Gender in Myanmar
Date of publication: July 2010
Description/subject: Executive Summary: This situation analysis aims to analyses the situation of population and development, reproductive health and gender in Myanmar and their linkages, to serve as a reference for informing policy makers and programme planners from both the government and the international community involved in protecting the rights and improving the lives of Myanmar’s population and furthering sustainable development. The situation analysis (SA) has been conducted by an independent team, which was supported by UNFPA. It was carried out between th e period of July 2009 to July 2010, using a life cycle perspective to understand the totality of population, the forces that contribute towards development and their interrelations with reproductive health and gender. Existing causalities between the issues of population development, reproductive health and gender require a holistic approach that unifies many sectoral and contextual issues. Myanmar is committed to the 1994 International Conference on Population and Development (ICPD) programme of action and also to fulfilling the Millennium Development Goals (MDGs). This situation analysis cuts across population and development, reproductive health and gender and is the first ever done analysis in Myanmar. Although there is limitation in geographic coverage and scarcity of data to be analyzed in further depth, this re view should be considered as a living document and a template for future documentation when new information and data becomes available. A notable challenge in the preparation of this situation analysis has been the limited scope of available data. The information gaps for evidence-based planning are well recognized as the most recent census was in 1983, after which there have only been a few nationally representative sample surveys for specific purposes. There is a great need to strengthen statistical services in Myanmar and foster greater data consistency..."
Language: English
Source/publisher: United Nations Population Fund (UNFPA)
Format/size: pdf (2.3MB)
Date of entry/update: 28 June 2015

Title: A ‘climate of fear’ at the Thai-Burma border
Date of publication: 03 February 2010
Description/subject: The oppressive regime running Burma has both forced many Burmese into displaced person camps in Thailand. Young Burmese people are particularly vulnerable, especially due to issues such as sexual health education and trafficking. By any account, Burma is a beautiful, naturally rich country with a diverse ethnic history. It is also run by one of the most oppressive regimes in the world, the State Peace and Development Council, an 11-member group of military commanders. This junta, in power under different names since 1988, has been cited for countless human rights abuses. The SPDC also oversees a corrupt, inefficient economy. In spite of the country’s natural wealth, social-economic conditions continue to deteriorate, along with Burma’s schools and hospitals.
Language: English
Source/publisher: Conversation for A Better World
Format/size: html
Date of entry/update: 02 November 2010

Title: Country Report on 2007 Fertility and Reproductive Health Survey
Date of publication: June 2009
Language: English
Source/publisher: Ministry of Immigration and Population: Department of Population, Union of Myanmar
Format/size: pdf (1.7MB)
Date of entry/update: 02 June 2015

Title: Accessing Maternal Health Services in Eastern Burma
Date of publication: 23 December 2008
Description/subject: This Perspective discusses the following new study published in PLoS Medicine: Mullany LC, Lee CI, Yone L, Paw P, Oo EKS, et al. (2008) "Access to essential maternal health interventions and human rights violations among vulnerable communities in eastern Burma". PLoS Med 5(12): e242. doi:10.1371/journal.pmed.0050242 Luke Mullany and colleagues examine access to essential maternal health interventions and human rights violations within vulnerable communities in eastern Burma.
Author/creator: Macaya Douoguih
Language: English
Source/publisher: PLoS Med 5(12)
Format/size: html
Alternate URLs: http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0050250
Date of entry/update: 03 February 2009

Title: Access To Essential Maternal Health Interventions and Human Rights Violations among Vulnerable Communities in Eastern Burma
Date of publication: December 2008
Description/subject: Background: Health indicators are poor and human rights violations are widespread in eastern Burma. Reproductive and maternal health indicators have not been measured in this setting but are necessary as part of an evaluation of a multi-ethnic pilot project exploring strategies to increase access to essential maternal health interventions. The goal of this study is to estimate coverage of maternal health services prior to this project and associations between exposure to human rights violations and access to such services... Methods and Findings: Selected communities in the Shan, Mon, Karen, and Karenni regions of eastern Burma that were accessible to community-based organizations operating from Thailand were surveyed to estimate coverage of reproductive, maternal, and family planning services, and to assess exposure to household-level human rights violations within the pilot-project target population. Two-stage cluster sampling surveys among ever-married women of reproductive age (15–45 y) documented access to essential antenatal care interventions, skilled attendance at birth, postnatal care, and family planning services. Mid-upper arm circumference, hemoglobin by color scale, and Plasmodium falciparum parasitemia by rapid diagnostic dipstick were measured. Exposure to human rights violations in the prior 12 mo was recorded. Between September 2006 and January 2007, 2,914 surveys were conducted. Eighty-eight percent of women reported a home delivery for their last pregnancy (within previous 5 y). Skilled attendance at birth (5.1%), any (39.3%) or  4 (16.7%) antenatal visits, use of an insecticidetreated bed net (21.6%), and receipt of iron supplements (11.8%) were low. At the time of the survey, more than 60% of women had hemoglobin level estimates  11.0 g/dl and 7.2% were Pf positive. Unmet need for contraceptives exceeded 60%. Violations of rights were widely reported: 32.1% of Karenni households reported forced labor and 10% of Karen households had been forced to move. Among Karen households, odds of anemia were 1.51 (95% confidence interval [CI] 0.95–2.40) times higher among women reporting forced displacement, and 7.47 (95% CI 2.21–25.3) higher among those exposed to food security violations. The odds of receiving no antenatal care services were 5.94 (95% CI 2.23–15.8) times higher among those forcibly displaced... Conclusions: Coverage of basic maternal health interventions is woefully inadequate in these selected populations and substantially lower than even the national estimates for Burma, among the lowest in the region. Considerable political, financial, and human resources are necessary to improve access to maternal health care in these communities.
Author/creator: Luke C. Mullany, Catherine I. Lee, Lin Yone, Palae Paw, Eh Kalu Shwe Oo, Cynthia Maung, Thomas J. Lee, Chris Beyrer
Language: English
Source/publisher: PLoS Medicine, December 2008 | Volume 5 | Issue 12 | e242
Format/size: pdf (186K)
Alternate URLs: http://www.burmalibrary.org/docs6/Access_To_Essential_Maternal_Health.pdf
Date of entry/update: 03 February 2009

Title: Maternal and Newborn Health - State of the World's Children 2009
Date of publication: December 2008
Description/subject: Search for "Myanmar" -- most useful are the tables.
Language: English
Source/publisher: UNICEF
Format/size: pdf (2.35MB)
Date of entry/update: 04 February 2009

Title: Increasing access to reproductive health services in eastern Burma
Date of publication: May 2008
Description/subject: EXECUTIVE SUMMARY: Alternative strategies to increase access to reproductive health services among internally displaced populations are urgently needed. In eastern Burma continuing conflict and lack of functioning health systems render the emphasis on facility-based delivery with skilled attendants unfeasible. Along the Thailand/Burma border, local organizations are implementing a unique pilot, the "Mobile Obstetric Maternal Health Workers (MOM) Project", which establishes a three-tiered collaborative network of community-based reproductive health workers. Health workers from local organizations receive practical training in basic emergency obstetric care plus blood transfusion, focused antenatal care, and family planning at a central facility. Returning to their target communities inside Burma, these first-tier “Maternal Health Workers ” (MHWs) train a second tier of local health workers (HWs) and a third tier of traditional birth attendants (TBAs) to provide a limited subset of these interventions depending on their level of training. Close communication between health workers and TBAs promotes acceptance and coverage of reproductive health services throughout the community. We describe the rationale, the design and implementation of the project and the parallel monitoring plan for evaluation of the MOM Project. This unique model of health care delivery may serve as a model for new strategies for increasing access to care in other conflict settings.... Keywords: Emergency obstetric care, reproductive health, misoprostol, internally displaced populations, Burma
Language: English
Source/publisher: The Mobile Obstetrics Maternal Health Worker Project (MOM)
Format/size: pdf (2.89MB)
Alternate URLs: http://www.ghap.org/reports/pdfs/MOM_Project_Descriptive_paper.pdf
Date of entry/update: 20 December 2008

Title: The MOM Project: Delivering Maternal Health Services among Internally Displaced Populations in Eastern Burma
Date of publication: May 2008
Description/subject: Abstract: Alternative strategies to increase access to reproductive health services among internally displaced populations are urgently needed. In eastern Burma, continuing conflict and lack of functioning health systems render the emphasis on facility-based delivery with skilled attendants unfeasible. Along the Thailand–Burma border, local organisations have implemented an innovative pilot, the Mobile Obstetric Maternal Health Workers (MOM) Project, establishing a three-tiered collaborative network of community-based reproductive health workers. Health workers from local organisations received practical training in basic emergency obstetric care plus blood transfusion, antenatal care and family planning at a central facility. After returning to their target communities inside Burma, these first-tier maternal health workers trained a second tier of local health workers and a third tier of traditional birth attendants (TBAs) to provide a limited subset of these interventions, depending on their level of training. In this ongoing project, close communication between health workers and TBAs promotes acceptance and coverage of maternity services throughout the community. We describe the rationale, design and implementation of the project and a parallel monitoring plan for evaluation of the project. This innovative obstetric health care delivery strategy may serve as a model for the delivery of other essential health services in this population and for increasing access to care in other conflict settings."...Keywords: antenatal care, childbirth, emergency obstetric care, misoprostol, internally displaced populations, Burma
Author/creator: Luke C Mullany, Catherine I Lee, Palae Paw, Eh Kalu Shwe Oo, Cynthia Maung, Heather Kuiper, Nicole Mansenior, Chris Beyrer, Thomas J Lee
Language: English
Source/publisher: "Reproductive Health Matters"
Format/size: pdf (544K)
Date of entry/update: 20 December 2008

Title: Reproductive health in Burma: a priority for action
Date of publication: 30 April 2008
Description/subject: There is an urgent need for improved reproductive health services in Burma. At 360 per 100,000 live births the estimated maternal mortality ratio is lower than for a number of other countries in the region but there is widespread belief that this number is not a true representation of the maternal deaths in the country. Contraceptive use is also low, with large regional variations; women in those areas most affected by conflict are less likely to use a modern contraceptive than those living in the central plains region. In Arakan (Rakhine) State, where many people are displaced from their homes or are returnees from refugee camps in Bangladesh, the contraceptive prevalence rate among married women is particularly low.
Author/creator: John Bercow
Language: English, Burmese
Source/publisher: "Forced Migration Review" No. 30
Format/size: pdf (English, 275K; Burmese, 190K)
Alternate URLs: http://www.fmreview.org/FMRpdfs/FMR30Burmese/22-23.pdf
Date of entry/update: 30 November 2008

Title: Borderline Health
Date of publication: 2008
Description/subject: As a "slow-motion genocide" envelops ethnic minorities in eastern Burma, health workers rely on innovative strategies and raw courage to save the lives of mothers and infants.
Author/creator: Cathy Shufro
Language: English
Source/publisher: "Johns Hopkins Public Health" Online Edition, FAll 2008
Format/size: html
Date of entry/update: 21 December 2008

Title: "Health Messenger" Magazine No. 37 -- special issue on maternal health
Date of publication: September 2007
Description/subject: I. Health:- 1. Female reproductive system (HM); 2. Lifestyle consideration during antenatal and postnatal period - Erika Garrity Pied (TBBC); 3. Breast-feeding - Erika Garrity Pied (TBBC); 4. Family planning (HM)... II. Medical:- 5. Pregnancy changes and management of symptoms - Dr. Htwe (AMI); 6. Antenatal care (SMRU); 7. Genital Haemorrhage: Differential Diagnosis and Treatment - Dr. Bertrand Martinez-Aussel (AMI); 8. Vaginal Discharge - Dr. Bertrand Martinez-Aussel (AMI); 9. Intra-natal and Post-natal care (SMRU)... Focus: "I don't have enough breast-milk!"; 10. Interview with ARC staff in Umpiem; Quiz.
Language: Burmese, English
Source/publisher: Aide Medicale Internationale (AMI)
Format/size: pdf (3.2MB)
Date of entry/update: 19 November 2007

Title: Myanmar Adolescent Health Fact Sheet
Date of publication: January 2007
Description/subject: Myanmar’s population is estimated at 50.52 million1 with a growth rate of 1%. Nearly 70% of the population is rural. The sex ratio was estimated to be 989 males per 1000 females in 20022. According to the Fertility and Reproductive Health Survey (FRHS) in 2001, the total fertility rate has decreased from 4.0 in 1990 to 2.4 in 20012. In 2001, the crude birth rate was 23.9 and crude death rate 11.23. The infant mortality rate has declined from 79 per 1000 live births in 1997 to 49 in 2001 (48.3 in urban and 50 in rural areas). In the year 2000 the maternal mortality ratio of the country was 360 per 100,000 live births. The adult literacy rate improved from 83.1% in 1995 to 96.5% in 2001 and the Human Development Index of Myanmar for 2003 was 0.5784.
Language: English
Source/publisher: World Health Organization_SEARO
Format/size: pdf (236.42 K)
Alternate URLs: http://www.searo.who.int/LinkFiles/Fact_Sheets_Myamnar-AHD-07.pdf
Date of entry/update: 12 November 2010

Title: Fertility Regulation through Traditional Midwives along the Thai-Burma Border
Date of publication: 21 July 2006
Description/subject: Reproductive Health in Developing Countries...SUMMARY: "Multiple confounders with important interaction make a cause & effect analysis difficult when discussing factors contributing to decrease reproductive mortality. Every sector taken up to be improved is a step towards the objective of improving women’s well-being. Findings of this literature review are: traditional midwives (TMs) as contraceptive distributors are not significant in reducing reproductive deaths. The main killer among mothers in Burma and along the Thai-Burma border is unsafe, septic, induced abortion. Even if TMs cannot provide emergency obstetric care, as distributors of modern contraception they could affect the maternal mortality in four ways. 1: Reducing number of pregnancies, which decreases the number of times women face risk of maternal death. 2: High-risk pregnancies at higher parities can be avoided. 3: Women can avoid unwanted pregnancy, which may end in unsafe abortion or in not seeking care or in abandoning a baby. 4: Involving TMs in contraceptive services may replace their practice of inducing unsafe abortions. As long as most of the deliveries are still at home with indigenous midwives maternal mortality can not be reduced below 100/100,000, even if there is functioning emergency obstetric care (EmOC) available. Examples from Brazil and China have shown this It is still realistic that the present high mortality from over 600/100,000 in Burma’s internally displaced people (IDP) areas can be significantly reduced. Fertility regulation is not a substitute for obstetric care in a limited budget country, but they should work together. TMs have been utilized in some countries by integrating them successfully into existing health systems. Even in countries with political stability the reduction of maternal mortality took decades. In an unstable population disrupted by civil war additional factors delay the process. To overcome the feminization of poverty girls schooling is to be promoted. The number of girls in secondary schools needs to be increased, so that the coming generation has a better understanding of health issues. No RH prospective intervention studies about postemergency settings with TM programmes for fertility regulation have been found in the literature. There cannot be one monopolized concept for healthcare or for safe motherhood, or for population stabilization. We need measured tailored projects for every ethnic group in its circumstances reaching each needy individual. If one way does not bring the expected results, the strategy must be changed. With motivated skilled midwives from the Backpack Health Worker Team (BPHWT) and additional trained EmOC-staff, who can form a link in a transition period until there are enough literate skilled midwives, as many lay midwives as possible should be offered training on a voluntary basis with as many skills as they can take in. Disarmament of rebel groups and peace negotiations are essential."
Author/creator: Inge Sterk
Language: English
Source/publisher: Liverpool School of Tropical Medicine
Format/size: pdf (855K - low resolution; 1.53MB - original, high resolution )
Alternate URLs: http://www.mitwelt-netzwerk.de/documents/thesis_2006-07.pdf
Date of entry/update: 22 February 2007

Title: Frauen in Bildung und Gesundheit
Date of publication: 29 December 2005
Description/subject: Armutsreduzierung und die Stärkung der Position von Frauen hängen in vielerlei Hinsicht zusammen. In Burma, so heißt es im Allgemeinen, nehmen die Frauen eine angesehene und respektierte Rolle in der Gesellschaft ein. In der Kombination mit Armut, Gewalt oder kulturellen Werten werden jedoch Diskriminierungen und Ungleichheiten sichtbar. Die meisten Gesundheitsprobleme, denen sich Frauen ausgesetzt sehen, sind auf schlechte Lebensbedingungen zurückzuführen. keywords: women, health, education, prostitution, HIV/AIDS, family planning
Author/creator: Ulrike Bey
Language: German, Deutsch
Source/publisher: Asienhaus Focus Asien Nr. 26, S. 37-43
Format/size: pdf
Date of entry/update: 20 March 2006

Title: Working Our Way Back Home - Fertility and pregancy loss on the Thai-Burmese border
Date of publication: December 2005
Description/subject: Findings:- Key findings from the research show that: While unplanned pregnancy and abortion are a large problem, they can be prevented. * Post abortion care at Thai and Burmese health facilities takes large amounts of health resources. * At least a third of women with post abortion complications have self-induced abortions. * Men and women have low levels of knowledge about modern methods of contraception. * Temporary contraceptive information or methods are not offered to women during post abortion care in the Mae Sot Hospital but are offered 6 weeks after discharge. Many women are affected by unplanned pregnancies ~ * The vast majority of women are married and two thirds have children. * A third of women have five or more pregnancies, which is a health risk in itself. The way the pregnancy ends can negatively affect women's health and wellbeing ~ * Unqualified abortionists and home remedies are the only recourse women have to end an unwanted pregnancy. * Women know of and use a wide variety of methods to end their pregnancy including self-medication with multinational and Burmese medicines, drinking ginger and whisky, vigorous pelvic pummelling and insertion of objects into the sex organs. * Post abortion treatment in hospital can be expensive if a woman does not have a work permit or is not referred by Mae Tao Clinic and can leave her with debts. Women are pressured by social and political circumstances to end their pregnancies~ * Women are often pressured by employers, husbands and the fear of unemployment to end their pregnancies. * Some women report domestic violence as influencing their decision to abort. Women were attempting to limit their fertility in many different ways ~ * Most women and lay midwives classified menstrual regulation and abortion as traditional methods of fertility control. * Most women accepted a diverse range of temporary and permanent contraceptive methods from the Mae Tao Clinic staff while they were still in-patients. The nature of forced displacement and lack of human rights directly effects reproductive health ~ * Having a work permit does not necessarily offer protection to women, as there is scrutiny to ensure a woman is not pregnant when a permit is issued.  As workers without work permits can be arrested and deported by Thai police, women are reluctant to travel to any type of health service and often wait until they are very unwell.  Burmese women as non-citizens are not included in Thai death statistics at a national level so the deaths of Burmese women go unnoticed, by both Thai and Union of Myanmar authorities.
Author/creator: Cynthia Maung, Suzanne Belton
Language: English
Source/publisher: Mao Tao Clinic
Format/size: pdf (2.2MB)
Date of entry/update: 23 December 2005

Title: A Pregnant Problem
Date of publication: November 2005
Description/subject: Young women trapped by dogma and the generation gap... "It’s only a couple of years ago that young people living in and around the Karenni refugee camp at Ban Tractor in Thailand’s Mae Hong Son Province were able to help themselves to free condoms from boxes attached to trees and wayside posts. It was the idea of the camp health department director, Say Reh, who had been growing increasingly concerned about the rising numbers of young unmarried women becoming pregnant and also about the risk of HIV/AIDS in the community. But it was a short-lived idea. Say Reh had to abandon his solo birth-control effort after three months because of strong opposition from many of the camp residents and Catholic and Protestant church ministers. “Older people here believe that distributing condoms and organizing sex education encourages young people to indulge in sex,” says Say Reh. Although he’s abandoned his free condoms initiative, Say Reh and some of his co-workers still hold occasional sex education classes for the young people of Ban Tractor, under the watchful eye of disapproving elder members of the community. “The problem is that parents are sensitive on sex issues and many are illiterate, so they don’t know how to educate their children and guard them from unwanted pregnancies,” he says..."
Author/creator: Louis Reh
Language: English
Source/publisher: "The Irrawaddy" Vol. 13, No. 11
Format/size: html
Date of entry/update: 01 May 2006

Title: Borders of fertility: Unwanted pregnancy and fertility management by Burmese women in Thailand
Date of publication: May 2005
Description/subject: Submitted in total fulfilment of the requirements of the degree of Doctor of Philosophy...Faculty of Medicine, Dentistry and Health Sciences, School of Population Health, Key Centre for Women�s Health in Society The University of Melbourne...This thesis, describes how women who are forced to migrate from Burma into Thailand manage their fertility, unwanted pregnancy and pregnancy loss. Unsafe abortion is a common problem and much time and resources are taken with the care of women suffering haemorrhage, infection and pain after self-induced abortion in both Thai and Burmese-led health facilities. The thesis examines the characteristics of 43 Burmese women admitted to health facilities with post-abortion complications and their chosen methods of self-induced abortion. There is no commonly agreed definition of abortion between formal, informal health workers or women. Most people considered it morally proscribed and in some cases knew it was illegal, but still felt it was necessary. Some aspects of post-abortion care are performed better by informally than formally trained health workers. Post-abortion family planning was poorly performed by Thai health workers. Lay midwives play a central role in fertility management and some are abortionists. Burmese women�s partners are not well informed about fertility management and frequently decline vasectomy. Within a relm of limited traditional and modern reproductive choices, women manage their fertility outcomes. The Burmese women in this study are generally married with children. Considered illegal migrants, they are employed and work in Thailand without work permits. Many women have a history of escaping human rights abuses and entrenched poverty in Burma. At least a third of women admitted into care with post-abortion complications have induced their abortion with oral herbal preparations, pummelling manipulations or stick abortions. Most of the abortion services are provided by Burmese lay midwives. Reasons for terminating the pregnancy include: poverty, gender-based violence and the local illness of �weakness�. In addition, incomplete sexual health knowledge, and difficult access to reproductive health services play a part in mistimed pregnancy. I argue that a lack of rights increases women�s risk of unsafe abortion. The rights to work and earn a fair wage and to move without fear influence reproductive health choices and access to health services. A lack of sexual health information for men and women and the ability to safely control fertility causes unwanted pregnancies. Furthermore, violence perpetrated at the individual and state level contributes to unsafe abortion. Burmese women�s mortality and morbidity associated with unsafe abortion in Thailand is largely unrecorded and unknown to the Burmese military government. Unwanted and mistimed pregnancy can be avoided through reproductive technologies, education programmes, and access to modern contraceptives. To safely terminate unwanted pregnancies and to treat the complications of pregnancy loss is a woman�s right. Burma and Thailand are signatories to Convention on the Elimination of all Forms of Descrimination Against Women, yet Burmese women continue to suffer, become sterile, socially vilified, unemployed or repatriated to Burma due to their reproductive status. Their sickness and deaths are secondary to the economic imperatives of Burma and Thailand.
Author/creator: Dr. Suzanne Belton
Language: English
Format/size: pdf (3.8MB)
Date of entry/update: 23 December 2005

Title: Fertility and abortion: Burmese women's health on the Thai-Burma border
Date of publication: January 2004
Description/subject: "In Thailand's Tak province there are 60,520 registered migrant workers and an estimated 150,000 unregistered migrant workers from Burma. Fleeing the social and political problems engulfing Burma, they are mostly employed in farming, garment making, domestic service, sex and construction industries. There is also a significant number of Burmese living in camps. Despite Thailand�s developed public health system and infrastructure, Burmese women face language and cultural barriers and marginal legal status as refugees in Thailand, as well as a lack of access to culturally appropriate and qualified reproductive health information and services..."
Author/creator: Suzanne Belton and Cynthia Maung
Language: English
Source/publisher: Forced Migration Review No. 19
Format/size: pdf (110K)
Date of entry/update: 08 June 2004

Title: Myanmar Fertility and Reproductive Health Survey 2001
Date of publication: December 2002
Description/subject: Preliminary Report: The 2001 Fertility and Reproductive Health Survey (FRHS) is the third survey to obtain detailed information on demography and reproductive health in Myanmar. The first survey was 1991 Population Changes and Fertility Survey (PCFS) and the second was the 1997 FRHS. This Preliminary Report is the first report of 2001 FRHS to provide policymakers, programme managers, international organizations, NGOs and scholars timely and reliable detailed but brief information on fertility, contraception, maternal and child health, infant and child mortality, knowledge of STDs and HIV/AIDS and internal migration in Myanmar. Two more detailed reports are planned to supplement this one: comprehensive Country Report (main survey report) and Report on Detailed Analysis of Trends and Patterns on selected topics.
Language: English
Source/publisher: Myanmar Department of Population
Format/size: pdf (2.21 MB)
Alternate URLs: http://countryoffice.unfpa.org/myanmar/?publications=1472
Date of entry/update: 22 October 2010

Title: Post Abortion Care: Who Cares?
Date of publication: September 2002
Description/subject: "This article is intended to give health workers an introduction into the individual implications of pregnancy loss as well as local issues on the Thai-Burma border and broader South-east Asian regional issues. I want to focus on the gender and social features rather than pure biomedical information, although this is of course highly important but is covered in other parts of this magazine. I will talk about some women�s stories that were collected in 2002 to outline typical cases, the reasons why the woman chose to end the pregnancy and impact on women�s lives. I will also present some findings from a medical records review conducted with the Mae Tao Clinic and discuss some findings from research in the international arena. So should we care about post abortion care? I hope to show that we should, as not only can it be a life threatening event for the woman but it reflects certain aspects about the communities we live in, social conditions, legal and religious norms, how we value human rights and the status of women..."
Author/creator: Suzanne Belton
Language: English
Source/publisher: Health Messenger
Format/size: html (60K)
Date of entry/update: 15 June 2004

Title: Lady’s Love Powder
Date of publication: June 2002
Description/subject: This article appeared in Burma - Women's Voices for Change, Thanakha Team, Bangkok, published by ALTSEAN in 2002... "...Unplanned pregnancies and sexually transmitted diseases are problems that many Burmese women face with little support and a poverty of health resources. Of course it is difficult to quantify such statements in light of the limited sharing of information that occurs between the Burman military government and the rest of the world. One informed source, Dr Ba Thike (1997), a doctor working in Burma, reported that in the 1980s abortion complications accounted for twenty percent of total hospital admissions and that for every three women admitted to give birth, one was admitted for abortion complications...The records at the Mae Tao Clinic in Thailand, a health service that offers reproductive health services to women coming from Burma as day visitors or as longer-term migrant workers, reflects a crisis in women�s health. In 2001, the Mae Tao Clinic documented 185 abortion complication cases (Out Patients Department) and 231 cases that needed to be admitted into the In-patients Department with complications such as sepsis, dehydration, haemorrhage and shock from abortions and miscarriage..."
Author/creator: Suzanne Belton (Ma Suu San)
Language: English
Source/publisher: Burma - Women
Format/size: html (24K)
Date of entry/update: 15 June 2004

Title: WOMEN'S HEALTH (Chapter from "Gathering Strength")
Date of publication: January 2002
Author/creator: Brenda Belak
Language: English
Source/publisher: Images Asia
Format/size: PDF (954K)
Date of entry/update: 03 June 2003

Title: "Escape From the Bear and Run Into the Tiger": The Impact of Violence and Fear on Migrants' Reproductive Health
Date of publication: December 2000
Description/subject: "The massive influx of migrants from Burma into Thailand is one of the largest migrant populations in Asia. Over one million migrants from Burma are currently residing in Thailand. An ethnically diverse group coming from all over Burma and speaking many different languages, these migrants often lack a common language even among themselves. What they do share are encounters of fear and violence, that affect most facets of their lives. During 1998, an Assessment of Reproductive and Sexual Health Perspectives, Concerns and Realities of Migrant Workers from Burma in Thailand was conducted under the guidance of Mahidol University's Institute of Population and Social Research (IPSR). The recently published results of the study reveal that a fear of violence and a preoccupation with staying safe determines almost every aspect of the migrants' lives, including their health care options and decisions. The study highlights the extremely limited health services that exist in Burma as well as the problems encountered by migrants in Thailand such as the ready availability of medicines without access to health services or education. Consequently, people from Burma suffer from easily treatable conditions, presenting a health care crisis on both sides of the border. Most migrants from Burma in Thailand reside illegally and are generally unable to communicate in Thai. They are often in situations which leave them vulnerable to violence and abuse by employers, authorities and even each other. These experiences, coupled with fears of violence and exploitation, create a vacuum in which the migrants have few or no options for health services. This reality is further compounded by cultural mores and the lack of basic and reproductive health education, which lead to high maternal mortality and morbidity rates, unwanted pregnancies, unsafe abortions and sexually transmitted diseases (including HIV/ AIDS)..."
Author/creator: Therese Caouette
Language: English
Source/publisher: "Burma Debate" VOL. VII, NO. 4 WINTER 2000
Format/size: pdf (329K - article; 1.22MB - full magazine)
Alternate URLs: http://www.burmalibrary.org/docs11/BD2000-V07-N04.pdf
Date of entry/update: 03 June 2003