Myanmar has an ethnically diverse population of approximately 51.5 million. 70 per cent of the population lives in rural areas. Although Myanmar is moving up to Middle income country status defined by the World Bank clarification, substantial disparities in housing and living conditions exist between rural and urban areas and between different parts of the country. 29 per cent of people in rural areas live below the poverty threshold, while in urban areas the poverty incidence is 15 per cent.i
Myanmar is the second largest country in Southeast Asia with abundant natural resources and a large working age population. The average annual gross domestic product (GDP) growth is estimated at 7 per cent during 2010 to 2014. The gross domestic product per capita is $1,203.ii Health expenditure in the state budget as a percentage of GDP is less than 1 per cent.iii
The maternal mortality ratio in Myanmar is high at 200 per 100,000 live births.iv HIV prevalence in the adult population aged 15 years and older was estimated at 0.54 per cent in 2014, a decline from 0.94 per cent in 2000.v While young people aged 10-24 years account for nearly 30 per cent of the population, population growth is slowing, and the proportion of children is declining.vi In the 2014 gender inequality index, Myanmar ranks as 85th of 187 countries.vii Myanmar’s geography makes the country disaster prone. Natural disasters and internal conflict have displaced hundreds of thousands of people, with one million people estimated to be in need of humanitarian assistance in 2016.viii
UNFPA in Myanmar
UNFPA has a history of more than 40 years in Myanmar. Assistance was first given in 1973, and again in 1983, towards Myanmar’s first and second population censuses. UNFPA’s activities grew in Myanmar in the 1990s with support for the collection of data on reproductive health and fertility. With improved availability of demographic data on reproductive health, and an urgent need for continued assistance, UNFPA’s activities expanded. In 2002 UNFPA adopted a programmatic approach, and today it assists Myanmar in the areas of:
- Maternal Health
- Population and Development
- Adolescents and Youth
- HIV and AIDS
- Gender Equality and Women’s Empowerment
- Gender Based Violence
- Humanitarian Assistance
|Total population||51.48 million|
|Female||51.8 per cent|
|Male||48.2 per cent|
|Population density||76.1 persons/km2|
|Urban population||30 per cent|
|Rural population||70 per cent|
|Life expectancy at birth||66.8 years|
|Maternal mortality ratio||200 (per 100,000)|
|Infant mortality rate||62 (per 1000)|
|Under-5 mortality rate||72 (per 1000)|
|Disability prevalence rate||4.6 per cent|
|Literacy rate||89.5 per cent|
|Labour force participation rate (15-64 year olds)||Total: 67.0 per cent
Male: 85.2 per cent
Female: 50.5 per cent
The Myanmar maternal mortality ratio - the number of women who die in pregnancy and childbirth – is 200.x This means that there are 200 deaths related to child-bearing for every 100,000 live births. This can be compared to the Southeast Asia average, which is 140.xi The infant mortality rate is also high at 62 per 1000 live births.xii
76 per cent of deliveries take place at home, where nearly 90 per cent of maternal deaths occur.xiii The main causes of deaths are post-partum haemorrhage (bleeding), hypertensive disorders of pregnancy (such as eclampsia), consequences of unsafe abortions, and sepsis (a whole-body inflammatory response to infection). Deaths are significantly higher in rural areas, where women have limited access to reproductive health services. Most maternal deaths can be prevented through cost-effective interventions such as the presence of skilled birth attendants during deliveries, emergency obstetric care, and access to birth-spacing commodities and services.
The antenatal care coverage rate is 70.6 per cent, while skilled birth attendants are present at 64.4 per cent of deliveries.xiv The main constraints are limited access to health services due to poverty, geographical barriers, and a shortage of health personnel, especially midwives. The availability of skilled birth attendants is far below the level recommended by the WHO: an additional 7,000 additional midwifes are needed in Myanmar.xv In additional concern is the quality of services.
The total fertility rate is 2.29. However, fertility among married women is significantly higher at 4.7. This is closely related to the fact that 53 per cent of women of all ages have never been married.xvi The prevalence rate for modern contraceptive among all women is 32.6 per cent, and the unmet need for family planning is 24 per cent.xvii Nearly 5 per cent of all pregnancies end in abortions, with women aged 15-19 years being the most vulnerable.xviii Abortion complications is one of the leading causes of maternal deaths. Ensuring adequate supply of contraceptives and improving quality of birth spacing services are crucial to reducing unintended and unwanted pregnancies and abortions.
Every year, thousands of women in Myanmar die in pregnancy and childbirth. But these tragedies, which leave families broken and children motherless, go unnoticed because they take place outside the public eye, within the confines of the family home. With the aim of increasing the number of safe births in Myanmar, UNFPA supports hands-on training in emergency obstetric and newborn care. Teachers from nursing and midwifery schools are trained by obstetrician-gynaecologists and paediatricians at teaching hospitals. These skills are then filtered down to midwife students, helping to build their capacity to manage complications before, during and after delivery.
UNFPA advocates for the upgrade of national midwifery standards. As a result, requirements in line with ASEAN guidelines have been developed, and plans are underway to upgrade the midwifery education from the current diploma course to bachelor and masters courses. UNFPA also supports the government on policy development and midwifery workforce planning though contributions to the Reproductive Health Five Year Strategic Plan (2014-2018) and the Costed Action Plan to meet commitments for Family Planning 2020. The aim is a more resilient health system, where sufficient numbers of skilled midwives are deployed areas in need.
Through the UNFPA Supplies programme, UNFPA increases the availability and use of medicines and other maternal health products, such as contraceptives, antibiotics, nutritional supplements, and safe delivery equipment, including dugs that keep women from bleeding to death during childbirth. Supplies are distributed to thousands of public and private health facilities throughout Myanmar. UNFPA also supports the development of a logistics system. Good logistics help avoid that clinics run out of critical supplies, and also help avoid overstocking which leads to valuable medicines going out of date.
Population and Development
Censuses were taken regularly in Myanmar during the British administration of the country from 1872 until 1941. After independence, with support from UNFPA, Population and Housing Censuses were conducted in 1973 and 1983. The 2014 Myanmar Population and Housing Census was the first in more than 30 years. A census gives a comprehensive picture a country’s people and of their social and living conditions. Only a census provides complete detail right down to the smallest area, and the results are an essential tool for effective policy, planning and decision making.
UNFPA has provided, and is still providing, critical technical and financial support towards the 2014 Myanmar Population and Housing Census together with donor countries. The census was an undertaking on massive scale and with profound significance for Myanmar’s future and for its political and economic transition process.
Nearly 98 per cent of the population was counted, engaging more than 100,000 enumerators across the country for 12 days. The exercise included drawing 80,000 maps and distributing more than 14 million questionnaires. Remote areas, never previously counted in a census (such as the Wa area), were included thanks to dedicated negotiations between the government and leaders of self-administered areas. An observer team of international experts and Myanmar researchers who witnessed a sample of the enumeration in every state and region vouched for the overall quality of the census enumeration.
The main census results were published in May 2015, providing much-needed evidence-based data for planners and policymakers to formulate, implement, monitor and evaluate development programmes and policies. The census plan also includes 13 in-depth thematic reports on key areas such as education, fertility, mortality, migration, disability, population projections, gender, housing conditions and assets, youth, and elderly.
The preparation and publication of the census results is complimented by consultation, distribution and training programmes aimed at planning officers, civil society, faith-based groups, media, political parties and academia. These activities help build capacity for informed decision making, allowing local stakeholders to develop strategies that address development priorities in their own constituencies.
Adolescents and Youth
In Myanmar, young people account for about 28 per cent of the total population.xix Young people include adolescents (aged 10-19) and youth (aged 15-24). Sexual and reproductive health is still considered a taboo subject, making it challenging for young people to access accurate information which helps them make informed choices for their future.
UNFPA works to strengthen the Myanmar health system to improve young people’s access to high-quality and equitable services in the area of sexual and reproductive health and HIV/AIDS. To support health workers, UNFPA created the “Adolescent and Youth Friendly Health Services Manual for Basic Health Staff” to promote and support youth friendly health services.
In the area of information, UNFPA conducts life skills training about sexual and reproductive health. The Skills Development Trainings promote communication, presentation and peer education. Activities also include radio programmes, edutainment shows and hotline counselling.
Having supported the development of the Five Year Strategic Plan for Young People’s Health (2016-2020), UNFPA is adopting a multi-sectoral approach in collaboration with the government, professional associations, and civil society organizations, including NGOs.
HIV and AIDS
HIV prevalence in the adult population aged 15 years and older was estimated at 0.54 per cent in 2014, a decline from 0.94 per cent in 2000. HIV in Myanmar is concentrated among key populations: people who inject drugs (23.1 per cent), men who have sex with men (6.6 per cent) and female sex workers (6.3 per cent).xx
Interventions to reach key populations began on a large scale after 2000 with condom and harm reduction programmes. The main focus is on prevention of HIV transmission with the concept of the three zeros: zero new infections, zero AIDS related deaths and zero discrimination for those living with HIV. Mapping exercises and size estimation are used to reach key populations through targeted outreach programmes, drop in centres, HIV testing, and referrals to antiretroviral treatment services.
The criminalisation of sex work and the carrying of condoms as circumstantial evidence have resulted in sex workers not accessing health and other social services for fear of being arrested. This increases both their personal vulnerability to HIV and other sexually transmitted infections, as well as that of their clients.
The comprehensive condom programme is a key priority for UNFPA because condoms are recognized as the only effective way to prevent HIV as well as other sexually transmitted infections and unintended pregnancy. Operating through both public and private entry points such as health clinics and drop in centres, UNFPA helps provide a consistent and affordable supply of condoms.
UNFPA has been working on HIV prevention among key populations, in particular female sex workers and their clients, since 2004. Recognizing the importance of involving beneficiaries in managing activities that affect their own lives, UNFPA works to engage community-based, sex-worker-led organizations programme design, implementation and monitoring.
Programmes promote safe behaviour and demand-generation for services, along with provision of those very services: access to condoms and lubricants, referrals to STI/HIV testing, antiretroviral treatment and other reproductive health services such as birth spacing support and opportunistic infections prevention. Other activities include information, counselling, social support, and capacity development of peer educators.
In 2015, UNFPA supported the development of national guidelines for HIV prevention among key populations. UNFPA also supports facilities that integrate different types of sexual and reproductive health services such as family planning, maternal health and HIV.
Gender Equality and Women’s Empowerment
In the 2014 gender inequality index, Myanmar ranks as 85th of 187 countries.xxi The Myanmar government is a signatory to the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW), the Beijing Platform for Action, the International Conference on Population and Development and the Millennium Declaration.
Nevertheless, there are gender inequalities in legislation, access to economic opportunities and political representation in Myanmar. In addition, the knowledge and involvement of men in family planning, safe motherhood and HIV prevention is limited. Women have little negotiation power for condom use to avoid contracting HIV even if they suspect their partners of having sex outside their relationship. There is a lack of open spousal communication about sexual matters and HIV/AIDS among the majority of the population. A shortage of gender statistics and research, a lack of awareness, and limited institutional capacity hinder the development and implementation of effective policies and programmes for the empowerment of women.
The National Strategic Plan for the Advancement of Women 2013-2022 outlines an integrated approach to improving the situation of women and girls in Myanmar. The plan provides an overarching framework, and details interventions and targets. The plan aims to create enabling systems, structures and practices for the advancement of women, gender equality, and the realization of women's rights.
UNFPA works together with the government, other UN agencies and local organizations such as the Myanmar Women Affairs Federation. UNFPA supported the development of the National Strategic Plan on Advancement of Women, especially in the areas of women and health, women and emergencies, women and human rights, violence against women, and the girl child. By supporting the operationalization of National Strategic Plan on Advancement of Women, UNFPA supports the right of women and couples to freely and responsibly decide the number and spacing of their children.
UNFPA co-chairs the UN Gender Theme Group and the government-led Gender Equality and Women Empowerment Working Group, which contributes to national coordination.
Gender Based Violence
Gender-based violence (GBV) is a term used to describe any harmful act that is perpetrated against a person’s will, and is based on socially ascribed norms. It knows no social, economic or national boundaries. GBV undermines the health, dignity, security and autonomy of its survivors. Violence against women and girls is one of the most prevalent human rights violations in the world and yet is the most silent. Survivors of violence often do not report or seek assistance due to fear of reprisal or stigmatization. Current programming in Myanmar to support survivors of GBV reveals high levels of intimate partner violence, which is indicative of high levels of gender inequality more broadly.
UNFPA works with the government, and international and local organizations to provide medical care and social support for the survivors of gender based violence. It also has programmes aiming to increase accountability and to prevent gender based violence more broadly.
UNFPA supports organisations in Kachin, Northern Shan and Rakhine (both financially and technically) to implement programmes centred around Women and Girls Centres. The Women and Girls Centres provide services to internally displaced and conflict-affected women and girls in Rakhine and in Kachin. The Women and Girl centres are places where women and girls can access emergency assistance and referrals to lifesaving health services as well as to legal assistance. In the centres, women and girls can access psychosocial support and counselling without fear of judgment or shame.
In addition to the Women and Girls Centres, UNFPA manages temporary safe spaces operating through mobile reproductive health clinics. In this way, UNFPA is able to access a greater number of women and girls to support survivors of gender based violence without stigma while simultaneously serving the reproductive health needs of women and girls.
UNFPA coordinates inter-agency actors to ensure a robust and multi-sector response to GBV from the earliest stages of emergencies. In addition, UNFPA works closely with women and girls across Myanmar to provide safe and confidential access to services to help recovery following gender based violence. Survivors of violence can suffer emotional trauma, sexual and reproductive health consequences, including forced and unwanted pregnancies, unsafe abortions, sexually transmitted infections, including HIV, and even death. UNFPA also support survivors of trafficking, forced and early marriage, and exploitation.
Nearly seven decades of internal conflict in Myanmar has affected the lives of hundreds of thousands of civilians in border areas. Myanmar is also prone to natural disaster such as earthquakes, floods, cyclones, droughts, fires and tsunamis. When large numbers of people are affected, the government asks the international community for support to respond to the disasters. Around half a million people were in need of humanitarian assistance in 2015, primarily in Rakhine, Kachin and northern Shan.
Women do not stop getting pregnant or having babies when disaster strikes. During conflicts and natural disasters, women and their babies at particular risk because of the sudden loss of medical support. The lack of medical services is compounded by trauma and exposure to violence. Urgent maternal health interventions can mean the difference between life and death for pregnant women and their newborns, and for other children and relatives under their care.
In Myanmar, UNFPA supports the government and local communities to help ensure that the lives, dignity and well-being of people, especially women and girls, affected by conflict and disaster are protected.
UNFPA provides life-saving and essential reproductive health services during humanitarian crises, covering both preparedness and response. Interventions aim to improve access to and quality of medical services. The Minimum Initial Service Package is designed to prevent excess maternal and neonatal mortality and morbidity, reduce HIV transmission, manage the consequences of sexual violence, and plan for the provision of sexual and reproductive health services in the early days and weeks of an emergency. UNFPA builds capacity to implement a Minimal Initial Service Package by supporting training and coordination, as well as warehouse facilities and stockpiling of emergency reproductive health kits. UNPFA also distributes and organizes the appropriate use of sexual and reproductive health supplies, including post rape kits, in emergency areas.
UNFPA works through international and national organisations that have nation-wide networks of doctors and midwives who are familiar with the Myanmar context. This helps ensure regular reproductive health care for internally displaced persons and communities in Kachin and Rakhine. UNFPA reaches different religious and ethnic communities in both state and non-state controlled areas. UNFPA chairs the Sexual and Reproductive Health Technical Working Group, which provides coordination and technical assistance to organizations working in humanitarian reproductive health programming in Myanmar.
i vi ix xii xvi xix 2014 Myanmar Population and Housing Census
iii World Bank Group
iv x xiii xiv xvii xviii Health in Myanmar 2014, Ministry of Health
v xx Global AIDS Response Progress Report Myanmar 2015, National AIDS Programme
vii xxi Human Development Report 2015
viii Humanitarian Needs Overview 2016, Humanitarian Country Team in Myanmar
xi The United Nations Economic and Social Commission for Asia and the Pacific (UNESCAP) Database
xv The World Health Report 2006, World Health Organization