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Maternal mortality and fertility in Myanmar

Goals (MDGs), which later encompassed reproductive health rights by affirming universal access to reproductive health
services (WHO, 2015a).
Despite global initiatives and country-led activities to reduce maternal deaths by improving antenatal care (ANC)
coverage, deliveries attended by skilled persons and contraceptive use, maternal mortality is still a leading cause of
death in women of reproductive age worldwide (WHO, 2015a). Although the global coverage of deliveries by skilled
birth attendants (SBA) has increased; more than 40% of deliveries in the WHO African and Southeast Asia regions were
not attended by a skilled person (WHO, 2016a). In 2015, only 40% of all pregnant women in low-income countries
had the recommended ANC visits (WHO, 2018a). Although the global contraceptive prevalence rate (CPR) increased,
214 million of women of reproductive age in developing countries who want to avoid pregnancy are not using modern
contraceptives (WHO, 2018b).
Since the onset of the primary health-care concept, Myanmar has paid attention to maternal and child health as
an essential component of the health-care system (Ministry of Health, 2014). The very first objective of the Myanmar
National Population Policy, which was drafted in 1992, is to improve the health status of women and children (MCH
section, 2014). With the National Population Policy acting as a guiding framework, the Myanmar Reproductive Health
Policy was established in 2002. That policy was developed in line with stipulations outlined in the ICPD program of
action and targets of the MDGs (MCH section, 2014). These political commitments led to the formulation of Strategic
Plans on Reproductive Health (2004-2008, 2009-2013, and 2014-2018) (MCH section, 2014). Myanmar is also one of
the family planning (FP) 2020 focused countries, and as such a costed implementation plan to FP 2020 commitments was
adopted in 2014 (Department of Public Health, 2015a) and implemented. Nonetheless, Myanmar is one of the countries
in the WHO Southeast Asia region, which failed to attain the MDG 5 target.
The implementation status and progress of health services including the aforementioned plans and commitments are
routinely assessed by a monitoring system. A Health Management Information System (HMIS) was established since
1995 for routine monitoring, which started with an essential set of indicators and reviewed and revised according to the
country’s needs (Ministry of Health and Sports, 2017a). Service coverage indicators for reproductive health such as ANC
and SBA and contraceptive prevalence are encompassed within this HMIS. While MMR and TFR are routinely stated in
the statistical yearbooks of Central Statistical Organization (CSO), some other distinct surveys have also been conducted
in the field of reproductive health, which provides estimates that reflect the reproductive health status of women at specific
time periods and enabling the policymakers to evaluate the progress.
Although the reproductive health data are available from various sources, a holistic and comparative review of all the
available data to reflect the country’s overall situation and progress has yet to be done. An analysis of data sources and gaps
published in 2010 compiled the data from different surveys (Ministry of National Planning and Economic Development
and UNDP, 2010), but did not include the routine administrative data. Thus, this paper aims to provide a comprehensive
overview of the historic trends of maternal mortality and fertility in Myanmar from 1990 to 2015/2016, focusing on the
coverages of ANC and SBA and CPR. We aim to review the progress made in the past decades by critically exploring and
comparing all the available national representative data, which are nationally or internationally published.
2. Method

The variables, MMR, TFR, total marital fertility rate (TMFR), ANC coverage, percentage of deliveries assisted by SBA, and
CPR, were selected for presentation in this paper. These maternal and reproductive health (MRH) indicators were accessed
through the online sources of MOHS and the Department of Population, and CSO Myanmar. The online sources of the
United Nations Organizations: The WHO, UNFPA, United Nations Children Fund (UNICEF), United Nations Population
Division (UNPD), and United Nations Development Programme (UNDP) were also reviewed to gather the Myanmar
country data. Nationally representative published data of the selected indicators in the past three decades were compiled to
present the trends in maternal mortality and fertility through analysis of service coverage indicators in Myanmar.
First, the MMR of Myanmar was assessed from “Health in Myanmar 2014,” which was published by the Ministry
of Health. Other data sources were followed through the sources and references of Health in Myanmar using a snowball
approach. Thus, we visited the websites of the Department of Population and CSO Myanmar to get maternal mortality and
fertility data. The online sources of UNFPA, UNICEF, UNPD, and UNDP also provided Myanmar country data from the
nationwide surveys which conducted in past decades. United Nations’ estimates of maternal mortality for Myanmar were
gathered from the Global Health Observatory data: Maternal mortality country profiles on the WHO website.
Second, coverages of ANC and delivery care, prevalence of contraception, and fertility estimates were assessed
using data from the 2001 and 2007 reports of Fertility and Reproductive Health Surveys (FRHS) by UNFPA, Integrated

28 International Journal of Population Studies | 2019, Volume 5, Issue 1