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Maternal mortality and fertility in Myanmar

and Sports, 2017b). Low institutional delivery percentages show that many births took place at home, those delivered by
midwifery assistance include. It may be attributed to poor access to health facilities in rural areas due to long distances
and a lack of appropriate facilities (Ministry of Health and Sports, 2017b).

3.2. Contraceptive Uptake and Fertility Decline
The inverse trend of CPR and TFR is presented in Figure 4. The contraceptive prevalence was the most promising indicator
in Myanmar, showing significant progress both measured as any methods or as modern methods. Very low contraceptive
use was observed in 1991 at 16.8% with only 13.6% of the women using modern methods (Department of Population
and UNFPA, 2002). Furthermore, CPR continuously increased and did not vary much among different surveys. The
trend lines are very steep with significant progress (P<0.01). The latest nationwide survey, MDHS 2015-2016 gave an
estimate of CPR (any methods) as 52.2%, and CPR (modern methods) was estimated at 51.3%, showing a very low use
of traditional methods (Ministry of Health and Sports, 2017b).
With an increased use of contraceptives, Myanmar has demonstrated a decreasing trend in fertility (correlation
coefficient between TFR and CPR of any method=−0.71). The 1983 census revealed a TFR of 4.7 (urban 3.4 and rural 5.2),
while the 2014 census reported a TFR of 2.5 (urban 1.9 and rural 2.8) (Department of Population, 2016b). Similarly, the
2015-2016 MDHS exhibited a TFR of 2.3 with 1.9 in urban and 2.4 in rural (Ministry of Health and Sports, 2017b).
Despite this progress, it is important to note the TMFR. For a society like Myanmar, childbearing and contraceptive use
is generally confined to married couples (Department of Population and UNFPA, 2009). At the time of the census in
2014, TFR was around 2.5, and TMFR stood at a much higher level of 5.0 (Department of Population, 2016b). The TFR
and TMFR differed considerably in both urban: 1.9 versus 4.4 and rural areas: 2.8 versus 5.2 (Department of Population,
2016b).
In relation to contraceptive use, the problem of unsafe abortions should be put into consideration. As per the findings
from the 2005 maternal mortality survey, approximately 10% of maternal deaths were from abortion-related causes
(MCH section, 2014). Likewise, septicemia was the leading cause of maternal mortality in 2008, while septic-induced
abortion as a result of unsafe abortions was a contributing factor (MCH section, 2014). In spite of the increased trends in
contraceptive use among Myanmar women, a considerable amount of unintended pregnancies end up in unsafe abortions
and contributing to maternal mortality.

3.3. Regional Variation in Maternal Mortality and Fertility
Even with the existence of some controversy and discrepancies, nationwide surveys and reports provide sufficient
information to present the variation in MRH indicators with temporal trends. Moreover, the 2014 Myanmar Census and
the very first Myanmar Demographic and Health survey 2015-2016 provided stronger evidence to reflect the reproductive
health situation up to the sub-national level. The MRH indicators with variations among different States and Regions are
summarized in Table 1.

60 8
Trend inTMFR Trend in CPR (any method)
R 2 =0.716 7
50 R 2 =0.945 6
Contraceptive prevalence (%) 40 Trend in TFR Trend in CPR (modern method) 5 4 Average number of births per woman
R 2 =0.663
30
R 2 =0.973
20
2 3
10
1
0 0
1980 1985 1990 1995 2000 2005 2010 2015 2020
CPR (any) CPR (modern) TFR TMFR
Figure 4. Trends in total fertility rate and total marital fertility rate and contraceptive prevalence of modern and any methods.
Data Sources: Contraceptive prevalence rate (CPR) (any) and CPR (modern) included estimates presented in Fertility and Reproductive Health Survey reports (2001 and
2007), Multiple Indicator Cluster Survey (2009-2010) and Myanmar Demographic and Health Survey (2015-2016). TFR and TMFR included estimates presented in FRHS
reports (2001 and 2007) and Thematic Report on Fertility and Nuptiality of the 2014 Myanmar Census.

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