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Wai M M, et al.

The main challenge in analyzing and comparing reproductive health indicators from various reports is the inconsistency
of the data. For example, ANC and SBA coverage data from the MICS report, as explained in the findings, and the
definition of SBA in IHLCA reports are two recognizable examples which can produce different estimates. Fortunately,
we get more reliable estimates at the end of MDG era, from the 2014 Myanmar Census and the 2015-2016 MDHS. Thus,
all the indicators we presented were summarized in a table as the reliable estimates are available up to the sub-national
level, and these can help to set priorities (WHO, 2006) by the program planners and implementers. For example, the
regions having MMR of 50-250/100,000 live births indicates that problems may exist in the quality of care for labor/
delivery, while the region having MMR higher than 250/100,000 live births may also have problems in access to services
(WHO, 2006).
These discrepancies among the data sources also demonstrate the need for a stronger health information system for the
country. The current HMIS collects data starting from the most basic unit (township) up to the national level. This routine
reporting also provides an input to the country’s CRVS, which is being established to be a stronger monitoring system
that strengthens the existing one. As of now, the Ministry is trying to strengthen the routine HMIS using an electronic
reporting system, replacing the current routine reporting, which uses paper sheets. It started in 2014 as a pilot and was
expanded yearly, covering two-thirds of the nation as at the end of 2016 (Department of Public Health, 2017). It would
be better to cover the whole country, to reduce contradictions between the data of different reports and to obtain reliable
estimates for monitoring of SDGs.

5. Conclusion
Although the MMR in Myanmar significantly declined in 1990-2015, it failed to reach a targeted low level. Myanmar still
needs to improve reproductive health services to increase ANC coverage, deliveries by skilled persons, and institutional
delivery. Although the contraceptive prevalence increased significantly in Myanmar giving a reduction in TFR; there
is a need to factor in the total marital fertility, which has not decreased much. Moreover, the issue of unsafe abortions
is another parameter highlighting the need for contraceptive services to improve more. Paying attention to in-country
differences and focusing more on the geographical and service areas with poor MRH status is a challenge that should be
taken head on to reduce maternal mortality.

Author’s Contributions
Myint Myint Wai conceptualized the study framework, compiled the published data from different reports, performed
analysis, and drafted the manuscript. Johanne Sundby conceptualized the study framework and gave intellectual inputs to
find relevant information, interpret the data, and draft the manuscript. Thein Thein Htay and Espen Bjertness contributed
to finding relevant information and interpretation of the data and information. Tippawan Liabsuetrakul contributed to
interpretation of the data and information. All the authors have read and approved the final manuscript.

Ethics
The data were compiled from publicly available data sources.

Availability of Supporting Data

All data are secondary data from publicly available data sources.
Conflicts of Interest

No conflicts of interest to disclose.
Funding

This work is supported by Norad/ NORHED-Project: MMY-13/0049 “Health and Sustainable Development in
Myanmar – Competence Building in Public Health and Medical Research and Education (MY-NORTH).”

References

AbouZahr, C. (2003). Safe Motherhood: A Brief History of the Global Movement 1947-2002. British Medical Bulletin, 67(1):13-25.
https://dx.doi.org/10.1093/bmb/ldg014.

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