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Contraceptive Practice and
Reproductive Health among Naga
Married Women in Hard-to-reach Area of
Lahe Township, Myanmar
Aung Kyaw Khant, Aung Aung, Poe Poe Aung, Kyaw Swar Aye,
Ohnmar Myint, Zayar Myatthu, Ye Lin Soe,
Nyan Lin Htet & Ye Lin Aung
1
Introduction
• Globally, 63 percent of married women were using some form
of contraception worldwide in 2017 which is projected to grow
by 20 million by 2030, from 758 million in 2015 to 778 million
in 2030.
• Myanmar is slowly but steadily moving towards the goal of
healthy family planning and increasing contraceptive
prevalence rate.
2
Introduction(2)
• Despite the high proportion of people who know different
types of contraception, uptake of contraception is still low in
Myanmar
• Specific method uptake is generally very superficial in Myanmar
especially hard-to-reach area
3
4
Infant mortality rate= 86/1000 live births
Under five mortality rate= 100/1000 live births
IMR= 60/1000 live births
U5MR= 62/1000 live births
IMR= 70/1000 live births
U5MR= 72/1000 live births
Introduction (3) • Economically and socio-demographically limited
region. • Per-capita income, health status and literacy rate is
far lower as compared to other states and regions of the country.
Lahe Township Sagaing region Myanmar
Lahe Township
Objective
• To determine knowledge and practice of contraceptive uptake
and reproductive health among Naga Married Women in Lahe
Township in Naga Self Administrated Zone, Sagaing Region
5
Methodology
• Study Design Mixed methods study using
quantitative and qualitative interviews
• Study Population and area currently married women, age
between 15 to 49 years
• Study Period From April to June, 2019
• Sampling method Stratified random sampling
6 Figure 1. Map of Sagaing Region Figure 2 Map of Lahe township
Methodology
7
Methods Ward/village Number of participants
Female Male
1. Focus Group Discussions
(FGD)
Myoma ward 10
Tar Lan ward 10
Lone Khin village 6
2. In-depth Interviews
(IDI)
Ma Kyan village 1
Lone Khin 3
3. Key Informant Interview
(KII)
Ma Kyan village 2
Lone Khin 1
No(1) Toe Chea ward 3 2
Table 1. Distribution of participants in qualitative data collection
Methodology
Data analysis
• For quantitative data
• For qualitative data
8
FGD with rural women
IDI with a mother
Results
10
Rural area, 78%
Urban quarters,
22%
Figure 3. Urban and rural Distribution of the study
N= 302
11
11.7%
54.4%
27.9%
18%
1.7%
36.6% 33.2%
14.9%
7.5% 6.1%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
Under 20years
21 yrs- 30 yrs 31yrs- 40 yrs 41yrs- 50yrs 51yrs- 60yrs 61 yrs andabove
Pe
rce
nt
Married women Husband
Figure 4. Distribution of age group of the study population
• Common age of marriage was 20 (range 14-39)
• Mean numbers of family member in a household was 29 (range 2-21).
N= 302
12
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
Illiterate Read andwrite
Primary/Basic school
Middleschool
High school
54.0%
5.3%
23.3%
12.0%
3.3%
53.3%
9.1%
14.5% 11.6% 9.8%
Per
cen
t
Married women
Husband
N= 302
Figure 5. Distribution of educational status of the study population
13
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
Dependent Governmentstaff
Employee Self-employ Farming
30.8%
2.1% 1.4%
54.7%
11.1%
1.8% 5.3%
8.1%
71.3%
13.7%
Per
cen
t
Married women Husband
Figure 6. Distribution of occupation of the study population
N= 302
14
[VALUE]%
[VALUE]%
[VALUE]% [VALUE]% [VALUE]% [VALUE]% [VALUE]% [VALUE]% [VALUE]% [VALUE]% 0
20
40
60
80
100
120
Per
cen
tage
N= 225
Figure 7. Types of Modern Contraceptive methods known by this study population (n=225)
Knowledge of modern contraceptive methods
• 78.7% knew modern contraceptive methods very well
• 21.3% does not know
15
Figure 8. Types of modern contraceptive methods currently use by this study population (n=117)
Practice of modern contraceptive methods
74%
21%
4% 2%
Injection
OC pills
Implant method
FemaleSterilization
41%
59%
Yes No
16
Figure 8. Types of modern contraceptive methods currently used by study population
Practice of modern contraceptive methods
74%
21%
4% 2%
Injection
OC pills
Implant method
FemaleSterilization
41%
59%
Yes No
N= 117 N= 302
Table 2. Association between educational status, place of delivery (n=277)
Educational status Delivery at
Home
N (%)
Delivery at
Health center
N (%)
95% CI
P value
Illiterate 119 (84.4) 22 (15.6) 1.05-1.63 0.012
Primary education 70 (88.6) 9 (11.4)
Middle school &
above
24 (66.7) 12 (33.3)
17
Table 3. Association between educational status and delivery person (n=277)
Educational status Delivered by
Relatives/ husband
N (%)
Delivered by Skilled
birth Attendance
N (%)
95% CI
P
value
Illiterate 70 (49.3) 72 (50.7) 1.0-1.57 <0.001
Primary education 46 (58.2) 33 (41.8)
Middle school and
above
7 (18.9) 30 (81.1)
18
Table 4. Univariate analysis in sociodemographic characteristics and contraceptive practice
Contraceptive Practice 95% CI
P value
No Frequency (%)
Yes Frequency (%)
Educational status (n=277)
Illiterate 98 (64.5) 54 (35.5) 1.1768-2.2712
0.003
Primary education 51 (61.5) 32 (38.5)
Middle school & above 15 (35.7) 27 (64.3)
Occupation (n=243)
Dependent 37 (41.1) 53 (58.9) 0.20911-0.59233
0.0001
Employee/ Self-employ 121 (68.5) 61 (33.5) 19
Table 5. Univariate analysis in sociodemographic characteristics and contraceptive practice
Contraceptive Practice 95% CI
P value
No
Frequency (%)
Yes
Frequency (%)
Residence (n=272)
Rural 140 (64.2) 78 (35.8) 0.23035-
0.71758
0.001
Urban 27 (42.2) 37 (57.8)
Family member (n=281)
2-7 numbers 72 (54.1) 61 (45.9) 0.37747-
1.04642
0.073
8-21 numbers 77 (65.3) 41 (34.8) 20
21
“အချ အနေေ သားဆကခခား ေညးန ေက ေားမလညသန ေရသလ
အချ ကလညး သားသမးများ အ ေက မ နင ာန ေရပါ ယ”
(a woman 20 years old, Ma Kyan village)
Reasons for not taking contraceptive • Affordability & accessibility • Lack of access • Family size • Traditional belief
“ စချ ဆရင ကနလးမရချငဘး … ဆငမာ ဝယရမာ ပကဆမရကကဘး… စချ ကကန ာလ နဆးရက သေားရမာ ရက ယ … အလေ ကနလးရရငလ ယလကကက ာပ…” ( FGD group from Lahe )
သားနကကာခြ ရင ကျေးမာနရး ထခကမာစး ယ. ကျေန ာ ဆက မေးမန ေက အလပကကမး လပနေရ ာ ခြစ အ ေက အလပမလပနငမာစး ာပါ…”
(30 years old, Male, Ma Kyan village)
22
ကနလးနမေးရင ကယအမမာ ကယဘာသာပနမေး ာပါ လကသညန ေ ဘာန ေမရပါဘး ငါ ောဂန ေက.. အမျ းသားန ေက နမေး ယနလ … (24 years old woman, Lone Khin village)
“ောဂလမျ းန ေက အ န ေပါပ… ကယမေးမက ကယဘာသာပ နမေးနပးကကပါ ယ… ကနလးနမေးပးရင မနအက ဆေခပ န ေဘာန ေ ကရပါ ယ… ကယဘာသာပ ချကနပးပါ ယ… ကနလးကကက ချကချငး န ကပါ ယ..
( FGD group from Lahe )
Mode of delivery by • Relative • Husband Breast Feeding after delivery
23
“ ကနလးနမေးရင ဘယလ ဘယလ လပရ ယ ဆ ာ ကယရ အနြေ အနမက
စဆင သငနပးခ ာနပါ… စကယ မး နမေး အခါကကန ာ သ နခပာခပခ ာေ ပါ ယ...” (a husband, 25 years old, Ma Kyan village)
“ ကနလးနမေးပပးရင ချကကကးခြ ာက ကယဟာကယ ခြ ပါ ယ ဝါးခခမးေပခြ ပါ ယ…
အချငးထေကလာရင အချငးထ ယနပါ… ကျေန ာကန ာ ကယအမဝေးထမာပ အဝ စေ ထပပး နခမခမပလကပါ ယ…”
(a man of 30 years old, Ma Kyan village)
Child delivering procedure • Traditional way • Risky behaviour
Handling difficulties during delivery
24
ကျေန ာ ောဂန ေက ပထမဆးကနလးနမေး အချေမာ
အခကအခအနခခအနေကကကညပပးန ာ နောကကနလးနမေးန ာမယဆရင
လ ေကပပးန ာ နဆးရကပကက ာပါ… ဒ ယကနလးက နဆးရမာ နလျောနလျောရရ
နမေးနငရင ယ ကနလးက အမမာပနမေးပါ ယ..
(30 yr old male, Lahe)
Practice of early marriage
25
“နယာကကျားနလးန ေ ငယငယနလးန ေေ
နကျာငး ကရငး အမနထာငကျသေား ာရ ယ
၁၅နစ၊ ၁၆နစ နလာကဘ ယကက ာများ ယ။” (a woman, 30 years old, Lahe)
26
“ကနလးမလချငလြျကချ ာမရဘ:
ကကားလညးမကကားြးပါ
ယလကကက ာများ ယ..” (a 30 years old man, Ma Kyan village)
Abortion • Very rare in this community. • When a woman got pregnant even if she is not married, • There is no stigma • keep the pregnancy and Deliver the baby • The community is accepting.
Premarital sex • Young men and women living together in the community without getting married.
• It is around 20% of couples
27
“ရးရးအမနထာငကျ ာမျ းမဟ ဘေ အမျ းသားေ အမျ းသမး အ နေပပး ကနလးရလ အမနထာငကျရ ာမျ း
ကယပ ဝေးကျငမာရကကပါ ယ..ရာာန ေမာ အဒါမျ းများပါ ယ…”
(a man of 25 years old, Ma Kyan village)
“ ရပကေကထမာ အချ က အ နေပပး မဂကလာမနဆာငဘ ကနလးရမ မဂကလာနဆာင ာ မျ းန ေန ာ ရပါ ယ…”
( FGD group from Lahe )
Discussion
• Majority of the respondents were from rural area
• Most common age group were 21-30 years of age.
• More than half of married women were illiterate.
• Half of them were self-employ
28
Discussion cont;
• Most of the respondents know modern contraceptive methods
and majority of them know injection method.
• Knowledge on birth spacing was associated with practice, and current
use of contraceptive. [Hlaing that yar study & Loikaw study, 2009, 2012]
• It may be possible that
• Convenient
• Cost-effective because injection was done 3 monthly.
• Educational level
• Miss time on using other method such as OC pill
29
Discussion cont; • Majority of them delivered in their home and very few people
delivered at health post especially hospital.
Most women delivered their children at a home (85.2%) [Naga study, 2019]
• Lower education level had higher experience of home delivery
compared to delivery at the health center
women with a post-secondary education were 2.48 (95% CI 1.04-5.93) times
more likely to deliver at a healthcare facility than women with a primary
education [Nigeria study 2017]
30
Discussion cont;
• Qualitative finding reflected self-delivery at home by husband
Health education program should focus on husband and pregnant women
Clean delivery practice should be promoted among rural populations
Program on distribution of clean delivery kit should be considered
31
• Despite contraceptive knowledge is adequate, utilization is
significantly low in this study, mainly due to fear of side effects
Health education on contraception choice could promote better utilization
and adherence
• Higher rate of contraceptive utilization found in women with
higher educational status
urban population
working married women 32
Discussion cont;
Ethnics group specific findings suggested -
• Premarital sex is not uncommon
• Abortion is very rare
• No stigma on getting pregnant and marriage
• Positive community attitude on reproductive health as whole
33
Discussion cont;
Conclusion
• Empowering women in Naga area, especially through education,
will enable them to participate in making healthy contraceptive
decision
• There is a need for Provision of knowledge about contraception
in hard to reach area.
35
Acknowledgement
• We would like to extend our thanks to Major General Soe Win, director of
Directorate of Medical Services for his permission in doing research and
funding support.
• Our sincere thanks are conveyed to Dr Kyi Minn, from Myanmar Health
and Development Consortium for his guidance and technical support.
• We have much pleasure in expressing our gratitude to Dr Htet Phyo Wai,
TMO of Lahe township hospital for allowing research in this area and his
support during data collection period in that area.
• Special thanks are owed to all the participants in Lahe townships and also
to volunteers for their enthusiastic participations in this study.
36
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37
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