Men's Shared Responsibility In Birth Spacing

Prepared and submitted by: Hla Myat Tun, Second Semester 2008-2009, Student ID 2008-96531

Men’s Shared-Responsibility in Birth Spacing

In partial fulfillment in the Course SPPS 201 (Strategic Planning: Theory and Methods)

Submitted to Dr. Rogelio N. Tagarino Institute of Strategic Planning and Policy Study College of Public Affairs University of Philippines Los Banos

Submitted by Hla Myat Tun, 2008-96531 Second Semester 2008-2009

Prepared and submitted by: Hla Myat Tun, Second Semester 2008-2009, Student ID 2008-96531

Executive Summary

Maternal health plays important role in health sector of every developing country. Maternal Mortality Ratio (MMR) shows the status of health of the countries and quality of life of people in the country. In Myanmar, MMR is high and one of the factors that affect maternal mortality is high unsafe abortion in the community due to the lack of access to contraceptive methods. The contraceptive programmes are especially targeted to women and there are no male oriented contraceptive programmes except condom promotion in existing birth spacing programmes. Building family is partnership and also having children and maternal health is partnership. Men are essential as partners, fathers, brothers, husbands, policy makers and community and religious leaders with women in the fight to reduce maternal mortality. Women have a right to health, but protecting that right often depends on a partner’s support and participation. This study aims to reduce maternal mortality by planning and implementing male contraceptive programmes in existing women-oriented birth spacing programmes.

Background

The total population of Myanmar is estimated at 55.4 millions with annual growth rate of 2.02 percent in 2006.1 The government has committed to achieve the Millennium Development Goals (MDGs) 5; to reduce maternal mortality by 2015. Supportive men’s role in reproductive health/birth spacing must be emphasized to meet the targeted aim in 6 years ahead. In public health sector, birth spacing services have long been offered mostly through the existing outlets of maternal and child health centers, which only women and mother attend. As the part of this reason, high policy makers, development, population and health agencies have largely ignored men’s responsibility on women’s reproductive rights and actions and also reproductive needs for men including contraceptive programmes. The government provides birth spacing services in health centers since 1991, contraceptive prevalence rate (modern methods) among married women in reproductive age (15-49) is 32.8 percent and unmet need for contraception is estimated at 16% among married

1 Statistical Year Book 2006, Central Statistical Organization, Ministry of National Planning and economic Development, The Government of the Union of Myanmar

Prepared and submitted by: Hla Myat Tun, Second Semester 2008-2009, Student ID 2008-96531

women of reproductive age (15-49) and could be higher if unmarried women were also included in the calculation in 2001.2 According to Fertility and Reproductive Health Survey (FRHS) in Myanmar 2001, the prevalence of male sterilization is 1.3% and condom use is 0.3% in the community and also 20% of women did not want to get pregnant, 14% wanted to limit their births and 6% wanted to delay their next pregnancies. There is a gap between male sharedresponsibility and existing birth spacing programmes. Knowledge on condom increased to prevent transmission of HIV/AIDS and sexually transmited infections for use by men with sex workers: they are not seen as a birth spacing methods.

Vision

The Ministry of Health (MOH) in Myanmar shall meet the Millennium Development Goals (MDGs), Goal 5, Improve maternal health by 2015 by accessing contraceptive services to both women and men. Moreover, the participation and shared-responsibility of men in reproductive health is visible and both men and women have equal responsibility in birth spacing.

Mission

The Ministry of Health (MOH) in Myanmar provides wider access of contraceptive methods in the community to improve quality of life on people in the community by legalizing and promoting male sterilization in existing birth spacing programmes and then allow married men to get the vasectomy services in the country to ensure equity in family health.

Goals

The goal of this study is to reach the MDGs, Goal 5: Improve Maternal Health, by supporting and empowering to get effective male participation, performance and taking responsibility in birth spacing to reduce unwanted pregnancies and unsafe abortion which is major cause of increasing maternal mortality. 2

UNFPA Statistics < http://www.unfpa.org/worldwide/indicator.do?filter=getIndicatorValues>

Prepared and submitted by: Hla Myat Tun, Second Semester 2008-2009, Student ID 2008-96531

Strength and Weaknesses / Challenges and Opportunity of Ministry of Health

The following strength, weaknesses, challenges and opportunities of the Ministry of Health (MOH) are identified to help the formation of new programmes, strategic planning and programme implementation with the aim of meeting the targeted goal by 2015. Strength o

Powerful leadership; National Health Committee which has highest policy making body under the chairmanship of the Prime Minister

o

Human resources (experienced, skilled, committed, capable and disciplined health personnel and volunteers; Community-Based health workers, youth volunteers, peer educators, national-level trained voluntary health workers)

o

Partnership and good networking; collaborative system exist which links with UN agencies, international, regional and national organization at all level (up to the grassroot level)

o

Good organizational setting

o

Health education and promotion programme (IEC project under the health system development for health education) supported by National Health Programme

o

Myanmar Reproductive Health Policy (formulated in 2002 and implemented at country level) for the improvement of reproductive health status

Weaknesses o

Weak monitoring and evaluation

o

Insufficient skilled human resources (health personnel) in rural and remote areas

Opportunities o

Obtain interest in reproductive health by donor agencies, decision makers and implementers

o

Better cooperative and coordination by national NGOs with the strong commitment to ICPD goals and MDGs

o

Encourage community participation to empower the community to take responsibility for their own health (Health by All)

o

Utilize the large sum of money in upgrading of rural health development

Prepared and submitted by: Hla Myat Tun, Second Semester 2008-2009, Student ID 2008-96531

Threats o

Political influence

o

Weak support form government (Infrastructure, Transportation, Material supply for hospitals and station hospital, Electricity)

o

Irrelevant policies between government and some international organizations for the development programmes especially in rural and remote areas

Problem Tree

High Maternal Mortality Ratio

High abortion rate

High unwanted pregnancies rate

Insufficient knowledge/service on birth spacing for women

Lack policy commitment on male participation in birth spacing/RH

Lack knowledge/service on birth spacing for men

Lack programme on male birth spacing

Prepared and submitted by: Hla Myat Tun, Second Semester 2008-2009, Student ID 2008-96531

General Strategies for the problem

Strategy 1 (SO): Empower male for effective participation in reproductive health including birth spacing to contribute in reducing unsafe abortion, which is the major factor of increasing maternal mortality among married couples. Strategy 2 (WO): Analyze, re-develop and implement joint monitoring and evaluation, coordination among government and international organizations for existing women birth spacing programmes Strategy 3 (ST): Develop specific joint work-plan with UN agencies and International NGOs for the formation and improvement of new and existing women birth spacing programmes Strategy 4 (WT): Provide fully support to health related UN and international NGOs to implement the programmes in the country

Prepared and submitted by: Hla Myat Tun, Second Semester 2008-2009, Student ID 2008-96531

Solution Tree

Reduce Maternal Mortality Ratio

Reduce abortion rate

Reduce unwanted pregnancies rate

Provide knowledge/service on

Provide knowledge/service on

birth spacing for women

birth spacing for men

Policy commitment on male

Provide programme on

participation in birth spacing/RH

male birth spacing

Prepared and submitted by: Hla Myat Tun, Second Semester 2008-2009, Student ID 2008-96531

Logical Framework Narrative Summary

Objectively Verifiable Indicators - OVIs

Means of Verification -MOVs

External Factors (Assumptions)

Long Term Objective • To access birth spacing services for both men and women • Both men and women have equal responsibility in birth spacing • To reduce Maternal Mortality Rate by 2015

• Reduced targeted MMR by 2015

Reports regularly issued by: • Government (Central Statistical Organization) • Ministry of Health • UNFPA, WHO and UNDP Statistical Year Book

• Ignorance of the government • Natural Disaster • War

Intermediate Objective • To be aware and access the contraceptive services by both men and women in the community • To promote and include male sterilization in existing reproductive health programmes • To reduce unsafe abortion rate and unwanted pregnancies among couples

• Increased % of male sterilization after the programme has started • Increased knowledge on the effectiveness of male participation in birth spacing • Decreased % of unsafe abortion rate

Ministry and UN’s • Project reports • Meeting reports • Departmental reports • Annual reports • Surveys

• Unexpected termination of Programmes • Authority focus on other programmes

• Increased knowledge after training (post test) • Increased number of male clients visit to service providers • Decrease number of unsafe abortion and maternal death in health centers/hospitals

• Training reports/evaluation • Hospital admission records • Surveys

• Ignorance of local authorities

• Specific criteria to get male sterilization • Implementation guidelines • Training manuals • Specific responsibilities for strategic work-plan • Monthly reports • IEC materials on male effective participation • Hospital/health centre data on male contraception • Training reports/evaluation • Annual reports

• Ignorance of government/ local authorities • Strict restrictions on male sterilization

Outputs (Results) 1. gain knowledge on male sterilization 2. increase % of male in contraceptive use 3. decrease unsafe abortion and maternal mortality

Activities 1. Legislation 2. Develop Suitable Policies 3. Education and IEC (Information, Education and Communication) 4. Accessibility and quality of services 5. Monitoring and Evaluation

Inputs 1.1 Legislation 2.1 Statement of the policy in existing reproductive health policies 2.2 Advocacy at all levels 2.3 Develop guiding principles 3.1 Develop training tools 3.2 Organize Coordination meeting, workshops and training 3.3 Effective use of mass media 4.1 Develop joint strategic workplan 4.2 Upgrading skills training to medical doctors and nurses 4.3 Provide “male-friendly” services and environment in existing female programmes 5.1 Collaborate M&E (MOH, UN and NGOs)

Prepared and submitted by: Hla Myat Tun, Second Semester 2008-2009, Student ID 2008-96531

Programme Implementation Guidelines The major processes for the effective implementation of male birth spacing programme are as follow:

Advocacy meetings for having political commitment will be organized with legislators, decision makers and high level authorities. Negotiation among ministries for the legislations of male sterilization will also be included for out coming of policy statement and specific criteria for male sterilization services.

Coordination meeting among stakeholders will be organized for development of effective joint workplan for programme implementation. Joint workplan will be developed for administrative and management system, implementation and coordination system, monitoring and evaluation system among MOH, health related UN agencies and international NGOs and local NGOs.

Dissemination of information on male contraception will be provided through health education and promoting programme supported by National Health Programme.3 Training tools, IEC materials and promotional items on male participation in birth spacing will be developed for the advocacy meetings to get effective support form local authorities, effective training activities and out-reach activities in the community. Effective use of mass media (using testimonials, source creditability, and role models) to disseminate information on importance of male-shared responsibility in birth spacing will be applied for persuasion of community participation as countrywide programme.

Organizing and Providing Training will be provided to ensure the effective quality services for male sterilization to doctors and nurses (health personnel in MOH and implementing agencies for instance; UN agencies, INGOs and NGOs). Upgrading interpersonal skills training will also be provided to service providers for the effective birth spacing counseling sessions in male programmes. 3

Information, Education and Communication (IEC) project under the health system development for health education, Ministry of Health

Prepared and submitted by: Hla Myat Tun, Second Semester 2008-2009, Student ID 2008-96531

Adaptation of male programmes in existing female programmes and infrastructure will be adopted because providing separate infrastructure is not necessary for male programmes. Using of existing health infrastructure will be encourage as possible in MOH, UN agencies, INGOs and NGOs. Condoms and vasectomy services will be provided as easily accessible in female infrastructure. Vasectomy services will be made male-friendly by using male promoters and providers to ensure greater responsibility and participation of male in birth spacing. Vasectomy methods will be included in birth spacing counseling for the couples. Mobile units will be provided for rural and remote areas where there is high incidence of maternal mortality rate.

Organizing of group meetings and promotional events will be included with appropriate interval for community mobilizing. Group meeting can be relatively efficient way to convey information, address individual concerns and create a basis for mutual support for behaviour change. Special display for sports, events, fairs, markets, and other place where large numbers of men congregate, will be organized to publicize service and service sites, encourage men to seek help when they need for contraception.

Promotion of Condoms as contraceptive methods will also be needed to empower among married men in community. Condom distribution programmes will be provided under birth spacing programmes and activities to ensure that condom have high effectiveness for birth spacing among married population.

Develop joint monitoring and evaluation (M&E) among MOH, health related UN agencies, INGOs and NGOs to overcome the weak M&E on existing programmes. M&E plan will be linked to strategic plan and work plan. Under the M&E plan, a set of indicators will be developed specifically to track progress in the provision of male contraceptive services. Activities for improving the delivery of male contraceptive services will then be integrated into the annual joint workplan. The collection of data for M&E plan will be contained 1). Set programme priorities 2). Develop programme framework 3). Develop M&E plan 4). Collect/analyze data 5). Set/review targets 6). Develop programme action plans and workplans. M&E plan will also be emphasized efficiency and cost-effectiveness, employed a participatory approach, drawn on the best combination of international and local expertise, used data from multiple sources,

Prepared and submitted by: Hla Myat Tun, Second Semester 2008-2009, Student ID 2008-96531

disseminated the results to a broad audience, facilitated the use of data for programme improvement and promoted sustainability.

Conclusion

Interest in male participation in reproductive health is growing, and there is increasing evidence that programme on male contraception can be effective in improving maternal health. Male involvement elements are needed in reproductive health programmes in all stags of development – from early stages in which community and political support is critical to later stages that focus on expanding and improving services. Government should promote greater male participation by: (a) removing restrictive policies and regulations; (b) looking for ways to adapt existing infrastructure and services to meet men’s need and preferences; (c) supporting IEC interventions that encourage male involvement and shared-responsibility; (d) ensuring that male services and information are offered throughout existing systems; and (e) ensuring that policy and programme performance indicators include male involvement activities. Men have great responsibility for families’ well-being and men’s role in reducing MMR becomes important part in the country. Supportive programmes on male participation and taking shared-responsibility in birth spacing will be achieved target aim in 2015

Prepared and submitted by: Hla Myat Tun, Second Semester 2008-2009, Student ID 2008-96531

References

- Exploring Strategic Change, Second Edition, Julia Balogun and Veronica Hope Hailey - The Rise and Fall of Strategic Planning, Reconceiving Roles for Planning, Plans, Planners, Henry Mintzberg - Myanmar Reproductive Health Policy, Maternal and Child Health Department, Ministry of Health, the Government of the Union of Myanmar - Myanmar Fertility and Reproductive Health Survey, 2001, Preliminary Report, Ministry of Immigration and Population, Yangon 2003 - World Health Organization South-East Asia Regional Office (WHO/SEARO). 2004. Family Planning Fact Sheets: Myanmar and Birth Spacing: An Overview. Web site: - Nationwide Cause Specific Maternal Mortality Survey 2004-2005 - Statistical Year Book 2006, Central Statistical Organization, Ministry of National Planning and economic Development, The Government of the Union of Myanmar - Population Policies and Programmes in Singapore, Saw Swee-Hock, Institute of

Southeast

Asian Studies - Fifth Asia and Pacific Population Conference, by United Nations Economic and Social Commission

for

Asia

and

Pacific,

United

Nations

(online

book)

http://books.google.com/books?hl=en&lr=&id=bhkyyFiqtsoC&oi=fnd&pg=PA253&dq=male+in volvement+in+Myanmar&ots=v-jqO6L0q8&sig=BX0B6LsjQEQLcKuZt7DUwRZDuM#PPA261,M1> - Male Involvement in Reproductive Health, Including family Planning and Sexual Health, United Nations Population Fund - Population Policies and Programmes: Determinants and Consequences in Eight Developing Countries, by London School of Hygiene and Tropical Medicine and United Nations Population Fund - - <www.un.org/esa/population/publications/abortion/doc/myanmar.doc>