Maternal mortality and fertility in Myanmar: State of the art
Many women in developing countries are dying from preventable causes related to pregnancy and childbirth. These maternal deaths are attributed to the poor coverage of reproductive health services and high fertility levels. A holistic review of the reproductive health is necessary to reflect the country’s situation and progress of reproductive health and provide recommendations for areas that need an improvement. The aim of this paper is to provide an overview of the historic development of maternal mortality and fertility in Myanmar during the past 25 years, focusing on the antenatal care (ANC) coverage, deliveries attended by skilled persons, and contraceptive use. All published nationally representative data were compiled, and trend analysis was performed. The maternal mortality ratio declined significantly by 9.1 (95%CI: 4.0-14.1) maternal deaths per 100,000 live births/year between 1990 and 2015, but it failed to achieve the target of Millennium Development Goals 5. There was no significant improvement in ANC coverage and care during delivery. Contraceptive use increased significantly, leading to a reduction in the total fertility rate. Nevertheless, overall reproductive health failed to reach a satisfactory level. Maternal mortality still remains high. Thus, there is a need to improve service coverage and more so in the regions with poor performance to reduce the high maternal mortality.
AbouZahr, C. (2003). Safe Motherhood: A Brief History of the Global Movement 1947-2002. British Medical Bulletin, 67(1):13-25. DOI 10.1093/bmb/ldg014.
Central Statistical Organization. (2012). Statistical Yearbook 2010. Naypyitaw, Myanmar: Ministry of National Planning and Economic Development.
Central Statistical Organization. (2016). Myanmar Statistical Yearbook 2016. Naypyitaw, Myanmar: Ministry of Planning and Finance.
Central Statistical Organization. (2017). Myanmar Statistical Yearbook 2017. Naypyitaw, Myanmar: Ministry of Planning and Finance. Available from: http://www.mmsis.gov.mm/sub_menu/statistics/fileDb.jsp. [Last accessed on 2019 June 14].
Department of Health Planning. (2014). Public Health Statistics 2012. Naypyitaw, Myanmar: Department of Health Planning in Collaboration with Department of Health. Ministry of Health. DOI 10.26440/ihrj/0302.05.521080.
Department of Population and UNFPA. (2004). Myanmar Fertility and Reproductive Health Survey 2001: Detailed Analysis Report. Naypyitaw, Myanmar: Ministry of Immigration and Population. Available from: https://myanmar.unfpa.org/sites/default/files/ pub-pdf/SPI0205.pdf. [Last accessed on 2019 June 17].
Department of Population and UNFPA. (2009). Country Report on 2007 Fertility and Reproductive Health Survey. Naypyitaw, Myanmar: Ministry of Immigration and Population. Available from: https://myanmar.unfpa.org/en/publications/country-report- 2007-fertility-and-reproductive-health-survey. [Last accessed on 2019 June 17].
Department of Population. (2015). The 2014 Myanmar Population and Housing Census: The Union Report; Census Report Volume 2. Naypyitaw, Myanmar: Ministry of Immigration and Population. Available from: https://myanmar.unfpa.org/en/publications/ union-report-volume-2-main-census-report. [Last accessed on 2019 June 12].
Department of Population. (2016a). The 2014 Myanmar Population and Housing Census: Thematic Report on Maternal Mortality; Census Report Volume 4-C. Naypyitaw, Myanmar: Ministry of Labour, Immigration and Population with Technical Assistance from UNFPA. Available from: https://myanmar.unfpa.org/en/publications/thematic-report-maternal-mortality. [Last accessed on 2019 June 15].
Department of Population. (2016b). The 2014 Myanmar Population and Housing Census: Thematic Report on Fertility and Nuptiality; Census Report Volume 4-A. Naypyitaw, Myanmar: Ministry of Labour, Immigration and Population with Technical Assistance from UNFPA. Available from: https://myanmar.unfpa.org/en/publications/thematic-report-fertility-and-nuptiality. [Last accessed on 2019 June 15].
Department of Public Health. (2015a). Costed Implementation Plan to Meet FP 2020 Commitments 2014. Naypyitaw, Myanmar: Ministry of Health.
Department of Public Health. (2015). Annual Public Health Statistics 2013. Naypyitaw, Myanmar: Ministry of Health.
Department of Public Health. (2017). Public Health Statistics (2014-16). Ministry of Health and Sports, Naypyitaw, Myanmar. Available from: http://mohs.gov.mm/content/publication/list?category=Annual%20Public%20Health%20Statistics&pagenumber =1&pagesize=40. [Last accessed on 2019 June 17].
Maternal and Reproductive Health Division. (2014). Maternal Death Review (MDR) in Myanmar (2013). Naypyitaw, Myanmar: Department of Health, Ministry of Health.
MCH Section. (2014). Five-year Strategic Plan for Reproductive Health (2014-2018). Maternal and Child Health Section, Public Health Division, Department of Health. Naypyitaw, Myanmar: Ministry of Health. DOI 10.26440/ihrj/0302.05.521080.
Ministry of Health. (2014). Health in Myanmar 2014. Naypyitaw, Myanmar.
Ministry of Health and Sports. (2017a). Strategic Action Plan for Strengthening Health Information (2017-2021). Naypyitaw, Myanmar. DOI 10.26440/ihrj/0302.05.521080.
Ministry of Health and Sports. (2017b). Myanmar Demographic and Health Survey 2015-16. Ministry of Health and Sports, Naypyitaw, Myanmar with the DHS Program. ICF Rockville, Maryland, USA.
Ministry of Health and Sports and ICF International. (2016). Myanmar Demographic and Health Survey 2015-16: Key Indicators Report. Naypyitaw, Myanmar, Rockville, Maryland, USA. Available from: : https://reliefweb.int/sites/reliefweb.int/files/ resources/MDHS%202015-16%20KIR.pdf. [Last accessed on 2019 May 14].
Ministry of National Planning and Economic Development and UNDP. (2010). Analysis of Data Sources and Gaps for Monitoring Living Conditions in the Union of Myanmar. Integrated Household Living Conditions Assessment Project. IHLCA Project Technical Unit. Yangon, Myanmar: United Nations Development Program.
Ministry of National Planning and Economic Development and UNDP. (2007). Integrated Household Living Conditions Survey in Myanmar (2009-10): MDG-RELEVANT INFORMATION. IDEA International Institute Quebec City, Canada and IHLCA Project Technical Unit. Yangon, Myanmar: United Nations Development Program.
Ministry of National Planning and Economic Development and UNDP. (2011). Integrated Household Living Conditions Survey in Myanmar (2009-10): MDG DATA REPORT. IHLCA Project Technical Unit. Yangon, Myanmar: United Nations Development Program.
Ministry of National Planning and Economic Development and Ministry of Health. (2011). Myanmar Multiple Indicator Cluster Survey 2009-2010 Final Report. Naypyitaw, Myanmar: Ministry of National Planning and Economic Development and Ministry of Health. DOI 10.1596/29037.
United Nations, Department of Economic and Social Affairs, Population Division. (2014). Abortion Policies and Reproductive Health around the World, Report. United Nations Publications, Sales No. E.13.11. DOI 10.18356/3fc03b26-en.
UNICEF. (2018). UNICEF Data: Monitoring the Situation of Children and Women. Available from: https://www.data.unicef.org/topic/ maternal-health/antenatal-care. [Last accessed on 2019 May 4].
United Nations Population Fund. (2014). C. Women’s Health and Safe Motherhood. In: Programme of Action of the International Conference on Population Development (20th anniversary edition). 8th. Health, Morbidity and Mortality. United Nations Population Fund Publications. p 86-90. DOI 10.18356/b30afeb1-en.
WHO. (2006). Reproductive Health Indicators. Guidelines for their Generation, Interpretation and Analysis for Global Monitoring. Reproductive Health and Research. WHO Publications.
WHO. (2015a). Chapter 4. Reproductive, Maternal, Newborn, Child, Adolescent Health and Undernutrition. In: Health in 2015: from MDGs, Millennium Development Goals to SDGs, Sustainable Development Goals. France: World Health Organization Publications, p71-98. DOI 10.1111/padr.12006.
WHO. (2015b). Trends in Maternal Mortality: 1990 to 2015: Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva, Switzerland: WHO Document Production Services. DOI 10.1111/padr.12033.
WHO. (2016a). Chapter 6. SDG Health and Health-related Targets. In: World Health Statistics 2016: Monitoring Health for the SDGs, Sustainable Development Goals. France: WHO Publications.
WHO. (2016b). WHO Recommendations on Antenatal Care for a Positive Pregnancy Experience. Luxembourg: WHO Publications.
WHO. (2017). World Health Statistics 2017: Monitoring Health for the SDGs, Sustainable Development Goals. France: WHO Publications.
WHO. (2018a). WHO Fact Sheet on Maternal Mortality. WHO Media Centre. Available from: https://www.who.int/news-room/fact-sheets/detail/maternal-mortality. [Last accessed on 2019 May 02].
WHO. (2018b). Fact Sheet on Family Planning/Contraception. WHO Media Centre. Available from: http://www.who.int/en/news-room/fact-sheets/detail/family-planning-contraception. [Last accessed on 2019 May 01].
WHO. (2018c). Global Health Observatory (GHO) Data: Maternal Mortality Country Profiles. World Health Organization. Available from: https://www.who.int/gho/maternal_health/countries/mmr.pdf?ua=1. [Last accessed on 2019 Jun 14].
WHO-Myanmar. (2014). WHO Country Cooperation Strategy. Myanmar (2014-2018). Myanmar, Yangon: World Health Organization, Country Office for Myanmar. DOI 10.1787/888932672422.
WHO-SEARO. (2016). Remarkable Progress, New Horizons and Renewed Commitment: Ending Preventable Maternal, Newborn and Child Deaths in South East Asia Region. India: World Health Organization, Regional Office for South East Asia. DOI 10.4103/2224-3151.213789.