Investing Management in Men’s Reproductive Health

For

Improving Women’s Health and Economic Development

In partial fulfillment in the Course

DM 224 (Public Affair Management)

Submitted to Prof. Aser B. JAVIER, IDMG, CPAf

Submitted by:

Hla Myat Tun

2009-2010 First Semester

2008-96531
I. INTRODUCTION

Myanmar is one of the United Nations member countries and the government has

committed to achieve the objective of Millennium Development Goals (MDGs) by 2015.

The MDGs were set by United Nations International Conference on Population and

Development (ICPD) in 1994. To meet the targeted goals of MDGs, human resources

must be considered as the key for all sectors. All of the citizens should have accessibility

of health information and services to be healthy and serve the country. If people in the

county are in poor health conditions, they might not participate in country’s development

programmes. In Myanmar, like other developing countries, reproductive illnesses are a

major threat to the health of adults, many of whom are in the early years of their working

lives. Reproductive health illness undermine economic development by weakening and

killing adults in the prime time of their working lives, by disrupting and cutting short the

lives of their children, and by placing heavy financial and social burdens on families. In

most developing-country settings, much of the loss of life and human productivity that is

due to poor reproductive health which could be prevented with affordable and cost-

effective programs. Men workforce is playing as the important role in various

development and economic sectors but men were unconsciously ignored in health sector.

The government has not addressed and provided the specific needs for men yet.

Maternal Mortality Ratio (MMR) shows the health status of the countries. Reproductive

health policy was formulated in 2002 and approved by Ministry of Health in 2003 to

improve health status by giving focus attention on the improvement of reproductive

health status and reducing MMR is one of the MDGs which need to be paid more

attention to achieve the targeted goal by 2015. Women health can not be improved as

well as MMR can not be reduced without effective men’s participation. Thus, in the

health sector, men’s reproductive health needs have to be considered in prior in 6 years

ahead.

Total population of Myanmar in 56.4 millions and participation of male labor force (15

years and above) is 16.29 million (80.05 % of total labour force) in 2004.1 Thus,

development programmes will more efficient by giving attention in men’s health. The

management for men’s need for reproductive health in the health sector is becoming the

important portion for the government. The health sector has to provide information and

services tailored to men according to their specific needs. The Reproductive Health (RH)

needs for men can be considered as three stages in men’ sexual and reproductive lives:

Men (as well as youth) 15-24 who becoming independent and initiating sexual

relationship, Men 25-39 who marrying, becoming fathers and starting family life, and

Men 40-60 who approaching the end of fathering and completing family building.

Understanding men’s health as a key component of public well-being and community

vitality will focus our attention on unmet needs that are weakening the social structural

fabric in distressed neighborhoods. Sexually Transmitted Infections (STIs), including

HIV/AIDS, and unplanned pregnancies because of lack of information and services for

birth spacing can devastate the lives of both men and women, and have negative

1
Human Resources Development Indicators 2005, United Nations Population Fund (UNFPA) and
Department of Labor, Union of Myanmar
consequences for families and communities. Addressing the sexual and reproductive

behaviors and health of men creates a win-win situation: The more informed and more

effective men become in living safer sexual and reproductive lives, the better it will be

for them and for their partners, children, community and also for the development of the

country.

This study aim to provide policymakers, health care providers and educators with the

basic information needed to design and implement infrastructure and programmes for

information and services that will improve the sexual and reproductive health conditions

of men who are the most important actors for country economic development.

II. PROBLEM STATEMENT

In Myanmar, abortion is illegal but the rate of occurrence of this practice is significant.

This tends to be the leading cause of maternal mortality because of unintended

pregnancies. At least 50 percent of maternal death and 20% of all hospital admission

have resulted from complication of unsafe abortion. Unsafe abortion rate is high because

of unwanted and unintended pregnancies among unmarried populations as well as

married population due to the lack of access to contraceptive methods and the insufficient

male support in contraceptive use are the major factors of increasing abortion rate across

the country2. The use of illegal and unsafe abortion methods are in large part of the result

of unmet contraceptive need among women and lack of men responsibility in

contraceptive use. As the result, Maternal Mortality Rate (MMR) is significantly high

2
Fertility and Reproductive Health Survey (FRHS), 2001. Preliminary Report, Ministry of Immigration and
Population, Yangon 2003
that must be reduced if not totally eliminated. It is estimated that one in three deaths

related to pregnancy and childbirth could be avoided if all the people in community had

access to contraceptive services. MMR can be reduced by men’s taking responsibility

among married and unmarried couples. The unmet need for contraception is estimated at

16.8 per cent among married population3 because of inaccessibility of contraceptive

methods to women. Men can be the solution for that issue in order to take part in

women’s health and reduce MMR. The MMR was 361 per 100,000 live births in 2005. 4

The government set a target of 56 per 1000 live births on MMR by 2015 based on 2001

data. One study found that the smaller the health institution in an area, the higher the

abortion rate in the surrounding area due to lack of access to contraceptive methods. The

Fertility and Reproductive Health Survey (FRHS) 2001 found out that 20% of women did

not want to get pregnant but were not using contraceptives. And thus at risk of pregnancy

14% of them wanted to limit their births. These suggest the lack of short-term and

acceptable long-term methods of contraception among married population should be

considered as an urgent agenda in the government health sector. To reduce MMR within

6 years is challenging task.

III. MEN’S IMPORTANT ROLE IN MATERNAL MORTALITY

Both men and women make important contributions and co-equal responsibility in

reproductive health. However, birth spacing programmes have been tended to focus on

women alone in the country. Men participation in birth spacing has been neglected even

3
Nationwide Cause Specific Maternal Mortality Survey 2004-2005
4
Fertility and Reproductive Health Survey (FRHS), 2001. Preliminary Report, Ministry of Immigration and
Population, Yangon 2003
though birth spacing methods have been available in public sector since 1991 and male

involvement programmes in reproductive health have been initiated since 2004. Men are

not conscious of their shared in responsibility on women’s health and contraceptive use.

The general perception and knowledge among men on the need for reproductive health is

primarily for the prevention of HIV/AIDS and Sexually Transmitted Infections (STIs).

Very low appreciations on the use of condom for birth spacing purpose and men are

unconsciously ignored and being unconsciously unequalled for birth spacing.

Nevertheless, there is high demand on contraceptive services for married population as

well as unmarried population. Limited access and information on birth spacing services

to women and men lead to increase the risk of unsafe abortion and maternal death. Thus,

male has a significant role in saving women’s life by taking responsibility in

contraception.

III. 1. Men 15-24: Becoming Independent and Initiating Sexual Relationship

5
The population of men in this age group (15-24) is 9.1% of the total population. Men

age range 15-24, as well as youth, can be called as future leaders of the country and they

need special focus for their well-being and also it is the most important time to equip

them with full of knowledge on reproductive health for their well-being and the future

world. Most of them are still in school, very few are married or have became fathers,

acquiring job-related training and work experience, and most still live with their family.

Youth can be divided into in-school youth and out-school youth. Most youth probably

learn about sex from their friends and on the street, rather than from parents or at school.

The government believes that when the youth were provided comprehensive sex

5
Human Resources Development Indicators 2005, United Nations Population Fund (UNFPA) and
Department of Labor, Union of Myanmar
education and early enough, the young people will have healthy sexual life. Thus, sex

education including HIV/AIDS protection has been a part of the school curriculum for a

few years and given by teachers in middle schools and high schools. The teachers were

trained for several days on sex education during summer and holidays. The problem is

almost all of the teachers in the schools are female and there are barriers between male

youth and female teachers. In Myanmar culture, male students can not discuss with their

female teachers. Myanmar is a conservative country and discussing about sex in public is

reluctant, therefore, male youth were being ignored and unequalled in the class sex

education sessions.

For the out-school youth, there are several youth sex education including HIV/AIDS

protection programmes jointly implemented by Ministry of Health, United Nations

agencies, International Non-Government Organizations and Local Non-Government

Organization, for disseminating information on reproductive health. The problem is out-

school youth are hard to organize in the community. In the health infrastructure, there are

no specific places as youth friendly places specifically for male to get health information

for instance, HIV/AIDS, STIs, and consultation for their sexual and reproductive health

problems including contraceptive needs.

Condoms using among educated youth is more frequent for protection of HIV/AIDS and

STIs but not as contraceptive method. Condoms are not easily available and accessible in

many parts of the country. Less-educated youth are not aware of condoms and they can

pregnant their partner before marriage. As a result, the induce abortion rate which is the

consequence of unintended pregnancies among unmarried population has increased and it

tends to be the major cause of maternal deaths in the country. The information and
services including accessibility of condoms for youth is critical for reducing maternal

death by 2015.

III.2. Men 25-39: Marrying, Becoming Fathers and Starting Family Life

Men in this age group are 11.4% of the total population in the country. Most of the men

in the age range (25-39) are working and are playing as important actors in economic

development of the country. By that time, most of the men 25-39 in Myanmar have

already entered marriage but few are still living with their parents as singles. The

contraceptive needs for the men in the category are more on short-term contraception for

their family planning. The government provides birth spacing services for married

population in health centers since 1991 but contraceptive methods are only available for

women. Myanmar’s Reproductive Health Policy was formulated in 2002 and approved

by the Ministry of Health in 2003 but there is no specific policy to improve men’s

reproductive health. As shown in Figure 1, married population largely depend on female

contraceptive methods and the condom use among couples is really low even though

condom promotion programmes are strongly implemented in the country. The reason is

that the condoms programmes are more likely promoted as HIV/AIDS prevention

method, therefore, men are more likely to use condoms with sex workers than with their

wives. As a consequence, condoms are not highly accepted among married population.

Condom usage is only 0.3% and is not common method among married population for

contraception and that is one of the factors contributing high MMR.

 Condom
63 Male Sterilization
Injections
1.2 Pills
Female Sterilization
1.8 Any traditiional methods
4.2 IUD
0.3
8.6 Other modern methods
4.6 14.8 1.5 Not using any methods

Source: Family and Reproductive Health Survey 2001, Department of Population,

Ministry of Immigration and Population
Figure 1. Contraceptive methods used by married population in Myanmar

Most of the men lack knowledge on sharing responsibility in family planning and

generally believe to assume less responsibility. They need knowledge on contraceptive to

discuss family planning with their partner and need skills to share responsibility with

their partners. According to surveys, men seek care pharmacists and providers of

traditional health care who have had no formal training because these resources are

affordable and less judgmental. Men also lack men friendly services for their

reproductive health needs such as STIs treatment, HIV/AIDS testing and especially

contraception. Unmet need for contraceptive affects men’s health, women’s health, the

family health and finally tends to the leading cause of high MMR. Also the inefficiency

in men’s health tends to decrease men’s ability in their work and finally affects the

country economic development.

III.3. Men 40-60: Approaching the end of fathering and completing family building.

Men in this category, 9% of the total population in country, are still working as the main

actors and are participating in country economic development. The majority of men in

their 40s and early 50s are married and they still have sexually active life meaning they

still can give pregnancy to their wives. They generally have come to the end of their

family building years and the need for them is different from other stages. As they have

already finished their family building, they need permanent contraception either for

themselves or their partner. They need information and services on permanent

contraception female sterilization and male sterilization. The percentage of female

sterilization is 4.6% and male sterilization is 1.5% (Figure.1). The contraception are

largely rely on female methods because older men may be less well informed than

younger men about the availability of permanent contraceptive methods, and older men

may hold more traditional cultural norms and myths that oppose to the sterilizations.

Male sterilization is illegal in the country but the use of male sterilization methods is

higher than condom among married population. Male sterilization is restricted by law to

those men whose wives have been approved but are unable to undergo sterilization for

medical reasons. Thus, men has the policy barrier to undergo voluntary sterilization even

though they realize that they have a significant role in saving women’s life by taking

responsibility in birth spacing among married population and to improve women health.

Men are poorly informed sexuality and reproduction and need information about male

and female contraception. They also need the confidence and guidance on how to share

decisions and negotiate choices with their partners for taking responsibility as part of

reducing MMR. On the other hand, the high-level decision makers have not considered
yet the access of male birth spacing activities in existing policies And also political

commitment and clinical services are needed to be addressed to provide voluntary male

sterilization with the aim of reducing maternal death by 2015. Lack of commitment for

men’s contraceptive health needs contributes to increase maternal death across the

country.

IV. MEN’S REPRODUCTIVE HEALTH MANAGEMENT

Managing of the men’s reproductive health programmes, men’s reproductive health

behavior and men’s responsibilities in contraception can contribute to decrease maternal

death and to meet the targeted goal by 2015. This is the time for the government in health

sector to consider supporting men’s effective participation for reducing MMR by

providing policies, programmes and infrastructure in the public health sector. By

investing in health for men (15-60) which is 29.5% of total population, they can more

effectively contribute in several sectors such as improving women’s health, reducing

abortion and MMR, improving family and community health as well as improving

economic status of the country. Therefore, investing and managing men’s health have

multi benefits for the country.

IV.1. Providing needs for Men 15-24 (Youth): Investment for Future

Educating youth is the most effective investment for the future. By investing in male

youth RH needs, the unwanted pregnancy rate, the maternal mortality rate and HIV/AIDS

prevalence rate among youth will decrease in the country. The Ministry of Health has to

provide tailored programmes collaborating with Ministry of Education, UN agencies,

INGOs and LNGOs for effective sex education programmes for in-school youth. The sex

education programmes for male should be paid more focus attention by providing male

friendly discussion session, for instance, providing male educators for male youth. The

Ministry of Health is implementing many sexual and reproductive health programmes

together with many UN agencies, INGOs and LNGOs. There are many trained youth

educators, peer educators and skilled trainers on RH. They can effectively disseminate

RH information to in-schools youth (male and female) rather than female school teachers.

For the out-school youth, the Ministry of Health has to increase collaboration with UN

agencies and INGOs and LNGOs for out reach sex education activities including

contraceptive methods. On the other hand, youth friendly space specifically men friendly

spaces in health setting in every level has to be provided for the RH services. Information

about sexuality, especially for young men, is the availability of good, clear, non-

judgmental information on a wide range of subjects; including the physiology of

reproduction, health sexual relationship, skills to communicate with partners on sexual

reproductive matters, protection against STIs, contraception, condom use and abortion.

There should be a particular place for male in every hospital and rural health centers

where they can get information and services including readily and cheaply available

condom supplies for their safe and healthy sexual life which affects their future families
as well as reducing abortion rate. As mentioned above, youth learn about sex from their

friends, so the safe environment for youth plays as a key factor. Youth have to be

surrounded by full of right information resources as early enough to provide and equip

knowledge to live healthy sexual lives and avoid preventive maternal deaths due to

insufficient contraceptive use for women. Male youth can be effectively involved in

reducing abortion by letting know their role and responsibility in the public health sector

and providing supportive environment for their taking responsibilities. Finally, induce

abortion rate, maternal death rate as the consequences of unwanted abortion among youth

and the prevalence of HIV/AIDS including STIs will be decreased in the country.

IV.2. Providing need for Men 25-39: Investing in Men for Family Health

Knowledge for sharing responsibilities is necessary in building families. Building a

family is partnering as well as decision making for having children between couples.

Providing information and services for contraceptive methods to men and providing skills

to share responsibility in family planning tend to increase maternal and family health as

well as family economic status. By providing men friendly corner in every level of health

centers, the necessary skills, information and services for married men also can be

disseminated. Men in this category need to know how to prevent unwanted pregnancies

by using condoms effectively or by reaching an agreement with their partner about the

use of an effective short-term or long-term contraceptive method. For men to be able to

talk to their partner about contraception, they need communication skills, as well as

information about the dangers and health problems that some women experience in

pregnancy and childbirth - information that will better prepare men to support their
partners. And men need and want knowledge and life skills that will help them become

fathers. Adult men, too, often need basic sexual and reproductive health information, as

well as a more specific understanding of their bodies, so that, they can discuss and pass

the knowledge to their children specifically to their sons. For the services, men’s corner

should also provide the effective testing for STIs including HIV/AIDS and treatment with

respectful and less judgmental doctor and health care workers.

IV.3. Men 40-60: Investing in Men’s Decision on Contraception

The government has to commit address men’s permanent contraceptive need since most

of the men 40-60 have married and completing having children. The government should

allow and legalize voluntary male contraception because of the survey result shown in

Figure.1, the use of male sterilization 1.5% is higher than use of condom 0.3% among

married population. Male sterilization programmes should be implemented the purpose of

reducing unwanted pregnancies, unsafe abortion and maternal death. Many studies found

out that in other countries, male sterilization has many favorable reasons compare than

female sterilization and effectively contribute to improve women and family health

finally economic development of the families. Restriction on male sterilization can

attribute to many factors: the greater motivation among women than among men to avoid

unwanted pregnancy because it is women who get pregnant; the belief held by some men

that sterilization leads to a loss of virility; the lack of public information about the simple

surgical technology now available; and the reluctance of national family planning

programmes to establish male sterilization services and to publicize them adequately.

V. CONCLUSION RECOMMENDATION

Investing in men’s health programmes is growing, and there is increasing evidence that

such programmes can be effective in improving male and female reproductive health,

family health, well-being and economic status of families. Male-involvement elements

are needed in reproductive health programmes in all stages of development--from the

early stages in which community and political support is critical to later stages that focus

on expanding and improving services. For providing men’s needs, services should be

accessible and projects must be carefully tailored to meet the special needs of young men,

adult men, poor men and minority men. Additionally, male-oriented programs should

consider the broader needs of boys and men for education and should help sexuality in

the context of the larger social, cultural and economic conditions that shape their

behavior. For filling the gaps of men’s needs for reproductive health specifically on

contraception, more researches are need to be done in country for effective programmes

design and implementation according to culture, beliefs, norms and ethnical standards of

the specific groups of men. Finally, investing in men’s health promises gains in health for

all and these 16.29 million of healthy men labor force can effectively bring the country to

high success in economic status.

VI. REFERENCES

1. Myanmar Reproductive Health Policy, Maternal and Child Health Department,

Ministry of Health, the Government of the Union of Myanmar
2. Myanmar Fertility and Reproductive Health Survey, 2001, Preliminary Report,
Ministry of Immigration and Population, Yangon, Myanmar 2003
3. World Health Organization South-East Asia Regional Office (WHO/SEARO)
2004. Family Planning Fact Sheet: Myanmar and Birth Spacing: An Overview
4. Nationwide Cause Specific Maternal Mortality Survey 2004-2005
5. Statistical Year Book 2006, Central Statistical Organization, Ministry Of National
planning and Economic Development, The Government of the Union of Myanmar
6. Javier, Aser B. 2002. Public Entrepreneurship as a Local Governance Strategy in
Decentralizing Polity, p. 17-24
7. Metcalfe, Les. 1994. Public Management: from Imitation to Innovation in
Koomin, Ja. 1994. Modern Governance, New Government-Society Interaction.
Sage Publication: p-174
8. Pinto, Rogerio F. 1998. “Innovations in the Provision of Public Goods and
Services.” Public Administration and Government. 18, p.387-397
9. In Their Own Right, Addressing the Sexual and Reproductive Health Needs of
Men World Wide, The Alan Guttmacher Institute 2003
10. Male Involvement in Reproductive Health, Including Family Planning and Sexual
Health, UNFPA Technical Report, No. 28
11. How Reproductive Health Services Work To Reduce Poverty, Fact Sheet, Series
14, Population Action International
12. Contraception: An Investment in Lives, Health and Development, 2008 Series,
No.5. United Nations Population Fund
13. Men: Key Partners in Reproductive Health, Bryant Robey, Elizabeth Thomas,
Soulimane Baro, Sidki Kone, and Guy Kpakpo 1998
14. Absent and Problematic Men: Demographic Accounts of Male Reproductive
Roles, Margaret E. Greene & Ann E. Biddlecom, 1997 No. 103, Population
Council