Opportunities and challenges in SRHR
Myanmar has an unprecedented opportunity to accelerate access to comprehensive health services to women and girls, including information and services supporting sexual and reproductive health and rights (SRHR). Significant social, political, and technological transition has opened new doors to promote women’s rights, empowerment, and well-being in public discourse and policymaking.
Myanmar’s first-ever National Sexual and Reproductive Health and Rights Policy, to be launched later this year, advances a vision for all people in Myanmar to enjoy sexual and reproductive health and rights fully by expanding the coverage of services, promoting quality of care, and urging reform of laws, policies, and practices that impede access to essential health care.
Expanding access to these services is a critical element to improving the health and well-being of women and girls. Women’s ability to access high-quality health care, to be free from gender-based violence, and to make their own decisions about marriage and family is key to the country’s development.
Yet, challenges and obstacles remain in ensuring that sexual and reproductive health and rights services reach all vulnerable women and girls in Myanmar: for every 100,000 births, 227 women die in childbirth; 40 out of 1,000 infants die before reaching one year of age; and just over half of all married women use modern methods of contraception. In 2016, only 37 percent of births were delivered in a facility such as a hospital.
Among vulnerable populations in Myanmar—such as adolescents, migrants, people affected by conflict, and people with disabilities—knowledge of and access to services supporting sexual and reproductive health and rights remain problematic. Challenges include high rates of maternal mortality, unmet contraceptive needs, widespread gender-based violence, and illegal and unsafe abortions.
PATH’s role in developing policy and guidelines
PATH in Myanmar has been actively engaged to address these concerns over the past few years and is a trusted technical assistant partner of the Maternal and Reproductive Health Division of the Ministry of Health and Sports.
In 2018, PATH provided technical assistance to the government to develop the first-ever guidelines in the country on cervical cancer screening, which were launched and disseminated in December 2018. PATH also trained health care providers on low-tech methods of screening for cervical cancer through simple, proven treatment of precancerous lesions using cryotherapy.
Over the past two years, PATH also provided technical assistance to the Maternal and Reproductive Health Division to develop the new SRHR Policy. The policy was endorsed in late 2018 and is expected to be launched in May 2019.
The policy will benefit communities in Myanmar through strategic actions defined under six thematic areas: maternal, newborn, and child health; family planning; adolescents’ sexual and reproductive health and rights; gender and gender-based violence; special groups; and reproductive health morbidities.
Under the policy, all people in Myanmar, regardless of their sex, race, age, and ethnicity, will have access to sexual and reproductive health and rights-related services. The government will ensure service provision reaches special and marginalized groups, such as lesbian, gay, bisexual, transgender, queer, and intersex individuals; people living with HIV; people who inject drugs; migrants; the elderly; people with disabilities; and individuals affected by emergencies.
The policy also acknowledges the need to address legal barriers and advocate for reforming restrictive laws and policies related to sexual and reproductive health and rights—for example, to ensure improved access to family planning services, such as emergency contraceptive pills. The policy will also pursue community-based and innovative ways to reach women and girls with modern family planning and contraceptives in hard-to-reach areas and give access to the human papillomavirus vaccine for girls between 9 and 13 years old to prevent cervical cancer.
Translating policy into practice
Starting from this year, PATH’s new SRHR STRONG+ (Sexual and Reproductive Health and Rights Strengthening the Realization of National Guidelines, Policies, and Plans) project, funded by the Access to Health Fund, will translate this important document into practice. The project will help make the content of the policy accessible and comprehensible for decision-makers, health providers, and community members through policy briefs and dissemination events.
It will mobilize civil society organizations and community members to hold service providers accountable for rights-based services and elevate their voices in the national policy dialogue. PATH will engage diverse stakeholders to participate in the policy’s implementation. It will ensure that the voices of women, young people, the elderly, sexual minorities, people with disabilities, migrant populations, individuals affected by emergencies, and people living in conflict-affected areas are represented and actively present at Sexual and Reproductive Health and Rights Policy workshops, meetings, and forums.
Without efforts to implement and coordinate the policy, the potential of the SRHR Policy may go unrealized.
PATH and its partners will also support the national rollout of new guidelines, strategies, and policies. These include a plan for improved cervical cancer screening and to improve the delivery of newborns in institutions.
PATH will advocate for and support the process of legal reforms identified in the Sexual and Reproductive Health and Rights Policy, including prevention of violence against women and protection for survivors, by updating laws on abortion, promoting guidelines on adolescent access to sexual and reproductive health and rights, and addressing regulatory barriers that inhibit access to contraceptives.
PATH will also support the overall strategy on reproductive, maternal, newborn, child, and adolescent health and, in this role, influence the development of new strategies and policies in SRHR. Without such efforts to implement and coordinate the policy, the potential of the Sexual and Reproductive Health and Rights Policy may go unrealized.