Contraceptive Practice and Reproductive Health among Naga ... · Contraceptive Practice and...

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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

Transcript of Contraceptive Practice and Reproductive Health among Naga ... · Contraceptive Practice and...

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.

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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

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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

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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

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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

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FGD with rural women

IDI with a mother

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Ethical consideration

• Ethical clearance- DSMRC, IRB

• Informed consent

Results

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Rural area, 78%

Urban quarters,

22%

Figure 3. Urban and rural Distribution of the study

N= 302

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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

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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

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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

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[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

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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

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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)

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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)

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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

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“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)

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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

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“ 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

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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

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“နယာကကျားနလးန ေ ငယငယနလးန ေေ

နကျာငး ကရငး အမနထာငကျသေား ာရ ယ

၁၅နစ၊ ၁၆နစ နလာကဘ ယကက ာများ ယ။” (a woman, 30 years old, Lahe)

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“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

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“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

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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

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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]

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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

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• 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

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Discussion cont;

Limitations

• Language barrier

• Time limitation

• Budget

• Geographical

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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.

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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.

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Thank you

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