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Abstract
<p><strong>PURPOSE: </strong>The purpose of our study was to explore and identify the reproductive health needs of women of reproductive age living in peri-urban Yangon, a dynamic series of townships on the periphery of Myanmar’s largest city. Specifically, we sought to identify the availability and accessibility of reproductive health services and products, as well as potential avenues for improving the delivery and accessibility of services. Our overall study focused on maternal health, delivery care, contraception, abortion and post-abortion care. In this paper we focus specifically on the dynamics shaping access to reproductive health services.<strong><em></em></strong></p><p><strong>PRINCIPAL RESULTS:<em> </em></strong>Our findings suggest that barriers to access specific to both urban and rural settings converge in peri-urban Yangon and create significant challenges for service delivery organizations to reach this population, and for this population to reach health care facilities. While contraceptives are relatively affordable and accessible, non-evidence based fears of side effects, including significant and noticeable weight gain, illness, organ damage and infertility, hinder consistent use among peri-urban women. Finally, our findings suggest that unmarried women and young women are largely excluded from reproductive health care and services, and face considerable barriers to access, including discrimination from providers.</p><p><strong>MAJOR CONCLUSIONS:<em> </em></strong>Our findings illustrate that despite an overarching availability of reproductive health services in peri-urban Yangon, a variety of geographic, socio-economic, information and socio-cultural barriers to access persist and there remains a dearth of services tailored to young and unmarried women. The peri-urban population requires a unique and tailored service delivery approach.</p>
Highlights
The country of Myanmar is experiencing a period of considerable growth and change
In this paper we focus on the dynamics shaping access to reproductive health services
Principal Results: Our findings suggest that barriers to access specific to both urban and rural settings converge in peri-urban Yangon and create significant challenges for service delivery organizations to reach this population, and for this population to reach health care facilities
Summary
Long ruled by a military dictatorship, Myanmar was isolated from much of the world until the 2010 elections installed a nominally-civilian elected government. The military remains powerful and the country’s long history of violence, forced labor, displacement and imprisonment is recent, continues to affect population health, and remains ongoing in parts of the country (Sietstra, 2012; Mullany et al, 2008). National spending on health has increased substantially in recent years, health outcomes across the country are varied and in many regions remain poor. Life expectancy is the lowest among the members of the Association of Southeast Asian Nations (ASEAN), and there are significant regional disparities in health indicators, including immunization coverage, and infant, maternal and child health (World Bank Group, 2014; IHLCA, 2011)
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