International Women's Day

AS the world marked International Women’s Day on March 9, issues involving reproductive and maternal health and the struggle for recovery faced by women in the cyclone-devastated Ayeyarwady Division were highlighted by NGOs and UN agencies working with women in Myanmar.

“If a woman in our village needs to go to town because the birth is going to be difficult, the fund pays for the transport to Labutta,” said Ye Ye Win, the leader of Nyaun Done, a village five hours from Labutta town. “It will also help pay for the doctor. Like insurance.”

The idea for the fund was born a few years ago during a discussion at a women’s self-reliance group (SRG) established by the United Nations Development Program.

Like most good ideas, funds such as the one instigated in Nyaun Done have a simple premise: A healthy community is good for everyone. If everyone decides that the health of mothers is in their interest, then a community is a few steps away from setting up a communal fund to cover the cost of healthcare for women at risk.

“They are taught how to do bookkeeping and how to start a small enterprise, and then with that money that they save and a small contribution from us, they use that to improve their life,” said Mr Bishow Parajuli, the UN resident coordinator for Myanmar.

“Some of them have weaving factories, some of them are pig rearing and tomato farming, others have rented a boat and use it commercially. It is about the value of managing their own life, about general awareness and leadership qualities. This is the future generation. Membership of the SRG is a means of changing lives for a better tomorrow.”

“The foundation of the group is women’s discussions and decisions about the direction of their own development,” said Mr Parajuli.

UNDP no longer works in Nyaun Done. Cyclone Nargis killed 859 women from the 741 self-reliance groups that functioned in the delta before Nargis; it ruptured the families and livelihoods of the remaining 9557 members and destroyed 70 percent of the communal funds of the groups, totalling US$1.24 million.

In Nyaun Done, however, the community persisted with the idea of a fund for healthcare emergencies.

“It’s our fund,” said Daw Myaing Myaing, a 40-year-old mother of four.

“UNDP helped at the beginning with training and we all discussed and decided that we wanted to buy medicine and sell them in the village, so that we would have medicine, but also the profits could go into birth-care,” she said.

It is important to recognise not just that more women than men were killed in the cyclone but also the specific needs of women in recovering from a disaster, said Ms Elizabeth Pender, a gender specialist for the United Nations Population Fund (UNFPA).

“Directly, women were impacted differently by Nargis,” she said.

“Socially, men are in positions where they can leave their children with their wives or daughters, will get preference for daily labour and do not have to worry about things like their physical safety so they can leave the village to access work that is unavailable to women,” said Ms Pender.

In the coming year UNDP is seeking US$2.25 million to restore the lost savings of the cyclone-affected SRGs and to form a further 1000 in the Ayeyarwady delta. So far 675 groups have been formed since last May, but only $500,000 has been committed by donors.

Supporting the specific needs of women in the delta was not the only way organisations marked International Women’s Day.

Daw Pansy Tun Thein, the assistant country representative for UNFPA, said maternal health is a top priority for achieving the goal of equality and justice for women, which UN Secretary General Ban Ki-moon described in a March 8 press release as including “economic and social policies that support women’s empowerment”.

“In this case you are saving two lives, not just one,” said Daw Pansy Tun Thein ahead of International Women’s Day.

UNFPA estimates that 3800 women die in pregnancy and childbirth in Myanmar each year and that 87 percent of maternal deaths occur in rural areas. Eighty-eight percent of the women who die in child birth are likely to do so at home, before they have time to reach a health professional.

It was to address this issue that UNFPA, in association with the Myanmar Medical Association, established three maternity waiting homes in Dedaye, Bogale and Labutta last year, said Daw Pansy Tun Thein. UNFPA has also organised 24 mobile medical clinics to visit women in their communities and provide support during their pregnancies and general healthcare.

“High-risk mothers have to be referred to the hospital – the closer you are to the hospital the higher the chance you’ll reach the hospital in time to receive medical care and survive,” said Daw Pansy Tun Thein. So far, 77 women have used the three facilities.

“Compared to my experience in other countries this is a very high number, very fast and shows there is a real need,” said Dr Stenly Sajow, the humanitarian response specialist at UNFPA.

Daw Pansy Tun Thein praised the government health infrastructure at city, township and rural levels and said she hoped UNFPA could work with these facilities to improve the care offered to pregnant women.

“The existing health structure is quite good,” she said. “If we can just strengthen these and provide all the materials and resources it will be good. There are still gaps because of funding requirements, remoteness of some of these areas and cultural beliefs [in the rural areas].”

Midwives are a key component for enhancing maternal health and the training of these women is an essential feature of UNFPA’s program. In rural areas midwives are often overworked as they try to address the needs of 10 to 15 villages each.

“Now the Ministry of Health has recruited many midwives,” said Dr Thwe Thwe Win, the national program officer for UNFPA. “But they are multi-purpose, so they cannot spend much time on antenatal care because their priority is universal health immunisation. They spend a lot of time – one week per month doing immunisation – going around all the villages. This is the main task now.”

“Comparatively, maternal and infant mortality is very high [in Myanmar],” said Dr Thwe Thwe Win, the national program officer for the UNFPA, adding that the mortality rate for infants under five is 103 per 1000 live births.

The government has pledged to meet the UN’s Millennium Development Goal of cutting this to 43 per 1000 by 2015.