CEDAW-Related CEDAW-Related Implementations on HealthImplementations on Health

Dr. Nilar TinDr. Nilar Tin

Director (Planning)Director (Planning)

Department of HealthDepartment of Health

CEDAW-Related Implementations on HealthCEDAW-Related Implementations on Health

Article 12Article 12• It seeks to eliminate discrimination in the access to

healthcare for women

• and necessitates gender specific healthcare services such as those related to pregnancy and postnatal care.

• GRs that pertain to Article 12 are 14,15,19,24

General Recommendation 14General Recommendation 14•It recommends several measures It recommends several measures to eradicate female to eradicate female circumcisioncircumcision…. …. NOT APPLICABLE TO MYANMARNOT APPLICABLE TO MYANMAR

CEDAW CONVENTIONCEDAW CONVENTION

General Recommendation 15General Recommendation 15

• In view of the risk and effect of AIDS especially among women and children it recommends that AIDS-combat programmes that incorporate the rights and needs of women especially in relation to their reproductive role and subordinate position be adopted.

• The participation of women in healthcare and HIV infection prevention programmes is to be encouraged

Responsible for providing health care covering Responsible for providing health care covering promotive, preventive, curative and promotive, preventive, curative and rehabilitative services to the entire population rehabilitative services to the entire population in the country.in the country.

Health care activities are in line with National Health care activities are in line with National Health Plan 2006-2011 Health Plan 2006-2011

Under the guidance of the Government of the Under the guidance of the Government of the Union of Myanmar, MOH is working in Union of Myanmar, MOH is working in collaboration with--collaboration with-- Related Ministries Related Ministries UN Agencies UN Agencies Bilateral OrganizationsBilateral Organizations Non Governmental Organizations both Local and International Non Governmental Organizations both Local and International Other civil societiesOther civil societies

Ministry of Health Ministry of Health

MOH is contributing the health care activities MOH is contributing the health care activities along the following International commitments: along the following International commitments:

ICPD plus 10ICPD plus 10 Universal Declaration of Human RightsUniversal Declaration of Human Rights Child RightsChild Rights CEDAW CEDAW Beijing Platform of ActionBeijing Platform of Action MDG 2015MDG 2015 FCTC (Framework Convention on Tobacco FCTC (Framework Convention on Tobacco

Control)Control)

Nation’s commitment to Nation’s commitment to International International InstrumentsInstruments

HIV/AIDS-combat programs-NAP,DOH,MOHHIV/AIDS-combat programs-NAP,DOH,MOH • Number of people living with HIV/ AIDS in Myanmar

among the 15 to 49 years was 240,000 in 2009.

• HIV prevalence in Myanmar has reduced from 1.5% in 2000 to 0.61% in 2009.

• HIV in Myanmar has had its peak in 2000, and then leveling off.

• A total of 15,191 AIDS patients have been receiving ARV as of 2008

• 30,344 PLHA have received Opportunistic Infection drugs in the public and private sectors by the end of 2008.

• Under the TB/HIV program, 1070 TB-HIV patients have been receiving ART.

HIV/AIDS combat programsHIV/AIDS combat programs• Prevention of Mother to Child Transmission Program (PMCT) was

launched since 2000-2001 and has been implemented both in community- and facility-based settings in coordination and collaboration with UNICEF, UNFPA, WHO, local and INGOS and related sectors.

• Community based PMCT established in (185) townships and institutional based PMCT in (38) hospitals over the country.

• As of 2009, prevention from mother to child transmission has been conducted in (1,773) couple of mother and child by giving prophylactic ARV from NAP.

•

HIV/AIDS combat programsHIV/AIDS combat programs

HIV/AIDS combat programsHIV/AIDS combat programs• As of 2008, 11,072 males and 11,749 females to a total of

23451 had obtained home based care for PLHIV.

• Greater involvement of people with AIDS (GIPA) programs have been implemented through formation of PLHIV networks by NAP in coordination with UN Agencies and NGOs.

• PLHIV and other civil society members have actively participated in the National Strategic Plan development process and are well represented in the Country Coordinating Body for 3 Diseases Fund as well as in Technical and Strategy Group for AIDS.

HIV/AIDS combat programsHIV/AIDS combat programs• Providing a caring, protective and supportive environment for

PLHIV and their families is a key priority in Myanmar.

• Strategies include – involvement of PLHIV in project activities as peer workers such as

counselors, health educators and outreach workers

– enabling access to education, employment and social support, along with the engagement of community leaders to promote a positive behavior around HIV issues .

– NAP with support from WHO and in close collaboration with many NGOs is also implementing comprehensive and continuum of care for PLHIV by integrating prevention, clinical care and support services aiming for universal access to care.

Care and support for the persons infected and Care and support for the persons infected and affected with HIV and AIDSaffected with HIV and AIDS

CEDAW CONVENTIONCEDAW CONVENTION

General Recommendation 19General Recommendation 19a)It recognizes the violence against women in general puts their a)It recognizes the violence against women in general puts their health and life at risk. health and life at risk.

DOH Gender and Women’s Health project has worked upon DOH Gender and Women’s Health project has worked upon GBV during 2008-2009 bienniumGBV during 2008-2009 biennium

1. Gender sensitive disaster management trainings were given to 1. Gender sensitive disaster management trainings were given to Basic Health Staff from the disaster affected areas of Basic Health Staff from the disaster affected areas of Ayeyarwaddy Division, Yangon Division and Mon State. Ayeyarwaddy Division, Yangon Division and Mon State. •Participatory training with exercises on sharing of experience of Participatory training with exercises on sharing of experience of BHS from disaster struck areas followed by theoretical training. BHS from disaster struck areas followed by theoretical training.

CEDAW CONVENTIONCEDAW CONVENTION2. Survey on Gender Based Domestic Violence in two townships 2. Survey on Gender Based Domestic Violence in two townships in Myanmarin Myanmar

Total (265) married women (107) from Pyinmanar and (158) from Total (265) married women (107) from Pyinmanar and (158) from Hlegu, living in periurban or rural areas were interviewed. Hlegu, living in periurban or rural areas were interviewed. Data analysis near to final. Data analysis near to final.

Later dissemination of survey results and sensitization of G Later dissemination of survey results and sensitization of G sensitive policy and programmes to PM. sensitive policy and programmes to PM.

General Recommendation 19General Recommendation 19

b)Similarly, certain b)Similarly, certain traditional practices harmful to health of traditional practices harmful to health of women and children,women and children, for example, female circumcision, for example, female circumcision, dietary dietary restrictions on pregnant women and preference of the male child,restrictions on pregnant women and preference of the male child, must be addressed.must be addressed.

Antenatal care for Pregnant MothersAntenatal care for Pregnant Mothers

Includes nutrition promotion activitiesand heatheducation for AN mothers to takenutritious foods during pregnancy

Control of Control of Protein Energy Malnutrition (PEM) in childrenProtein Energy Malnutrition (PEM) in children

• Interventions : – Growth Monitoring and Promotion– Nutrition Rehabilitation

• Community Nutrition Centres• Hospital Nutrition Units• Village Food Banks

– Proper infant and young child feeding• Impact: Prevalence of under-weight decreased

from 38.6% in 1997 to 31.8% in 2003

Preference of male childPreference of male child• Myanmar culture also prefers male

child as the parents would have a

chance to let the son enter into

monkhood (Shin pyu) which happens

to be a huge ceremony, depending

upon the capacity of the family,

believed to be a great merit to the

family.

• Although this value has in most

people’s heart, if girls are born still there is no discrimination as girls are thought to be the ones who will look after the family.

(results from BHS trainings on Gender and Health)

CEDAW CONVENTIONCEDAW CONVENTIONGeneral Recommendation 19 c)It also seeks to prevent coercion of women with respect to

fertility and reproduction, and recommends fertility control to help avoid unsafe medical procedures.

• In Myanmar, birth spacing project -started since 1991, providing services thru’ community-based distribution system.

• The birth spacing projects were funded by different funding agencies FPIA, UNFPA and UNDP.

• It has been expanded in phase manner.

• Couple counseling and informed choices of both male and female contraceptive methods are the main activities in quality reproductive health care services.

• Previous-unwanted, unplanned pregnancy in married couples leading to unsafe abortion-complications-MMR;CPR 40%(2007)

CEDAW CONVENTIONCEDAW CONVENTIONGeneral Recommendation 24 • Unequal power relations based on gender and harmful

traditional practices like female genital mutilation, polygamy and marital rape make women more vulnerable to AIDS

• Therefore, states are called upon to ensure women’s right to sexual health information, education and services (including illegal women residents and those who have been trafficked with due regard to confidentiality)

CEDAW ConventionCEDAW Convention

• As a result of safe motherhood activities, maternal mortality ratio (MMR) has declined over the years from 580 per 100,000 live births in 1990 to 380 in 2005 (Revised 1990 estimation of maternal mortality 1996 WHO/UNICEF).

• With a paradigm shift from safe motherhood to Making Pregnancy Safer, Myanmar is striving to improve the health of mother through women's rights approach.

• Ensuring universal access to essential reproductive health care information and services by 2015 is of national health concern.

CEDAW ConventionCEDAW Convention

Strategic Plan for Reproductive Health (2009-2013)

• Behavior Change Communication Strategy for Reproductive Health-to adolescent girls and women to have information on – sexual health– promotion of birth spacing and preventing unwanted pregnancies– dangers of unsafe abortion– danger signs during pregnancy, childbirth and postpartum– preventing and use of services on reproductive morbidities including

STI/RTI/HIV and reproductive cancers

(RH/WCHD/Adolescent Health/Gender)

Body mapping exercise with girls

CEDAW ConventionCEDAW Convention• General Recommendation 24• It recognizes specific health care needs of women in

difficult situations such as those in armed conflict, prostitution or trafficking, and women with vulnerabilities like older women and women with disabilities. It also calls upon the states to ensure healthcare services that address the needs of these special groups of women.

• Elderly Health Care project- DOH MOH initiated since 1993 and covers (80) townships – Community based elderly health care– Opens clinics at different levels up to Rural Health Center– Medical check up, treatment and counseling – Encourage exercise– Encourage self help groups, recreation and local visits