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The 1997 Fertility and Reproductive Health Survey (FRHS) is a nationally representative survey conducted by the Department of Population during
March to May 1997.

It is a component of the project entitled “Strengthening of Birth Spacing Programme” funded by UNFPA and is the second most comprehensive effort
to secure accurate and detailed demographic and health related information
on the Union of Myanmar since the 1991 Population Changes and Fertility
Survey (PCFS).

It is also designed to provide information on reproductive health, maternal mortality and knowledge on STDs and AIDS which was not previously available at the national level.

UNFPA Country Support Team from Bangkok, UNFPA Chief Technical Advisor
for the Strengthening of Birth Spacing Programme and the National Technical Advisor for the Department of Population gave technical assistance throughout the survey period – from the preparation of the survey questionnaires to the finalization of the current report. Assistance was also sought from an international sampling specialist on the sample design.

A total of 21742 households and 16042 eligible women (ever-married women
15 to 49) were interviewed. A preliminary report was released in October 1998.
In this report, findings from the survey are presented at some detail at the national level as well as by urban-rural residence.

Although the sample design is not meant for producing results at sub-national level besides urban and rural, some of the findings are presented at state/division (or domain) level so as to fill the gap for the much needed demographic and reproductive health related data. However users should
take note of this fact when using the data at the sub-national level.

As to the representativeness of the survey, the areas excluded from the sample frame constitute less than 1 percent of the country’s population;
about 96 percent of the households selected in the sample were successfully interviewed and the response rate was also very good (93 percent) for the interviews with the eligible women. It is also found that the age-sex distribution from the survey resembles closely to that of the official population estimate and it is also identical with the United Nations’ Population estimate of medium variant projection revised in 1998.

The age structure of the sample population reveals that the proportion of population in age group 0-4 years is less than that in age group 5-9 which is again less than the proportion in age group 10-14 indicating fertility decline
has set in. Fertility decline seems to have started earlier in urban than in rural areas.

Concerning headship, female headed households are about 18 percent. Among single-member households, female heads are nearly twice as many (65 percent) as male heads (35 percent) and it holds true in both urban and rural. On the average, female headed households are smaller than male headed households by about one member, both in rural and urban areas.

Total lack of schooling among the sample population is about 30 percent; it is higher in rural than urban. ‘No schooling’ category has been decreasing continuously for both males and females. Among ever-married females, about 25 percent have no schooling, 50 percent have primary level and 25 percent above primary level of education. Among husbands, 23 percent have no schooling, 37 percent have primary level and 40 percent above primary level.

The nuptiality pattern in Myanmar has been changing, the proportion never married has increased over the years at all ages for both sexes. The singulate mean age at marriage has increased for both males and females: from 23.8 years in 1973 to 27.6 in 1997 for males and 21.2 years in 1973 to 26.0 years in 1997 for females.

Proportion never married among females is as high as 15 percent in age group 40-44 and 12 percent in 45-49. Among those who marry, the mean age at (first) marriage has remained constant for both sexes over the past several decades; the 1997 figure being 23.3 years for male and 20 years for females. In Myanmar, the proportion of wives with same age or higher age than husbands is significant (27 percent). While age at (first) marriage has not changed, the extent of non-marriage has increased significantly.

Marriage transition in Myanmar has varied and far reaching implications for education, employment and particularly fertility. Nearly half of the decline in fertility in Myanmar seems to be accounted for by marriage-transition, the other half by contraception including abortion.

The total fertility rate for Myanmar estimated from FRHS is in the range of 2.7 to 2.9. Regional variation in fertility exists - the highest is observed in Rakhine State and the lowest in Yangon Division. The difference between urban and rural fertility (1.8 versus 3.1) is substantial.

It is also found that fertility is inversely related with level of education. Mean age at first birth is 21 years and there is very little variation among age cohorts. First birth also follows soon after marriage. Nearly one-third of ever-married women have their first birth in their teens. Pregnancy wastage due to abortion accounts for nearly 6 percent, stillbirth accounts for about 4 percent and about 90 percent of all pregnancies result in live births.

The inter live births interval is 37 months on the average. The extent of teenage reproduction has been declining in Myanmar. Contribution of women 15-19 to overall fertility is only about 3 percent and this decline seems to be due to postponement of marriage rather than postponement of first birth.

Knowledge of contraceptive methods and sources is virtually universal (over 90 percent). Among knowledge of sources, 56 percent mentioned private sources and 40 percent mentioned government sources.

For both ever-use and current-use, injectables are most popular followed
by pills. Contraceptive prevalence rate reached about 32.7 percent for all methods and 28.5 percent for modern methods. The CPR has increased from 16.8 percent in 1991. Method mix is undergoing change in favour of injectables- the most popular was pills in 1991.

Condom use is still negligible. Interestingly, a fifth of the women with no children are currently using a method, probably part of it is due to the newly married couples using contraception for spacing the first child. Among the current users of modern methods, private sources are more common (57 percent) than government sources (41 percent).

There is no organized opposition to contraception. More than 50 percent of
the married women and 45 percent of the husbands approve contraception
and hardly any method-related problems are mentioned. However, the results indicate that a large unmet need does exist.

In Myanmar, about 46 percent of currently married women want no more children, additional 8 percent are already sterilized and another 6 percent
are believed to be infecund, thus a total of 60 percent are limiters. In the remaining 40 percent, nearly half want their next child only after 2 years (spacers).

It is also striking that 17 percent of teenagers and 11 percent of those with
no children expressed desire to have no children. In Myanmar, very few women past age 35 or past 3 living children want to have any more children. Mean ideal size of 3.6 is only slightly larger than mean actual CEB of 3.3.The vast majority are fairly decided on the number of children they would like to have.

With regard to the antenatal care (ANC), among the last 4 pregnancies during the 5 years preceding the survey, 84 percent received ANC and the nurse/midwife seems to be the main provider of ANC (64 percent). The proportion who receive ANC is higher in urban than rural and is also higher among better-educated women. There exist regional variations and Rakhine State stands out as the region having the lowest proportion of women having ANC. Mean number of ANC visits is 5. Further it is gratifying to note most of ANC is in the hands of better-qualified personnel.

More than three-quarters of pregnant women receive at least one dose of Tetanus Toxoid Injection (TTI). The proportion receiving TTI is higher in urban than in rural and also higher among better-educated women. Regional variations do exist with Rakhine State having the lowest proportion receiving TTI.

Attendance at delivery was obtained on the last two live births. About 45 percent are attended by nurses and 38 percent by traditional birth attendants (TBA). Those attended by doctors come to 11 percent. Incidentally ANC by doctors is also 11 percent, which implies doctors may have attended the deliveries of pregnancies to which they have given ANC. Skill pattern in attendance at delivery changed for the better between 1991 and 1997 – increase in care by doctors and nurse/midwife and decrease in care by TBA.

Three-quarters of (last two) children under five were immunized for BCG, Polio, DPT and Measles with Polio having the highest coverage of 85 percent and BCG 83 percent. About 14 percent of the children had none of these immunizations. Immunization levels of 12-23 month olds are even better. Also immunization level is better in urban than rural and better for better-educated women.

Among children under 5 years of age prevalence of diarrhea during the past 24 hours was 3.8 percent and during the past 2 weeks, it was 8.5 percent. Mean duration of diarrhea was 4 days. About 37 percent of the children under 5 suffering from diarrhea were taken to health facility, 30 percent were given
self treatment and 28 percent were not given any treatment. Substantial differences exist in total absence of care with 42 percent in Rakhine State compared to 16 percent in Yangon. These regional differences reflect a combination of care availability and care-seeking behaviour.

In Myanmar breastfeeding is not only universal but of relatively long duration. Nearly 94 percent among last births which occurred during the five years preceding the survey were breastfed. No significant difference was found between urban and rural, younger and older women, better and less educated and also among regions. Mean duration of breastfeeding is about 19 months. Accordingly the mean duration of postpartum amenorrhea is found to be 10 months and no significant variation among subgroups of population is found.

The estimated infant mortality rate during the five year period prior to the 1997 FRHS is 75 per thousand live births. Infant mortality is sharply lower in urban areas than in rural areas. There are regional variations in infant as well as child mortality. Under-five mortality is lowest in Yangon and the highest in Rakhine and Chin/Sagaing. The association of lower mortality with higher level of mother’s education is quite prominent.

Mothers with better education are likely to have better access to health care facilities and services as a result of a number of factors including probably a better financial situation as well as increased knowledge of health care in general. The relationship between mother’s age at childbearing and infant
and child mortality is curvilinear. The pattern of infant mortality by birth order follows the expected U shape.

The pace of childbearing shows a strong association with the survival chances of children. The indirectly estimated infant mortality analysed in this study appears to be consistent with the direct estimates for the period 1992-96. Maternal mortality ratio, which is well over 200 per 100,000 live births, is only an indirect estimate subject to several limitations of data quality as well as robustness of the method of estimation.

Regarding knowledge of STDs and HIV/AIDS, awareness of AIDS (82 percent)
is higher than that of STD (75 percent) and knowledge on the prevention is claimed to be about 50 percent. Exposure to mass media seems to make considerable difference for the knowledge regarding STDs, AIDS and their prevention.