Challenges faced by skilled birth attendants in providing antenatal and intrapartum care in selected rural areas of Myanmar

Background: In Myanmar a large proportion of antenatal and intrapartum care in rural areasis provided by skilled birth attendants (SBAs), this study assessed the coverage by these healthworkers of all births, their adherence to service guidelines, and community opinion on the antenataland delivery care they give in two rural health centres in Pathein Township, Ayeyarwaddy Regionto identify the challenges and improve antenatal and intrapartum service delivery provided by theSBAs.Method: A structured questionnaire was used to interview 304 women who had infants under oneyear of age, and in-depth interviews were held with 12 SBAs and 10 community members.Results: Of the 304 pregnancies, 93% had received antenatal care (ANC); 97% of these werecovered by SBAs at an average 15 weeks’ gestation. The average frequency of ANC visits was 9.Rates of home and hospital deliveries were 84.5% and 13.8% respectively. Among home deliveries,use rate of SBA was 51.4%, while for postnatal care, 31.3% was given by unskilled providers(traditional birth attendants (TBAs) 17.5%, auxiliary midwives (AMWs),13.8%). Multivariate analysisshowed that interviewees aged 30 years and below (OR=0.468, P=0.046), with an education atprimary level and below that of husband (OR=0.391, P=0.007) or not residing in the village of therural/station health centre (OR=0.457, P=0.011) were significantly less likely to use SBAs. Thecategories of supervision, referral, and health education activities of SBAs were not in line withservice guidelines. The main reasons were lack of access and community acceptance of TBAs.Conclusion: Heavy workload, geographical location, transportation and financial concerns weremajor challenges for SBAs, along with community compliance and mutual coordination. Goodcommunication and service management skills were important to overcome these challenges.

Dissemination of reproductive health knowledge by questions and answers through telephone hotline: a feasibility study in Myanmar.

This study was conducted to determine the feasibility of disseminating reproductive health (RH) information to the general public of Myanmar in a confidential, anonymous and interactive way through a telephone hotline. We carried out a cross-sectional study using a short questionnaire interview with the RH hotline callers and analyzing sample audio recordings of conversations. The hotline was advertised in print media. It was answered by trained hotline responders (medical doctors) of Department of Madical Research (Lower Myanmar) (DMR-LM). There were 743 calls during six months, from all 14 States and Divisions. Most of the calls were from Yangon, Mandalay and Bago Division. Both male (48%) and female (52%) callers used the hotline. The majority of callers (74%) were between 25 and 45 years old; 21% were young people (15-25 years old). Married people (81%) used the hotline more than singles (19%). Most of the callers (91%) had a high school to graduate education level. The most frequently asked topics were infertility (23%), birth spacing (22%), sexual problems (13%) and adolescent health, including reproductive function (12%). The anonymity of the callers, the non-judgmental attitudes of the responders and the use of media for publicity appeared to facilitate the use of the hotline by the public. More linkages with service entry points, enhancement of communication skills, sexual counselling training and use of media can improve topic coverage and utilization of the reproductive health hotline.