A dearth of family planning services and sex
education in Chin State is endangering women and reinforcing patriarchal
culture.
LATE ONE
night, Nu Ngun Bil Sung was called to help a woman suffering a complicated
miscarriage in the eighth month of her pregnancy.
The 67-year-old midwife
travelled as quickly as she could through mountainous, jungle-covered terrain
of remote Chin State to reach the woman’s village.
“When I
arrived, the baby’s body had already been delivered, but the head was cut off
and had been left inside the womb,” said Ngun Bil Sung. “The placenta was all
mashed up inside her.”
She
questioned the woman, who admitted she had travelled to Falam, the nearest
town, for a late-term abortion before returning to her village. The abortion
provider had timed it so that the drugs she administered vaginally would kick
in when the woman reached her home — far from a hospital — and her neighbours
would think she was having a miscarriage.
“The
woman was in a very bad way,” Ngun Bil Sung said. “She was bleeding a lot and
exhausted.”
With
difficulty, Ngun Bil Sung saved the woman’s life, but in the morning the
villagers were furious with her. They accused the mother of murdering her baby
and said she should have been left to die.
Ngun Bil
Sung has never received any formal training. But in the 32 years since she was
“called by God” to assist women in labour in devoutly Christian and deeply
impoverished Chin State, she estimates that she has safely delivered nearly
1,500 babies, including her own.
"Mai Nun Thiam regularly encounters women
who say they don’t want to have more children, but their husbands won’t let
them stop conceiving. Sometimes they ask to be supplied with contraception in
secret, but often they are too afraid."
Although
she earns a living from childbirth, Ngun Bil Sung’s vast experience has led her
to believe that people in Chin State need better family planning advice and
greater access to contraception.
Her views
are based on a number of observations from her work. In addition to having seen
desperate and dangerous illegal abortions, she said in about a third of births
she attends, the mother had fallen pregnant shortly after giving birth to her
previous child. Another is that many of the women are either very old or very
young to be giving birth, putting them at greater risk of miscarriage and other
complications.
About 40
percent of women in Myanmar use contraception, but in Chin State that figure is
just 3 percent, according to United Nations figures. World Bank figures show
that Myanmar has the second highest maternal mortality rate in Southeast Asia,
with unsafe abortion one of the leading causes of death. UN figures show that
87 percent of maternal deaths occur in rural areas, which account for 70
percent of Myanmar’s population.
But
improving access to family planning services and reproductive health education
in Chin State will be extremely difficult. Many Chin people believe using
contraception is against God’s wishes and promotes promiscuity. There is also a
commonly held view, particularly among men, that women are meant to have babies
whenever they can, for as long as they can.
Mai Nun
Thiam, a 28-year-old government midwife who works in Si Ngai village, Falam
Township, regularly encounters women who say they don’t want to have more
children, but their husbands won’t let them stop conceiving. Sometimes they ask
to be supplied with contraception in secret, but often they are too afraid.
Recently, she said, she was approached by a 31-year-old schoolteacher who had
five children already and didn’t want another. The woman’s husband, though, had
decreed that she would “keep having babies for as long as she can”, Nun Thiam
said.
The
midwife said this reinforced the power men held over their wives: The more babies
women have, the more dependent on men they become. “It becomes their duty to
look after the children, while the husbands go to the farm and become the sole
provider of the family, so they are stuck in an inferior role. As they keep
having babies their role gets lower and lower, to the point where they have to
listen to everything their husband says.”
Dr Henri
Za Lal Lian, manager of Marie Stopes International’s Falam Centre, said he had
seen women who had to obtain contraception, such as intrauterine devices and
contraceptive implants, without their husbands knowing. “Sooner or later the
husband finds out and immediately asks them to go and take it out,” he said.
“It’s not exactly domestic violence, but they can be pretty rough.”
Za Lal
Lian explained that a woman who doesn’t produce enough babies is considered
both a bad wife and a bad daughter-in-law in Chin State. “[The family] can
practically disown the woman and nobody says a bad thing about them [the
family].”
A group of women listen
to a presentation by Marie Stopes International
about reproductive
health in Chin State. (Charlotte England / Frontier)
On the
other hand, it is considered completely unacceptable for unmarried Chin women
to have children. Single women with babies are stigmatised and shunned, and
many turn to abortion.
Nun Thiam
said that when she worked in Falam town at least five women came to her seeking
abortions because they weren’t married. She turned them all away. Three of the
five were subsequently forced by their families to marry the fathers and bear
children they didn’t want. The other two, she believes, successfully sought
abortions elsewhere.
Abortion
is illegal in Myanmar, except to save a woman’s life. Of course, this doesn’t
stop abortions from happening – it just means they’re unsafe, expensive, and
often a desperate last resort for unmarried women and people who can’t afford
to have more children. Difficulty accessing abortion can also force women to
wait longer, resulting in even more dangerous late-term abortions, at six,
seven, or even eight months.
One
source told Frontier there had been nearly 150 abortions so far this year in
Falam Township — population 50,000 — alone. Local people said they knew of at
least two illegal abortion providers in and around Falam. Many also told of
people going to the state capital, Hakha, for an abortion. They said that all
providers charged according to the same scale: K100,000 for a pregnancy of one
month, K200,000 kyat for two months, and so on.
The same
stigma that forces unmarried women to have secret abortions makes unmarried
people who are sexually active afraid to buy contraceptives in pharmacies, in
case people see them and talk about them.
In a bid
to surmount this, Mai Elizabeth Kim, a staff member at Marie Stopes
International’s Falam office, explained that part of her job was to discreetly
deliver condoms and emergency contraception to Falam residents who phone and
ask for supplies or advice.
Chin
people, particularly women, are also made vulnerable by a lack of information.
Sex education was only recently introduced in government schools as one element
of a ‘life skills’ class. It is not compulsory, and many teachers – who are
normally women – are reluctant to discuss sex with their students. As a result,
many people have little knowledge of the contraceptive options available to
them and no concept of safe sex. Women are often told by their parents just to
stay away from men once they hit puberty.
“It’s
important for young women like me to have knowledge before they become sexually
active, so that they can protect themselves,” said Mai Helen Leng Zun Rem, a
26-year-old who also works at MSI in Falam. She said some of her peers had
become pregnant unintentionally, including an unmarried woman from an extremely
poor family who at 23 already had two small children.
Leng Zun
Rem said the woman was one of seven siblings, none of whom had been formally
educated. She began working as a labourer on road projects in distant parts of
the state to support her family. Away from Falam, she was surrounded by male
road workers and with little knowledge of sex, let alone contraception, she
quickly fell pregnant. “Everyone talks bad about her,” said Leng Zun Rem. With
two dependants and the stigma of sex before marriage, the woman now had almost
no chance of escaping poverty, she said.
A woman at a clinic in Chin State receives an implant from
a midwife. (Charlotte England / Frontier)
Despite
an abundance of individual injustices in Chin State, the reproductive health of
Chin women is broadly improving, albeit slowly. When MSI first arrived in the
region, they faced deep hostility, including verbal attacks from strangers in
the street. Now they have seen 13,725 clients in Chin State – below their
target, but a respectable number considering not only the cultural barriers but
also the sparse population and tough terrain.
Za Lal
Lian said encouraging men to attend education sessions had increased the uptake
of services. “The husbands are still the key players in their household, so
male involvement is critical,” he said.
“Often
the men are not supportive because they don’t know what the heck is going on.
They don’t want to talk about menstrual cycles, they don’t want to talk about
contraceptives, they don’t want to talk about the uterus. But if they do have
to listen, then the men become quite active.” On occasion, he said, men have
attended education sessions alone, and brought their wives back later to obtain
contraception.
But while
pragmatic, persuading men to co-operate does little to challenge patriarchal
norms, at least in the short-term: women still don’t have the ability to make
independent decisions about their reproductive health in Chin State, despite
the fact that they’re the ones who are endangered in childbirth, who are
responsible for caring for children, and who sometimes have no choice but to
undergo dangerous, illegal abortions.
To
sustain progress and eventually bring about wider change, Za Lal Lian looks to
the new government. To begin with, he said, comprehensive sexuality education
needs to be implemented in schools all across Myanmar. Personally, he said,
he'd also like more research to be done into the impact of the abortion ban on
women in Myanmar, and for the relevant sections of the Penal Code to be
reviewed.
“[A woman
should] be in charge of her own body,” he said, “and make her own choices regarding
reproduction health.”
Charlotte
England
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