A tentative start is being made in Myanmar to
teach children about sexual and reproductive health but overcoming entrenched
conservative attitudes is a challenge.
At the
end of a day learning about sex, Dr Ne Win’s students show how they feel by
placing stickers on a daily “mood meter”.
At the
Myanmar Medical Association’s three-day workshop, they play games and sing
songs to learn about topics like teenage pregnancy and HIV, and then break into
small clusters of boys or girls who sit in a circle on the carpet and practice
slipping condoms onto a wooden dowel.
“When we
talk about ‘my body’ we don’t start with presentations. We have card games,” Ne
Win said.
The
workshop, in other words, is carefully designed to make the learning experience
for its students as comfortable as possible in a society that would rather talk
about anything else but sex.
At an
institutional level, Myanmar is doing relatively well on education and
resources for sexual and reproductive health. The National League for Democracy
government has set up public youth information and resource centres in rural
areas and works with NGOs for further support. The adolescent fertility rate
was only 17 births per 1,000 in 2015, show World Bank figures. In Thailand, by
contrast, it was 45:1,000.
Despite
the low number of adolescent births, knowledge of sex is a mire of rumours and
half-truths in classrooms, teashops and on family farms across Myanmar.
Assessments
by the United Nations Population Fund found that many young people lack basic
understanding of menstruation or how contraceptives work. Young people were
aware of HIV, the virus that causes AIDS, but had little knowledge of other
sexually transmitted infections.
Community
focus groups identified unmarried women as at-risk for induced abortion, yet
insisted that young women rarely had premarital sex.
“If you
ask [teens], ‘Do you know about emergency contraceptive pills?’ they say ‘yes.’
‘Do you have friends who have used it?’ They say, ‘yes.’ But they are thinking
you have to use one dose whenever you have sex. So if you have sex three times,
they use three doses in one day,” said Dr Sithu Swe of the UNFPA’s Youth
Development Programme.
“Research
is very scant,” Sithu Swe said. “In the last few years, sexual education
programs are very difficult among Myanmar people.”
UNFPA’s
Youth Development Programme has conducted training sessions in rural and urban
communities for eight years, but the effort has had the social and political
decks stacked against it. Under the old regime, the government was reluctant to
gather young people together.
Anything but sex
The
authorities are now more willing to allow training, but community leaders and
parents insist on sitting in.
“Young
people cannot ask the questions if adults or young people are sitting beside
them,” said Sithu Swe.
As for
demonstrating condom use: “When we do that, sometimes the parents, adults,
guardians, say: ‘You guys try to teach my children dirty things!’ They tell us
to get out. We run away.”
Ma Aye
Hla Yi began as a participant at Ne Win’s Myanmar Medical Association workshop
and now works as a staff trainer. “Sometimes what we hear from even the married
women, they don’t know. They just have sex, get a baby,” she said.
Many
parents do not want their children to be ignorant about sexual issues but are
too embarrassed to discuss them, said Aye Hla Yi. MMA workshops have a waiting
list of about 200 young people, many sent by parents eager for their children
to learn but afraid of losing respect if they discuss sex themselves.
Before
she attended Ne Win’s training, almost everything she knew –from menstruation
to birth control – she learned from friends or older peers, never her parents.
When
teaching other girls: “At first they are shy to see the body parts, especially
for the genitals, but after a while they are satisfied because they haven’t
obtained this information within the family.”
Even
medical professionals are reluctant to discuss sex education, Ne Win said. The
Myanmar Medical Association training program started with the children of its
members. “It is very difficult in our culture,” he said. “Sometimes they feel
that if they talk about sex in front of their children, their respect will be
gone.”
What
remains is an informal network of friends and, recently, the internet, which
the MMA’s Youth Development Centre works to tap. It maintains two sexual and
reproductive health hotlines, a “pink line” for girls and “white line” for
boys, and staff and volunteers (who begin as students) head off-site for
peer-to-peer training in schools, teashops, malls and anywhere else young
people gather.
Outside
Yangon, the Ministry of Social Welfare, Relief and Resettlement, along with
UNFPA and a handful of NGOs, holds training events for both adolescents and
adults in rural communities. In the Samalauk Youth Information Corner in
Ayeyarwady Region, for example, villagers arrive on boats to attend training
sessions, ask questions and seek resources.
Nevertheless,
Sithu Swe said, “We don’t have a standard guideline for the sexual education.
Different organisations have different models they are using.”
Cultural sensitivity
A
national sexual and reproductive policy is still in its infancy. Although the
UNFPA and NGOs follow guidelines approved at the 1994 International Conference
on Population Development in Cairo, Sithu Swe said they cannot be used
“directly” in Myanmar. “We are a culturally sensitive country. We need to
tailor guidelines specifically to Myanmar,” he said.
Even at
the highest level, progress in teaching sexual and reproductive health is
encountering a culture that would rather look the other way.
The
Ministry of Education has made a start on sex education in public schools
within a “Life Skills” curriculum developed by the UN children’s agency,
UNICEF, but it is extra-curricular.
“There is
no need to [study it] for the exam, so teachers don’t concentrate on that. Most
of the teachers are women, so they are reluctant to talk about sexual health
issues among their students,” Sithu Swe said.
On the
government side, winning over conservative officials to the need for a sexual
health education curriculum and programs has always been an uphill battle,
although Sithu Swe said it had become easier under the NLD government.
Sithu Swe
said he and his colleagues were waiting, not for a sex education curriculum or
more resource centres, but for a general national youth policy that would bring
together ministries, NGOs, resource centres, a sex education curriculum and
anything else related to young people.
The
policy must be broad because sexual and reproductive health is a broad issue.
It goes beyond knowing how to use condoms.
“Whenever
we say ‘sexual and reproductive health education’, it’s not only about sexual
matters,” Sithu Swe said. “It’s also about life skills. Decision-making. Peer
pressure. Her boyfriend is persuading her to go to the guesthouse to have sex.
At some point the young girl has to decide if she will follow him or not. If
she has no decision-making skills, she will follow him, have sex, maybe get
pregnant,” he said.
As Ne Win
put it: “Even with one decision, their life can change.”
Jared
Downing
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