The Asia Pacific Women thought leadership series brings focus to the status of women in the Asia-Pacific region through expert commentary on women’s social inclusion and economic engagement in several aspects of life.
Despite being a signatory to the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW), the Beijing Platform for Action, and the International Conference on Population and Development, Myanmar ranks as 145 of 189 countries in the United Nations (UN) gender inequality index. Social and political institutions limit women and girls’ access to economic independence and political representation in Myanmar. Culturally, men are the primary decision-makers in all aspects of households, particularly, when it comes to health and finances, limiting women’s opportunities to seek appropriate health care for themselves or their children. This includes women and girls’ access to sexual and reproductive care, including family planning services. Unless there is a radical reprioritisation of women’s economic and health risks by Myanmar’s COVID-19 Control and Emergency Response Committee, the COVID-19 outbreak will entrench the inequalities that women and girls were already facing before the pandemic.
While many studies agree that the needs of women and girls during the COVID-19 crisis will be different, it is also noted that the responses to the COVID-19 pandemic in most contexts are the same, in that they are not gender-sensitive. The Myanmar government is no different. The government has taken immediate mitigation steps including restricting movement and travel, and formed a COVID-19 Control and Emergency Response Committee led by State Counsellor Daw Aung San Suu Kyi. However, to date the majority of the committee members are men and the response of the committee has shown minimal consideration of the effects of COVID-19 on women from a health, economic and social perspective. The government has initiated and developed the COVID-19 Economic Relief Plan. Within this seven goal plan, Goal 4: ‘Erasing the impact on households’, may be interpreted as directly referring to an increase of funds for maternal and child support. Aside from this small increase in cash funds for families, there is no relief fund identified to prevent and respond to the increasing trend of domestic violence, nor women’s specific health risks due to the lockdown. We will address each in turn.
Myanmar women and girls face a high risk of gender-based violence, including sexual violence committed by intimate partners and have little protection from state law. The Myanmar Demographic and Health Survey (DHS) reported that 15% of women have experienced physical violence since the age of 15, and 21% of married women have experienced spousal violence. Among this 21%, one in five (22%) have experienced physical or sexual violence and 37% have never told anyone about the violence. During the Covid-19 outbreak, it has been acknowledged that a rise in domestic violence has occurred during the country’s lockdown, but there is no data to establish the scale of the problem. It has been established that in lockdown situations women face a higher risk of domestic violence as well as a higher risk of reproductive coercion. In Myanmar, the failure to address the risk of domestic violence has the potential to escalate the reproductive health crisis that Myanmar women and girls were already facing.
Progressive gains in reproductive health in Myanmar were already fragile before COVID-19. The 2014 census reported that the maternal mortality ratio for Myanmar is 282 maternal deaths per 100,000 live births (this is the second highest rate in ASEAN), with disproportionate numbers across states and regions— the highest reported is 354 maternal deaths per 100,000 live births in Chin state.
Movement restrictions, though slowly lifted in some areas, coupled with a temporary shutdown of services have resulted in limited service providers in rural and hard to reach areas—where maternal mortality was already well above the national average.
Yet there is little evidence to date that the Myanmar government is prioritising women’s reproductive care, and the impact of the Covid-19 lockdown on women’s health.
Less than half of Myanmar women make decisions on their own health care and 83% of married women require the participation of husbands to make health care decisions, including family planning. Empowering women within the household remains a challenge for many married women in Myanmar. This fact is prominent when looking at fertility rates and contraceptive prevalence rates. The fertility rates vary across different states and regions of Myanmar. The higher rates correspond with high maternal mortality rates in rural states (4.6 in Chin compared to the national average of 2.1); but access to family planning services remains low across the country. The national prevalence of contraceptive use is 52% and the unmet need remains high at 16%. The decision-making power of women for spacing birth and using contraceptives is largely influenced by partners. Contraception use in Myanmar is shown to improve in households when women are involved in the decision making of financial matters and the purchase of household goods. This data suggests that there are grave consequences for women in Myanmar if their economic and health security is not prioritised in the current COVID-19 response.
Coupled with the high levels of domestic violence within Myanmar, reproductive coercion within families and communities was present before the arrival of COVID-19. Now it has added potential to scale up and escalate.
The extra burden of family care (already seen as the primary role for women in Myanmar) during the homestay and school closures will give women less opportunity to earn and pay for the health services they need, including contraceptives.
Lower family incomes coupled with the higher unemployment rate, may lead to added pressures on women to have more babies in order to receive the state increase in cash funds for ‘maternal and child support’. In families where women have little control over finances, the decision to pay for contraception or maternal health may become secondary to other priorities of the household.
For women and girls, the lockdown has also intensified their limited access to contraception. Stigma for women and girls who seek access to contraception is high among unmarried women and adolescents in Myanmar. For instance, the adolescent (15-19) fertility rate is 36 births per 1000 women and the prevalence of contraceptive use among all young girls is very low at 7%. The extension of school closures will lead to a higher level of sexual exposure coupled with limited opportunity to access to contraception, which will produce an increase in unwanted pregnancies. There is little evidence that the Myanmar government is prioritising adolescent access to contraceptives or sexual education (for boys and girls) during the COVID-19 outbreak.
Finally, the gravity of the health situation for women is no doubt intensified by the conflicts in some Myanmar states. The ongoing conflicts and limited living space among IDPs are a challenge to practice social distancing and escalate family tensions. Humanitarian aid is prioritising personal protection equipment and social distancing measures; but there is little time and space to discuss the social and human rights needs of IDPs. The recent government order to shut down internet access in conflict-affected states illustrates the significant barriers for civilians, including IDPs, to access basic health information awareness on COVID-19, let alone the opportunity to treat health conditions including access to sexual health commodities.
The information barriers during the pandemic pose additional risks to women and girls in Myanmar, including loss of access to information and services for sexual and reproductive health during the COVID-19 lockdown.
The Myanmar government has taken early steps in trying to combat the COVID-19 pandemic. The confirmed number of incidents has been maintained at about 300 and it seems that community transmission is under control. This has been helped by the fact that Myanmar remains a predominantly rural country (70% of the population residing in rural locations). However, the compounding effect of underdeveloped infrastructures and socio-economic barriers has limited the availability and accessibility of reproductive health services. The economic cost of the lockdown and the gender-blind response of the government means that women and girls will suffer from the direct impact of the regulatory measures imposed to address COVID-19. There is an urgent need to recognise and address the risks to the sexual and reproductive health of women and girls in the country because of recent government response against COVID-19.
Rapid assessments should be economically and politically prioritised to understand the current challenges of women and girls in accessing sexual and reproductive health services. Such priorities should include additional barriers to access and utilisation of services as a result of the pandemic, adolescent’s health, and their access to contraceptives and gender-based violence and its impacts on women’s health. This will help to integrate the sexual and reproductive health needs of women and girls while developing the COVID-19 response plan and achieve gender-responsive regulatory outcomes, and consequently the wellbeing of women and girls in Myanmar.
Phyu Phyu Oo is a PhD candidate in the School of Government and International Relations at Griffith University. Her thesis is titled ‘Sexual and gender-based violence in armed conflict areas: a case study of Myanmar’.