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The 2015-16 Myanmar Demographic and Health Survey (2015-16 MDHS) was implemented by the Ministry of Health and Sports of the Republic of the Union of Myanmar. Funding for the survey was provided by the United States Agency for International Development (USAID) and the Three Millennium Development Goal Fund (3MDG). ICF provided technical assistance through The DHS Program, which assists countries in the collection of data to monitor and evaluate population, health, and nutrition programs.

Objective The main objective of the 2015-16 MDHS is to provide information on fertility levels, marriage, fertility preferences, awareness and use of family planning methods, breastfeeding practices, nutrition, childhood and maternal mortality, maternal and child health, awareness and behavior regarding HIV/AIDS and other sexually transmitted infections (STIs), and other health-related issues such as smoking and knowledge of tuberculosis. This information is essential for program managers and policymakers to evaluate and design programs and strategies for improving the health of Myanmar’s population.

The Survey The 2015-16 MDHS is the 1st Demographic and Health Survey conducted in Myanmar as part of The DHS Program. It is designed to provide estimates at the national and regional levels, for urban and rural areas, and for each of Myanmar’s 15 states/regions.

Sample Design Sampling Frame: Based on the 2014 Census sampling frame First Stage: 442 clusters selected—123 urban and 319 rural Second Stage: 30 households were selected from each cluster, for a total sample size of 13,260 households Selected households were visited and interviewed; all women age 15-49 and half of all men age 15-49 in all of the selected households were interviewed.

Representing all of Myanmar Data were collected in non-state controlled areas and an IDP camp Interviewers from these regions were deliberately recruited Advocacy efforts in place before survey Additional security and training for some regions ADD CLUSTER MAP

15 Regions/States Covered by the MDHS

Questionnaires Household Questionnaire Woman’s Questionnaire English Questionnaires were translated into Myanmar

Biomarkers Height and weight measurements: Children under 5 Women age 15-49 Anemia testing: Children age 6-59 months

Results of the Household and Individual Interviews Household Interviews Households selected 13,238 Households occupied 12,780 Households interviewed 12,500 Response rate 98% Interviews with Women age 15-49 Eligible women 13,454 Women interviewed 12,885 Response rate 96% Interviews with Men age 15-49 Eligible men 5,218 Men interviewed 4,737 Response rate 91%

Survey Results: Households and Respondents

80 % of households have an improved source of drinking water Percent of households 80 % of households have an improved source of drinking water Nearly 8 in 10 rural households in Myanmar. In urban areas, bottled water is the most common water source. In urban areas, households get their water from tubewells/boreholes and protected wells or springs. Overall, 20% of households do not have access to clean drinking water.

Toilet Facilities Percent of households Nearly half of households have an improved sanitation facility not shared with other households, and 10% use a shared facility. 32% of households use an unimproved toilet facility. 11% of households have no toilet facility. Generally, households in urban areas have higher access to improved sanitation than rural areas. Rural households are more likely than urban households to have no toilet facility (14% versus 1% ).

Electricity Percent of households 56% of households have electricity in Myanmar. Electricity is more common in urban areas (92%) than in rural areas (42%).

Educational Attainment of Respondents age 15-49 Percent of women and men age 15-49 by highest level of education attended 13% of women and 12% of men have never attended school. 41% of women and 36% of men have attended only primary school; 36% of women and 45% of men have attended secondary school. Only 10% of women and 7% of men have gone beyond secondary school.

Survey Results: Fertility and Family Planning

Fertility Differentials Births per woman for the 3-year period before the survey The TFR for the 3 years preceding the survey is 2.3 births per woman, with rural women having about 0.5 children more on average than urban women.

Fertility by Region/State Births per woman based on the 3-year period before the survey Myanmar 2.3 Regionally, TFR is lowest in Yangon and Magway at 1.8 births per woman and highest in Chin at 4.6 births per woman.

Fertility in the Region Births per woman for the 3-year period before the survey

Median Age at First Sex, Marriage, and Birth Among women and men age 25-49 Women in Myanmar marry at a median age of 22.1 years. Men marry about 2 years later, at a median age of 24.5. Women initiate sexual intercourse just after marriage, at a median age of 22.5. Men initiate sexual activity about a year before marriage, on average, at a median age of 23.6. The median age at first birth is 24.7 NA

Fertility Preferences of Married Women Percent distribution of currently married women age 15-49 by desire for children in the future 61% of currently married women want no more children or are sterilised. 13% of women want another child soon (within 2 years) while 18% of women want another child 2 or more years later.

Current Use of Contraception Percent of married women age 15-49 The contraceptive prevalence rate (CPR) is defined as the percentage of married women using a method of contraception. Currently, the CPR for Myanmar is 51% of married women using modern methods of contraception and 1% using any traditional method of contraception. Among married women, injectables, the pill, and female sterilization are the most popular methods.

Current Use of Modern Contraception by Region/State Percent of currently married women age 15-49 using any modern method of contraception Myanmar 51% Regionally, modern contraceptive use ranges from a low of 25% in Chin to a high of 60% in Yangon and Bago.

Use of Modern Methods in the Region Percent of currently married women age 15-49 using any modern method of contraception

16% of currently married women have an unmet need for family planning: 5% for spacing 11% for limiting Unmet need is 16% in Myanmar.

Demand for Family Planning Percent of currently married women age 15-49 Overall, 16% of currently married women have an unmet need for family planning. 52% percent of women have a met need for family planning or are using a contraceptive method. If all currently married women who say they want to space or limit their children were to use a family planning method, the CPR would increase to 69%, or total demand. Of the total demand for family planning methods, 76% is satisfied by using any method and 75% is satisfied by using modern methods.

Survey Results: Mortality, Maternal and Child Health

Childhood Mortality Rates Deaths per 1,000 live births for the 5-year period before the survey Infant and under-5 mortality rates in the 5-year period before the survey are 40 and 50 deaths per 1,000 live births, respectively. At these mortality levels, 1 in every 25 children dies before reaching age one. One in every 20 children does not survive to their fifth birthday. The neonatal mortality rate in the past 5 years is 25 deaths per 1,000 live births.

Under-5 Mortality by Region/State Deaths per 1,000 live births for the 10-year period before the survey Figures in parentheses are based on 250-499 unweighted exposed persons. Under-5 mortality ranges 44 deaths per 1000 live births in mon to 104 in Chin.

Trends in Childhood Mortality Deaths per 1,000 live births for the 5-year period before the survey Although there has not been a DHS done in Myanmar prior to 2015-16, the 2015-16 survey collected information on births and deaths up to 15 years prior to the survey. These data indicate that childhood mortality has declined in the most recent period before the survey.

Under-5 Mortality in the Region Deaths per 1,000 live births The under-5 mortality rate in Myanmar is similar to the rates seen in Bangladesh and Nepal. Under-five mortality is lower in Cambodia, and higher in Pakistan.

Adult Mortality by Age As expected, mortality tends to increase with age. Males have a higher rate of mortality at almost all ages.

Pregnancy-related Mortality Pregnancy-related mortality ratio (PRMR) for the 7-year period before the survey = 227 deaths per 100,000 live births 8% of female deaths were pregnancy- related PRMR is based on a reported 22 deaths in the 7 years before the survey. Pregnancy-related deaths accounted for 8% of all female deaths in the previous 7 years. Another way of expressing the PRMR is that for every 1,000 live births in the previous 7 years, slightly more than 1 women died during pregnancy, delivery, and within 2 months postpartum.

Antenatal Care by Provider Percent distribution of women age 15-49 with a live birth in the five years before the survey 81% of women received ANC from a skilled provider* 81% of mothers receive antenatal care from a skilled provider, with54% receiving antenatal care from a nurse/midwife or lady health visitor *Skilled provider includes doctor, and nurse/midwife, and lady health visitor

Timing of Antenatal Care and Number of Visits 40% of women went to their first ANC visit during the 1st trimester of pregnancy, as recommended. 59% of women had 4 or more ANC visits. 40% of women make their first antenatal care visit during the 1st trimester of pregnancy. 59% of pregnant women make 4 or more ANC visits during their pregnancy.

Place of Delivery Percent distribution of live births in the 5-year period before the survey 37% of births in Myanmar take place in a health facility; 31% in a public facility, 6% in a private facility. 63% of births occur at home. Delivery in a health facility is more common in urban areas (70%) than in rural areas (28%). In rural areas, 72% of births are delivered at home.

Delivery in a Health Facility by Region/State Percent of live births in the 5-year period before the survey delivered in a health facility Myanmar 37% Regionally, health facility-based deliveries range from a low of 15% in Chin to a high of 65% in Yangon.

Assistance during Delivery Percent distribution of live births in the 5-year period before the survey 60% of births were delivered by a skilled provider* 60% of births are delivered by a skilled provider. Doctors assist with 32% of deliveries and Nurses, midwives, or Lady Health visitors assist with 29% of deliveries. TBAs, which are not considered a skilled provider, assist with 29% of deliveries, and auxiliary midwives assist with 6%. *Skilled provider includes doctor, nurse/midwife, and lady health visitor (LHV).

Assistance during Delivery by Region/State Percent of births in the last 5 years that were assisted by a skilled provider Myanmar 60% Regionally, assistance by a skilled provider is lowest in Rakhine and Chin States and high in Yangon and Mandalay regions. *Skilled provider includes doctor, nurse/midwife, and lady health visitor (LHV).

Place of Delivery and Assistance at Delivery in the Region Percent of live births in the 5 years before the survey that received assistance from a skilled provider Myanmar lags behind Cambodia and Pakistan health-facility births, but is ahead of all neighboring countries but Cambodia in skilled assistance at delivery. *Bangladesh is based on the 3 years before the survey

Basic Childhood Vaccinations Percent of children age 12-23 months vaccinated Overall, 55% of children age 12-23 months have received all basic vaccinations. 88% of children received the BCG vaccination and 77% are vaccinated against measles. Coverage of the first two doses of the DPT/pentavalent and polio vaccines is relatively high (77% or above); however, only 62% received the third dose of DPT/pentavalent and 67% received the third dose of polio. 8% of children did not receive any vaccination at all. DPT/Pentavalent Polio

Basic Vaccination Coverage Region/State Percent of children age 12-23 months with all basic vaccines Myanmar 55% Regionally, vaccination coverage ranges from a low of 34% in Ayeyarwady to a high of 81% in Mandalay.

Basic Vaccination Coverage in the Region Percent of children age 12-23 months with all basic vaccines Many countries in the region have higher vaccination rates than Myanmar.

Survey Results: Nutrition

Breastfeeding Status Under 6 Months Percent distribution of youngest children under 6 months who are living with their mother by breastfeeding status Supplementing breast milk with other liquids or foods starts at an early age in Myanmar. Contrary to the recommendation of exclusive breastfeeding, 26% of children under 6 months were given plain water, other milk, or other non-milk liquids while 21% were fed complementary foods in addition to breast milk.

Percent of children age 6-59 months classified as having anaemia Anemia in Children Percent of children age 6-59 months classified as having anaemia Almost 6 in 10 children age 6-59 months are anemic. 31% have mild anemia while 26% have moderate anaemia.

Percent of women age 15-49 classified as having anemia Anemia in Women Percent of women age 15-49 classified as having anemia Almost half of women are anemic. Most of these women have mild anemia.

Nutritional Status of Children Percent of children under 5 29 7 Children who are stunted are considered too short for their age. 29% of children are stunted. This is a sign of chronic malnutrition. Children who are wasted are too thin for their height. 7% of children are wasted. This is a sign of acute malnutrition and often reflects a more recent scarcity of food. Children who are underweight are too short for their height. 19% of children are underweight. This indicator combines stunting and wasting. 19 *Based on the 2006 WHO Child Growth Standards

Child Stunting by State/Region Percent of children under 5 stunted, or too short for age In Myanmar, stunting is most common in Chin and Rakhine and least common in Yangon. Myanmar 29%

Percent of children under 5 stunted, or too short for age Stunting in the Region Percent of children under 5 stunted, or too short for age Myanmar has the lowest rate of stunting compared to neighbors with recent DHS surveys

Women’s Nutritional Status Percent distribution of women age 15-49 The 2015-16 MDHS also took weight and height measurements of women age 15-49. Just 15% of Myanmar women are thin. 25% are overweight or obese (BMI>=25.0).

Survey Results: Malaria and HIV

Ownership of Mosquito Nets Percent of households with at least one mosquito net Almost all households have some type of mosquito net, but only 27% have an insecticide-treated net.

Ownership of LLINs by State/Region Percent of households with at least one LLIN Myanmar: 24%

Use of ITNs Percent who slept under an ITN the night before the survey among all households Percent who slept under an ITN the night before the survey among households with at least one ITN Among all households in Myanmar, 16% of households had all household members sleeping under an ITN the night before the survey. Net use is slightly higher among children under age 5 and pregnant women—the groups most at risk from malaria. Owning a net does not automatically mean families use it. All family members slept under a net the night before the survey in just over half of households that owned a net. 56% of children under 5 and 62% of pregnant women in households with an ITN slept under an ITN the night before the survey.

Awareness of AIDS by Education 92% of women and men in Myanmar have heard of AIDS

Knowledge of HIV Prevention Methods Percent of women and men age 15-49 who know that HIV can be prevented by: Knowledge of HIV prevention measures is much lower that HIV awareness. 54% of women and 62% men know that the risk of getting HIV can be reduced by using condoms and limiting sex to one faithful, uninfected partner.

Percent of women and men age 15-49 HIV Testing Percent of women and men age 15-49 18% of women and 21% of men have been tested at some time and received the results. In the 12 months before the survey, 5% of women and men have been tested and received the results.

Survey Results: Women’s Empowerment and Domestic Violence

Employment Percent of currently married women and men age 15-49 who were employed in 12 months before the survey More men were employed in the last year than women. Only 71% of women compared to 99% of men were employed.

Ownership of House and Land Percent of women and men age 15-49 About half of women and men own a house alone or jointly; the same percentage own land alone or jointly

Women’s Participation in Decision Making Percent of currently married women age 15-49 who usually make specific decisions by themselves or jointly with their husband The 2015-16 MDHS asked currently married women about their participation in three types of household decisions: her own health care, making major household purchases, and visits to family or relatives. 88% of women have sole or joint decision-making power about visiting family or relatives, while 74% participate in decisions about major household purchases. 83% of married women participate in decisions about their own health care. 5% do not participate in any of the three decisions; more than 6 in 10 women report that they participate in all three decisions.

Attitudes towards Wife Beating Percent of women and men age 15-49 who agree that a husband is justified in beating his wife under certain circumstances The MDHS asked female and male respondents if they think a husband is justified in beating his wife under a series of circumstances: wife burns the food, wife argues with him, wife goes out without telling him, wife neglects the children, and wife refuses to have sex with him. Overall,about half of women and men agree that wife beating is justified in at least some cases. Neglecting the children is the most commonly cited justification for wife beating.

Experience of Physical Violence 15% of Myanmar women have ever experienced physical violence (since age 15) 9% have experienced physical violence recently (in the year before the survey)

Experience of Sexual Violence 3% of Myanmar women have ever experienced sexual violence (since age 15) 2% have experienced sexual violence recently (in the year before the survey)

Spousal Violence Percent of ever-married women age 15-49 who have ever experienced violence committed by their husband Spousal violence is physical, sexual, or emotional abuse committed by a husband or intimate partner. 15% of ever-married women report that they have ever experienced physical violence by their husband/partner, which is the most common form of spousal violence. Emotional violence (14%) and sexual violence (3%) are less common. 21% of ever-married women have experienced physical, sexual, or emotional violence.