1. pets
2. birds

ISSUE 23, MARCH, 2004
1
rmwdum
CONTENTS
trSwf 23 rwfv 2004 ckEpS ?f
usef;rma&;ynmay;
ISSUE 23 MARCH, 2004
/ Health Education
rdom;pkprD cH suo
f nfrnfonft
h a=umif;a=umift
h a&;yg&ygoenf;? (tJvpfpbuf tDrmpef/ urBBm@use;f rma&;tzG@J )
2
Why is Family Planning Important? (Elisabeth Emerson, WHO)
trdsd K;rsKd ;aomoaE<wm;enf;rsm;rSmtb,fenf;? (use;f rma&;apwrmeftzG@J )
What are the Different Contraceptive Methods? (Health Messenger Team)
awG@qHak r;jref;jcif; / Interview
oaE<wm;jcif;oH;k pGo
J rl sm;tm;a&G;cs,rf r_ eS u
f efap&efun
l jD cif;
(yD/ yD/ at/ wD tzGJ@ESifhusef;rma&;apwrmeftzGJ@yl;wGJa&;om;onf)
Helping Clients to Make the Right Choice
ukojcif;
?
(Health Messenger Team in collaboration with PPAT)
/ Treatment
t"duoaE<wm;enf;rsm;.tm;omcsuEf iS t
hf m;enf;csurf sm; (aaaaaaaaaaaaaaaaaaaaa)
Advantages & Disadvantages of the Main Contraception Methods (Health Messenger Team)
aemfyvef@ (usef;rma&;apwrmeftzGJ@ ESifh yD/ yD/ at/ wD tzGJ@wdk@yl;wGJa&;om;onf)
Norplant
(Health Messenger Team in collaboration with PPAT)
vlr_qufqHa&;
/ Social
rSm;,Gi;f aomt,ltqrsm;ESirhf o
d m;pkprD u
H ed ;f (use;f rma&;apwrmeftzG@J )
Misconceptions (Health
Messenger Team)
pdwaf 0'em'%f&m (usef;rma&;apwrmeftzGJ@)
Mental Trauma (Health
Messenger Team)
urBmhtjrifEiS hf uav;ppfom;rsm; (use;f rma&;apwrmeftzG@J )
Child Soldiers - A Global Overview (Health Messenger Team)
pdwaf 0'em'%f&m (use;f rma&;apwrmeftzG@J )
Mental Trauma (Health Messenger Team)
urBmhtjrifEiS hf uav;ppfom;rsm; (use;f rma&;apwrmeftzG@J ESihf yD/ yD/ at/ wD tzG@J w@kd y;l wGaJ &;om;onf)
Chlld Soldiers - A Global Overview (Health Messenger Team)
taxGaxGusef;rma&;
/ General Health
trsKd ;orD;rsm;.use;f rma&;ESio
hf ifah vsmaf omoaE<wm;enf;rsm; (use;f rma&;apwrmeftzG@J )
The Suitable Family Planning Methods According to Women’s Health (Health Messenger Team)
}udKwifumuG,jf cif;
/ Prevention
rdom;pkprD u
H ed ;f wGit
f rsKd ;om;rsm;.yg0ifr+tajctae (use;f rma&;apwrmeftzG@J )
The Situation of Male Involvement in Family Planning (Health
Messenger Team)
jrefrmvdk bmomjyefay;aom bmomjyefq&mrsm;/ t*Fvyd v
f kd y&kyzf wfay;aom rpPwmpwD;zefvu
k Ef iS hf yef;csq
D &m qkcsprf if;rvDw@kd tm; aus;Zl;wif&ydS gonf?
Thanks to our translators for Burmese translation, Mr. Stephen Look for English proof-reading, Mr. Suchit Mingmalee for drawings.
This text has been drafted with financial assistance from IRC/USAID
The views expressed herein, in no way reflect the official opinion of IRC/USAID
The procedure, explanations and treatment given in this publication are based on research and consultation with medical
and nursing authorities. They all reflect accepted medical practices. Nevertheless they cannot be considered absolute and
universal recommendations. The authors, the editor and the publisher disclaim responsibility for any adverse effects
resulting directly or indirectly from the suggested procedures, from any undetected errors, or from the reader's
misunderstanding of the text.
2
trSwf=23 rwfmv 2004 ckESpf?
usef;rma&;apwref
t,f'w
D mhtmabmf
Editorial
cspcf ifav;pm;tyfaom pmzwfy&dowfrsm;cifAsm;/
Dear Readers,
2004 ckEpS w
f iG f yxrOD;qH;k xkwaf 0aom use;f rm a&;
apwrmefr*~Zif;onf u|eaf wmfw@kd twGuf ta&;ygaom
tcsurf sm;&Syd gonf? Tr*~Zif;onf pDrcH sun
f ESd i_d ;f aqmif
&Guo
f t
l opf Adik af &mepfwm&mqD. yxrOD;qH;k vuf&m jzpfonf?
u|eaf wmfw@kd EiS t
hf wl 2 ESpcf JG wm0efxrf;aqmifcb
hJ ;l ol
&D%aD uGzv
J v
f ufonf +yD;cJah om 'DZifbmvwGif tjcm;
tvkyo
f pfo@kd ajymif;a&$ŒoGm;ygonf? tmzcefepfwef
EdkifiHY vlxk qufoG,fa&; tawG@t}uHKrsm;pGm&Sdol
Adkifa&mepfwm&mqDtm; &D%Dae&mwGif wm0efxrf;
aqmifapygonf?
TpmapmifwiG 'f u
k QonfEiS ahf &$@ajymif;tvkyo
f rm;rsm;
twGuaf &;w}u;D vdt
k yfaomrdom;pkprD u
H ed ;f ESiyh f wfoufonfh
aqmif; yg;rsm;tygt0ifudk,f0efwm;enf;trsKd;rsKd;ESifh
vufawG@t oH;k 0ifrnfh ESpo
f rd ahf qG;aEG;enf;rsm;udk wifjy
xm;ygonf?
TpmapmifwiG u
f |eaf wmfw@kd onf xkid ;f jrefrme,fpyf
wavsmufYaexdkifolwdk@jzpfavhjzpfx&dSaom pdwfxd
cdu
k 'f %f&m&r_ ta=umif;udv
k nf;txl; jznfph u
G af z: jyxm;
ygonf?
The first issue of the year 2004 is very special
to us for a couple of reasons. This is the first
issue co-ordinated by our new Project
Co-ordinator, Veronique Terrasse.
Rene Queffelec, after working with us for
two and a half years, moved on to new
challenges during last December. He has been
replaced by Veronique Terrasse, who has
extensive media experience working in
Afghanistan.
This issue focus on family planning, which is
an important need for the refugees and migrants
workers. We also provide information about
contraceptives and practical tools to manage
counselling session.
We are also running a special supplement on
mental trauma in this issue, which is one of the
common problems for the people living along
Thai-Burma border.
&$iv
f ef;pGm zwf&E_ ikd yf gap!
Enjoy your reading!
av;pm;pGmjzifh
a'guw
f m oef;
t,f'w
D m
Best regards,
Dr. Than
Editor
ISSUE 23, MARCH, 2004
3
rdom;pkprD cH suo
f nfrnfonft
h a=umif;a=umift
h a&;yg&ygoenf;?
usef;rma&;apwrmeftzGJ@
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om;qufjcm;jcif;ESifhrdom;pkpDrH csufvkyfief;onf
rdbrsm;tm; rnf onfh tcsdefumvwGifuav;ta&
twGurf nfr#vv
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_ yk f ief;onf trsK;d om;ESihf trsK;d orD;wd@k .
rdom;pkta&twGuf uef@oef@ xdr;f csKyrf w
_ @kd xufvnf; ydyk g
onf? taumif;qHk; uav;&,lr_ t csdefumvESifh
uav;wa,mufEiS hf wa,muf uGmjcm;onhf tcsed u
f kd a&G;
cs,f E d k i f o nf h t jyif uav;rsm;ES i f h rd c if w d k @ .
use;f rma&;udv
k nf; ydrk kd aumif;rGef apEdik o
f nf?
rdom;pkprD cH suo
f nftrsKd ;orD;rsm;. use;f rma&;udk ydrk kd
aumif;rGeaf ponft
h jyif touftEW&m,fukd umuG,f
ay;ygonf?
•
ud,
k 0f efzsucf sru
_ kd OD;wnfapEdik o
f nfh rvdv
k m;aom
ud,
k 0f ef&&drS t
_ m; rdom;pkprD cH surf S wm;qD;Edik yf gonf?
• ud,
k 0f ef&jSd cif;tm;jzifh tE W&m,f&aSd pEdik o
f nfh tcsKd @
aom trsKd ;orD;tkypf w
k @kd twGuv
f nf; ta&;}uD;yg
onf? Ttkypf rk sm;wGif touf 1* ESpaf tmufEiS hf
touf 35 ESpt
f xuf trsKd ;orD;rsm;yg0ifygonf?
• uav; 4 a,muftxuf&aSd om trsKd ;orD;rsm; t
wGuf uk,
d 0f efwnf&jS dcif;onf tE W&m,f}u;D rm;onf?
odk@r[kwf aoG;tm;enf;aom/ 0ufoufa&m*gESifh
ausmufuyfa&m*g&dSaom trsdK;orD;rsm;twGuf
4
uav;rsm;vm+yD !
Too many children !
vnf; ud,
k 0f ef&&djS cif;onf tE W&m,f &dyS gonf?
• rdom;pkprD rH t
_ wGuf toH;k jyKaomud,
k 0f efwm;enf;
wcsK@d onf umvom;a&m*gtm; umuG,af y;jcif;jzifh
use;f rma&;udk tumtuG,af y;ygonf? uGe'f ;Hk udk
t+rJreS u
f efpmG oH;k pGjJ cif;jzifh tdwcf st
f idk Af /DG attdik 'f D
tufp/f *Edak &m*gEiS hf tjcm;umvom;a&m*g ul;puf
r_ukd enf;yg;apygonf?
rdom;pkprD cH suo
f nf uav;rsm;. touf &Sio
f efrE_ iS hf
use;f rma&; aumif;rGerf w
_ @kd udk apmifah &Smufay;Edik o
f nf?
•
•
•
•
•
om;qufjcm;jcif;tm; ud,
k 0f efwm;enf;jzifh tenf;
qH;k 2 ESpt
f xd jcm;Ixm;Edik v
f #if wpfEpS af tmufEiS hf
tjcm; uav;rsm;. aoqH;k E_e;f udk enf;yg;apEdik o
f nf?
uav;wa,mufEiS w
hf a,muf uGmjcm;onft
h csed f
umvonf 2 ESpfxuf enf;v#if wpfESpfatmuf
aoqH;k r_Ee_ ;f onf 60 rS 70 &mckid Ef e_ ;f wd;k jrifEh ikd o
f nf?
w}urd af rG;zGm;+y;D aemufxyfw}urd f jrefjrefarG;zGm;v#if
tcsed rf wdik rf DS arG;zGm;r_jzpf&ef tcGit
hf vrf;rsm;+y;D / ud,
k f
tav;csed f pHcsed rf rSD arG;zGm;Edik I
f aoqH;k &ef tcGit
hf
vrf;vnf; ydrk rkd sm;jym;onf?
uav;wOD;ESiw
hf OD; tcsed w
f u
kd mvtwGi;f eD;uyfpmG
arG;zGm;v#if aemufarG;zGm;rnfu
h av;onftouf
&Si&f ef tcGit
hf vrf; enf;yg;onf?
aemufxyfuav;arG;zGm;jcif;onfa&SŒrS arG;xm;+y;D
uav;twGuf Ed@k jzwf&+y;D tqdyk guav;tm; jyKpk&ef
trSwf=23 rwfmv 2004 ckESpf?
usef;rma&;apwref
Why is Family Planning Important?
Health Messenger Team
This article demonstrates the importance of family planning by showing how the lives of
women and children can be saved.
Each year, half a million women in developing
countries die during pregnancy or in childbirth.
Burma still has one of the highest maternal death
rates in Asia, and many of these deaths are the
result of complications from unsafe abortions.
Modern methods of contraception are not widely
used in Burma. UNFPA estimates that only 28%
of fertile-age women use a modern method of
contraception, which indicate an unmet need for
fertility control.
Family planning allows parents to choose the
number of children they want to have, when they
want to have them. It does more than just enable
women and men to limit family size. By allowing
enough space between the birth of two children
and choosing the best time to have a child, family
planning save lives and improves the health of
both women and children.
Family planning can save the lives and
improve the health of women.
•
•
•
Family planning can save the lives and
improve the health of children.
•
•
Family planning can avoid unwanted
pregnancies, which may lead to an abortion.
An unsafe abortion can cause severe illness
•
•
•
rdom;pkpDrHudef;.tusdK;aus;Zl; Benefits of Family Planning
ISSUE 23, MARCH, 2004
and even death.
It is especially important for certain groups
of women for whom pregnancy may be a
greater risk. This includes women under age
18 and those who are over 35 years of age.
Pregnancy is also a greater risk to women
who have had more than four children or to
those who have health problems such as
anaemia, heart disease, hepatitis, measles
or renal disease.
Some contraceptives used for family
planning can guard a woman’s health by
providing protection from sexually
transmitted diseases. The consistent and
correct use of condoms can lower the risk
of HIV/AIDS, gonorrhoea, chlamydia and
other sexually transmitted diseases.
•
When contraceptives are used to space
births by at least two years, infant and child
deaths can be reduced.
When births are less than two years apart,
the average chance of death during infancy
is increased by 60-70 percent.
Children born very soon after a previous
delivery are more likely to be premature.
They are more likely to have a low birth
weight, and this increases their chance of
dying.
When children are born close together, the
preceeding child is less likely to survive.
The arrival of the new baby means breast5
tcsed af y;Edik rf _ enf;aponf?
• uav;wOD;ESih f wOD; 12 v (wpfEpS )f xufenf;I eD;uyf
pGmarG;v#if t&ifuav;onf aoqH;k &eftcGit
hf vrf;
70 rS 80 &mckid Ef e_ ;f ydrk sm;onf?
• touf 18 ESpaf tmuf rdcifraS rG;aomuav;onf
aoqH;k &ef tcGit
hf vrf;ykrd sm;onf? 18 ESpaf tmuf
udk,f0efaqmifrdcifonf tcsdefrwdkifrSDESifh udk,ft
av;csdef pHcsdefrrDSaomuav;arG;&ef tcGifhtvrf;
vnf; ydrk sm;onf? tqdyk guav;onf i,f&,
G pf Of
aoqH;k &ef eD;pyfonf?
• uav; 4 a,muftxuf&Sd rdcifonf aemufxyfu
av;arG;ygu/ xdkuav;onfwESpftwGif; ao&ef
tcGifhtvrf;rsm;onf? rdciftouf}uD;avav
tqdyk g tcGit
hf vrf;rsm;avavjzpfonf? touf 35
ESpftxufrdcifrsm;onfvnf; rdcifa&m uav;yg
tE W&m,fyrk d rk d sm;jym;onf?
rdom;pkprD cH suo
f nfro
d m;pkom,mr_ut
kd axmuf tul
jyKonf
•
use;f rma&;ESihf jynfph o
kH nfu
h av;ta&twGuf enf;
aom ZeD;armifEo
HS nf tpm;tpm/ t0wftxnf/
aetdrfESifh ynmoif=um;a&;tcGifhtvrf;rsm;udk
uav;rsm;tm; ykrd jkd znfq
h ;D ay;Edik o
f nf?
• oaE<wm;enf;oH;k I rvdv
k m;onfh ud,
k 0f ef r&Edik f
aoma=umifZh eD;armifEo
HS nf vdirf _ udpPudk tjynft
h 0
ydrk ckd pH m;Edik o
f nf?
• rdom;pkprD cH suo
f nf rdom;pk. tE W&m,f t}uD;
rm;qH k ; jzpf o nf h rd c if a oqH k ; r_ u d k umuG , f & ef
tul t nD ay;Ed k i f o nf ? rd c if o nf rd o m;pk .
pdwfydkif;ESifh&kyfydkif;qddkif &m om,mr_&&dSa&;twGuf
ta&;yg+y;D rdom;pk pDrH ude;f onf rdcif.use;f rma&;udk
taxmuftul ay;onf?
use;f rma&;jynfph o
kH nfu
h ,
dk 0f ef
pdwcf s&aom ud,
k 0f efonfrcd if.touf/ vuf&u
Sd av; ta&twGu/f uav;wOD;ESiw
hf OD; om;qufjcm;aom
umvwd@k onf ta&;ygaomtcsurf sm; jzpfonf? rdcif tE W&m,fenf;yg;ap&ef atmufyguo
hJ @kd ud,
k 0f ef&&djS cif;rS
a&Smif&mS ;&rnf?
•
i,f&,
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f iG f ud,
k 0f efaqmif
jcif;? ? touf 18 rjynfrh DS ud,
k 0f efaqmifv#if
tqdyk gred ;f uav;. cE<mud,
k o
f nf t&G,rf &ifh
tqifoifhrjzpfao;onfh tajctaea=umifh
tEW&m,f rsm;onf?
• toufvGefpGm}uD;aomt&G,fwGif udk,f0ef
aqmifjcif;? ? touf 35 ESpt
f xuf ud,
k 0f ef
aqmifv#if ud,
k 0f ef zGm;jcif;ESihf arG;zGm;jcif;.
'%fcsurf sm;tm; cHEikd af & r&dI
S tE W&m,frsm;
onf? 35 ESpt
f &G,rf cd if aoE_e;f onf 20 - 29
rl&if; - Source: WEAVE
ESpt
f &G,f rdcifaoE_e;f xuf 5 q ydrk rkd sm;jym;
onf?
• t}urd rf sm;pGmuk,
d 0f efaqmifjcif;? ? ud,
k 0f efaqmifr_ 4 }urd x
f ufyv
kd #if w}urd x
f ufw}urd f ydI
k ydI
k aoqH;k r_
tE W&m,f/ &_waf xG;r_tE W&m,f rsm; vmonf?/ uav; 2 a,mufrS 3 a,mufarG;+y;D olxuf uav; 5
a,muftxufarG;+y;D onfrh cd if aoE_e;f tE W&m,fonf 1Œ5 q rS 3 q ykd rsm;onf?
• uav;vGepf mG eD;jcif;? ? trs;kd orD;wOD;taejzifh ud,
k 0f efw}udraf qmifonfh tcsed u
f mvrS aemufw}udrf
ud,
k 0f efaqmifonfh tcsed =f um;wGif tem;&&ef vkt
d yfonf? 2 ESpx
f uf enf;+yD; om;qufv#if rdcif
ESiu
hf av;.use;f rma&;twGuf tE W&m,frsm;onf?
(use;f rmaomrdcif/ use;f rmaomuav;-'bvsLtdwt
f kd 1991 )
6
trSwf=23 rwfmv 2004 ckESpf?
usef;rma&;apwref
•
•
•
feeding stops and the mother has less time
to care for the older children.
When children are born less than 12 months
apart, the risk of death for the preceding
child is increased by 70 -80 percent.
Infants born to mothers under age 18 are at
a greater risk of dying. A woman under
age 18 is more likely to give birth
prematurely, with an underweight baby. The
higher risk of death for these babies
continues through childhood.
Infants born to mothers who already have
four or more children are at greater risk of
dying. The higher risk may be related to
maternal age. Births to mothers above age
35, pose a greater risk for both the mother
and infant.
Family planning improves the family’s well
being.
•
•
•
}u;D xGm;aomae&mjcm;pku
d jf cif;ESiahf o;i,faomuyfpu
kd o
f nfrh ek v
f mO
Healthy spaced carrot compared to unhealthy unspaced carrot
Couples with fewer and healthier children
are usually better able to provide for their
children and themselves with adequate food,
clothing, housing and educational
opportunities.
With a contraceptive method, couples can
enjoy their sexual relations more because
they do not have to fear an unwanted
pregnancy.
Family planning can help avoid one of the
most traumatic events for a family, which is
the death of a mother. A mother is vital to
the family’s emotional and physical well
being, and family planning can help ensure
a mother is healthy.
A healthy pregnancy
The mother’s age, the number of children and the space between two births are important
factors for a safe pregnancy. To minimise the risks women should avoid getting pregnant
•
•
•
•
Too early: before 18 years old, young women face greater risks during pregnancy
because their bodies are not fully mature.
Too late: after 35 years old, women face greater danger in childbirth and delivery,
because their bodies might not stand the burden of pregnancy and delivery. Maternal
death is five times higher after 35 years old than it is between 20-29 years old.
Too many times: risks of death and complication increase for each birth after the
fourth. The risk of maternal death is 1.5 to 3 times greater for women with five children
or more than for women with two or three children.
Too close together: a woman’s body needs to recover after each pregnancy. There
is more heath risks for both mothers and children when a pregnancy comes less than
two years after the previous one.
(Healthy mother, Happy Baby, WHO 1991)
ISSUE 23, MARCH, 2004
7
trdsd K;rsKd ;aomoaE<wm;enf;rsm;rSmtb,fenf;?
usef;rma&;apwrmeftzGJ@
azmfjyyg aqmif;yg;wGif trsK;d rsK;d aom oaE<<wm;aq;rsm;udk +cHKiH+k yD; az: jyxm;I cE<<mud,
k x
f w
J iG f rnfuo
hJ @kd
vkyaf qmifonfukd &Si;f jyxm;onf? (rnfuo
hJ @kd vkyaf qmifonfEiS hf cE<<mud,
k x
f w
J iG f rnfuo
hJ @kd ud,
k 0f efukd
wm;qD;a=umif; &Si;f jyxm;onf)?
rdom;pkprD u
H ed ;f onf oaE<<wm;enf;rsm;pGmudk oH;k pG&J ef
ay;xm;ygonf? tqdyk genf;rsm;rSm obm0 oaE<<wm;
enf; rsm;rS om;a=umjzwfenf;ESiahf &wdek nf;rsm;jzpfaom
ae@pOfo;kH pm;aq;rSa&&Snef nf;rsm;jzpf=uaomxd;k aq;rsm;
om;tdrx
f x
J nfo
h nfyh pPnf;rsm; ta&jym;atmuf xJh
onfyh pPnf;rsm; od@k r[kwf twm;tqD;enf;rsm;jzpfonf?
ZeD;armifEt
HS m;vH;k wd@k twGuf taumif;qH;k enf;wck
[lI r&daS y? trsKd ;orD;wk@d .rsKd ;yGm;Edik o
f nfh oufwrf;w
av#mufwiG f use;f rma&;/ vlra_ &;ESiu
hf ,
kd yf ikd f tajctae
rsm;t& oifah v#maf omenf;rsm;udk a&G;cs,Ef ikd yf gonf?
a&G;cs,&f ef rsm;jym;us,jf yef@aom oaE<wm;enf; qdk
onfrmS ZeD;armifErHS sm;/ trsKkd ;orD;rsm;taejzifh od=um;
xm;jyD;rSom a&G;cs,rf j_ yK&eftwGuf use;f rma&;0efxrf;
rsm;wGif ta&;ygaom vkyfief;rsm;&dSaejcif;jzpfonf?
tqdyk g tcsuw
f iG f wdusjywfom;aom &Si;f vif;ajymjycsuf
rsm;/ trsKd ;orD;wdik ;f aocsmpGmem;vnfoabmaygujf cif;/
tjcm;oaEE<wm;enf;rsm;
ud,
k 0f efrwnfatmif wm;qD;&mwGif aq;0g;rsm;/ "gwyk pPnf;rsm;ESihf ud&,
d mrsm; toH;k jyK&ef vdt
k yfjcif; r&do
S nfh
enf;rsm;udk obm0enf;jzifh oaE<wm;jcif; [kac:onf?
tqdyk genf;rsm;onftrsK;d orD;wOD;taejzifrh rd rd nfonft
h csed w
f iG f ud,
k 0f efwnfEikd o
f nfukd od&aSd p+y;D / 4if;umv
twGi;f rdr.
d taz: ESihf vdiq
f ufqrH u
_ kd a&Smif&mS ;Edik &f efjzpfonf?
obm0enf;jzifh oaE<wm;aomenf;onf tjcm;enf;rsm;/ (Oyrm - a[mfrek ;f toH;k jyKaomenf; od@k r[kwf
om;tdrx
f x
J nfah omypPnf;/ aemfyvef@) ponfw@dk avmuf xda&mufr_ pdwcf s&r_ r&daS y?
⇒ rdcifE@kd wu
kd af epOf vpOfaoG;ay: r_r&dS jcif; (ToaE<wm;enf;onf arG;zGm;+y;D aemuf "rRwmaoG;ay:r_r&db
S J
rdcifonf 6 vtxd rdcifE@kd wckwnf; wdu
k af u|;v#if &&dES ikd o
f nf?)
⇒ pD;csuf 0g;csuf od@k r[kwf jyuQ'deef nf; - trsKd ;orD;. vpOfaoG;ay:r_ tcsed Zf ,m;t&/ oaE<wnfEikd o
f nfh
&ufrsm;ESio
hf aE<rwnfEikd o
f nfh &ufrsm;udk wGucf suaf om enf;jzpfonf? ( pmapmif 21 pmrsuef m 33 =unf)h
⇒ om;tdraf cgi;f c|eJ nf; - om;tdraf cgi;f &daS om c|.
J taetxm;udk =unf+h yD; oaE<wnfEikd o
f nf&ufrsm;
oaE<rwnfEikd o
f nf&h ufrsm;udk wGuaf omenf;
⇒ tajccHudk tylcsed w
f ikd ;f enf; - tajccHtrsKd ;orD;.cE<mudk tylcsed t
f ajymif;v$u
J kd avhvmI oaE<wnfEikd f
onf&h ufrsm;ESihf oaE<rwnfEikd o
f nf&h ufrsm;udk wGucf suaf omenf;jzpfonf
txufygenf;rsm;onf cef@reS ;f csurf sm;jzpf+yD; rSm;,Gi;f r_ tvGerf sm;Edik o
f nf?
8
trSwf=23 rwfmv 2004 ckESpf?
usef;rma&;apwref
What are the D ifferent
C ontraceptive M ethods?
Health Messenger Team
The following article gives an overview of the different types of contraceptive methods and
their mode of action inside the body (what they are and what they are doing inside
the human body to prevent pregnancy).
Family planning offers many different
contraceptive methods. They vary from natural
contraception to sterilisation and from shortacting daily oral pills to long-acting injectables,
intrauterine devices, implants or barrier
methods.
No one method is best for all couples.
Throughout their reproductive lives, women will
choose the most appropriate methods according
to their health, social and personal criteria.
The wide choice of contraceptive methods
means that health workers have a crucial role in
guiding couples and women to make informed
choices. This involves providing clear
explanations of the methods available, and
Other forms of contraception:
Natural methods of family planning attempt to prevent pregnancy without the use of any
devices or chemicals or medicines.
These methods help a woman know when she is fertile (able to become pregnant), so she
can avoid having sex with her partners at that time.
They are less reliable than other methods such as hormonal methods, IUD, or Norplants...
⇒
⇒
⇒
⇒
Lactational Amenorrhea method (LAM) : contraception achieved by exclusively
breast feeding baby for up to 6 months after birth provided the woman’s menses
have not returned yet
Rhythm or calendar Method: calculating fertile and infertile days according to the
length of the woman’s menstrual cycles. (See issue 21 page 33 for rhythm methods
and menstruation cycle)
Cervical mucus methods: calculating fertile and infertile days by the change of
character of the cervical mucus.
Basal Body Temperature (BBT): calculating fertile and infertile days by observing
changes in the woman ‘s basal body temperature.
All those methods are approximated and have a high failure rate!!
ISSUE 23, MARCH, 2004
9
enf;rsm;.qd;k usKd ;ESit
hf medoiftusKd ;oufrr_ sm;udk odjcif;
wd@k yg0ifonf? Tpmapmifr*~Zif;wGif t"du atmifjrifr_
&&daS eaom oaE<wm;enf;rsm;udk tav;xm; az: jyygrnf?
ae&mtcuftcJa=umifh obm0enf;uJhodk@ enf;rsm;udk
tusOf;r#om az: jy&ef qHk;jzwfxm;ygonf? (atmuf
wGiaf bmifcwfxm;onfu=kd unfyh g)
xdak q;toGio
f ;kH Edik o
f nfo
h aEE<wm;aq;rsm;
[krd ek ;f 2 rsKd ;ygoaEE<wm;xd;k aq;
rnfonft
h &mjzpfoenf;?
a[mfrek ;f tDpwd*k siEf iS yhf &d*k supf wd*k si[
f I
l 2 rsKd ; yg0if
onf?
'kuQonfpcef;rsm;wGif oH;k pGo
J nfh oaEE<wm;aq;rsm;
ta=umif; +cHKikaH vhvmjcif;
euf&i_d ;f aomtom;aq;tjzpf wvv#iw
f }udrx
f ;dk
&onf?
a[mfrek ;f ESprf sKd ;ygoaEE<wm;pm;aq;
rnfonft
h &mjzpfoenf;?
a[mfrek ;f tDpwd*k siEf iS yhf &d*k supf wd*k si[
f I
l 2 rsKd ; yg0if
onf?
rnfuo
hJ @kd vyk af qmifoenf;?
Otdrrf S om;Oxkwjf cif;udk &yfap+yD; om;tdraf cgi;f &dS
c|rJ sm;udk ap;jypfxx
l aJ pI okwyf ;kd rsm; om;tdrx
f o
J @dk
0ifa&mufjcif;rjyKEdik af p&ef tumtuG,af y;onf?
rnfuo
hJ @kd vyk af qmifoenf;?
Otdrrf S om;Oxkwjf cif;udk &yfap+yD; om;tdraf cgi;f &dS
c|rJ sm;udk ap;jypfxx
l aJ pI okwyf ;kd rsm; om;tdrx
f o
J @dk
0ifa&mufjcif;rjyKEdik af p&ef tumtuG,af y;onf?
y&d*k supf w
f *kd siw
f rsKd ;wnf;yg oaEE<wm;pm;aq;
rnfonft
h &mjzpfoenf;?
y&d*k supf wd*k siaf [mfrek ;f wrsKd ;wnf;yg0ifonf?
rnfuo
hJ @kd vyk af qmifoenf;?
om;tdraf cgi;f &dcS |rJ sm;udk ap;jypfxx
l yfapI okwyf ;kd rsm;
y&d*k supf w
f *kd siw
f rsKd ;wnf;ygoaEE<wm;xd;k aq;
rnfonft
h &mjzpfoenf;?
y&d*k supf wd*k siaf [mfrek ;f wrsKd ;wnf;yg0ifonf?
rnfuo
hJ @kd vyk af qmifoenf;?
om;tdraf cgi;f &dcS |rJ sm;udk ap;jypfxx
l yfapI okwyf ;kd rsm;
om;tdrx
f o
J @dk 0ifa&mufjcif; rjyKEdik af p&ef tumt
uG,af y;onf? tqdyk gaq;onfOtdrrf S rsKd ;Oxkwjf cif;
udv
k nf; tawmftwef wm;qD;aponftjyif om;
tdrfESifhjyGefrsm;wGifvnf; rsdK;ratmif&ef tajctae
jzpfaay:aponf?
ta&jym;atmufxnfo
h nfyh Pnf; (aemfyvef@)
rnfonft
h &mjzpfoenf;?
trsdK;orD;.vufarmif;.tay:ydkif;/ atmufydkif;
od@k r[kwf qD;cH;k &d;k tay: ta&jym;atmufwiG f xm;&dS
+y;D ydu
k if ,frS y&d*k supf wd*k sit
f m; wjznf;jznf; xkwaf y;
onf? xnfo
h iG ;f &efEiS hf jyefvnfxw
k &f ef oif wef;&+y;D
u|r;f usio
f l vkyd gonf?
om;tdrx
f o
J @dk 0ifa&mufjcif; rjyKEdik af p&ef tum t
uG,af y;onf? tqdyk gaq;onf Otdrrf rS sKd ;Oxkwjf cif;
udv
k nf; tawmftwef wm;qD;aponftjyif om;
tdrEf iS jhf yGerf sm;wGiv
f nf; rsKd ;ratmif&ef tajc tae
jzpfaay:aponf?
10
rnfuo
hJ @kd vyk af qmif oenf;?
om;tdraf cgi;f &dcS |rJ sm;udk ap;jypfxx
l yfapI okwyf ;kd rsm;
om;tdrx
f o
J @dk 0ifa&mufjcif; rjyKEdik af p&ef tumt
uG,af y;onf? tqdyk gaq;onf Otdrrf S rsKd ;O xkwjf cif;
udv
k nf; tawmftwef wm;qD;aponftjyif om;
tdrEf iS hf jyGerf sm;wGiv
f nf; rsKd ;ratmif&ef tajctae
jzpfaay:aponf?
trSwf=23 rwfmv 2004 ckESpf?
usef;rma&;apwref
making sure every woman or couple understand
the side effects and the effectiveness of the
methods. In this magazine, we will focus on
the methods of contraception with the highest
rates of success. For space reason we are
only giving an overview of the other forms
of contraception called ‘’natural methods’’.
(See box page 7.)
Overview of the contraceptive methods
available in the camps
Combined injectable contraceptive (CIC)
What is it?
Contains 2 hormones, oestrogen and
progestogen, administered by deep
intramuscular injection at monthly intervals.
What does it do?
Stops ovulation and thickens the cervical
mucus, which prevents sperm from entering
the uterus.
Progestogen injectable contraceptive (PIC)
Combined oral contraceptive (COC)
What is it?
Contains 2 hormones, oestrogen and
progestogen.
What does it do?
Stops ovulation and thickens the cervical
mucus, which prevents sperm from entering
the uterus.
Progestogen oral contraceptive (POC)
What is it?
Contains progestogen.
What does it do?
Thicken the mucus, which prevents sperm
from entering the uterus. It also prevents
ovulation to some extend and causes changes
in the uterus and fallopian tubes, which
prevent fertilisation.
ISSUE 23, MARCH, 2004
What is it?
Contains progestogen.
What does it do?
Thicken the cervical mucus, which prevents
sperm from entering the uterus. It also
prevents ovulation to some extend and causes
changes in the uterus and fallopian tubes,
which prevent fertilisation.
Subdermal implants (Norplant)
What is it?
Contains progestogen which is slowly
released from capsules implanted under the
woman’s skin, usually at the upper arm, lower
arm or supra pubic. It s insertion and removal
11
om;tdrx
f x
J nfah omyPnf; (tdik ,
f 'l )D
rnfonft
h &mjzpfoenf;?
om;tdraf cgi;f rSwqifh om;tdrt
f wGi;f od@k xnfah om
ao;i,fonfyh vyfpwpfu&d ,
d muav;wckjzpfonf?
a=u;eD"gwf od@k r[kwf y&d*k supf wd*k siaf [mfrek ;f udk om;
tdrx
f o
J @kd wjznf;jznf;xkwaf y;onf?
rnfuo
hJ @kd vyk f aqmifoenf;?
tdik ,
f 'l o
D nfow
k yf ;kd rsm;ukd +idro
f ufaponfh tpGr;f
&d+S yD; trsKd ;orD;rsKd ;yGm;t*F gvrf;a=umif; ae&mrsm;od@k
oGm;vmjcif;r&daS p&ef [ef@wm;onf? tdik ,
f 'l o
D nf
om;tdrEf iS jhf yGerf sm;udv
k nf; tajymif;tv$J jzpfay:ap
+yD; rsKd ;OESihf okwyf ;kd aygi;f pyfatmifjrifru
_ kd umuG,f
onf?
twm;tqD;oHk;aomenf;rsm;
uGef'Hk;rsm;
cGpJ yd jf cif;jzifo
h aEE<wm;enf;rsm; -trsKd ;om;ESihf trsKd ;orD;
rsm;om;a=umjzwfjcif;
trsdK;om;ta=umjzwfjcif;
rnfonft
h &mjzpfoenf;?
uyfyg,f (a0S;ap) tdy2f tdyaf b;zufw@kd wiG f ao;i,f
aom cGaJ =umif;ay;+yD; okwaf =umukd &SmazGxw
k af z:
onf? xkad emuf jzwfjcif;/ csjD cif; od@k r[kwf nSyjf zifn
h yS f
jcif; wckcjk yKvkyo
f nf?
rnfuo
hJ @kd vyk af qmifoenf;?
trsd K ;om;.ok w f v $ w f a =umuk d yd w f q d k @ tm;jzif h
okwyf ;kd wd@k ukd okw&f nfw@kd raygi;f ap&efEiS hf vdiw
f o
H @kd r
a&mufap&ef wm;jrpfonf?
rnfonft
h &mjzpfoenf;?
qvif'gxv
k ;kH yHak vwufa&mfbmtpGyw
f ckjzpf+yD;vdif
qufqHonfhumv tcsdeftykdif;tjcm; trsdK;om;
vdiw
f rH mpOfwiG f pGyx
f m;&efjzpfonf?
rnfuo
hJ @kd vyk af qmifoenf;?
trsKd ;orD;.arG;vrf;a=umif;xHo@kd okwyf rkd sm;ta&muf
&d&S ef wm;qD;onf? uGe'f ;kH wGiyf g&o
Sd nfh okwyf ;kd owfaq;
acsmqDonf okwyf ;kd rsm;udk v_y&f mS ;r_enf;yg;+idro
f uf
aponf?
12
trsKd ;orD; om;a=umjzwfjcif;
rnfonft
h &mjzpfoenf;?
ao;i,faomcGpJ yd af =umif;ay;jcif; od@k r[kwf tayguf
azgujf cif; jyK+yD;om; tjyGew
f @kd xHa&mufatmif vky+f yD;
aemuf jzwfjcif;/ csjD cif; ok@d r[kwf nSyf jcif;wckcjk yKvkyf
onf?
rnfuo
hJ @kd vyk af qmifoenf;?
trsK;d orD;. om;tdrjf yGerf sm;udk ydwq
f @kd jcif;jzifh om;
Otdrrf x
S w
k af om trrsKd ;Oonf okwyf ;kd ESiahf ygi;f pyfjcif;
rjyKEdik af y?
trSwf=23 rwfmv 2004 ckESpf?
usef;rma&;apwref
No method of contraception is 100 %
effective - sterilisation offers the best
chance at 99.99 % effectiveness
(depends on the surgical procedures etc.)
requires a trained person and last up to 5
years.
What does it do?
Thicken the cervical mucus, which prevents
sperm from entering the uterus. It also
prevents ovulation to some extend and causes
changes in the uterus and fallopian tubes,
which prevent fertilisation.
IUD
What does it do?
Block s the release of sperm into the vagina.
The spermicide lubricant in the condom also
activates or kills sperm.
Vasectomy
What is it?
A small incision made on both side of the
scrotum to expose the vas deferens which is
then cut tied or clipped.
What does it do?
Blocks the vas deferens in the male so that
sperm cannot travel to the penis with semen.
Sterilisations are permanent methods
and require consent and make sure
patient understand they are irreversible
and need anaesthesia and hospitalisation
Female sterilisation
What is it?
A small plastic device inserted into the uterus
through the cervix. The copper or
progestogen is slowly released in the uterus.
What does it do?
Inactivates the sperm and prevents sperm
migration into the female genital tract. The
IUD also causes changes in the uterus and
fallopian tubes, which prevent fertilisation.
What is it?
Puncture or small incision made to the
abdomen to gain access to the fallopian tubes,
which are then cut, tied or clipped.
Condoms
What is it?
A cylindrical latex sheath worn over the penis
during intercourse.
What does it do?
Blocks the fallopian tubes in the female so
that the eggs produced by the ovaries cannot
unite with the sperm.
ISSUE 23, MARCH, 2004
13
Process of pregnancy
Pregnancy means having children. It is also the condition of having a developing embryo or foetus
in the body, after union of an ovum (egg from female) and spermatozoon (sperm from male).
Ovulation and sperm production: The ovaries on both sides of a woman’s womb produce ova
(eggs) and the testes of a man produce sperms.
Fertilisation
A woman’s body makes an egg that travels through one of the tubes into the womb. The
father’s body makes a seed (sperm). When he and a woman have sex, his seed travels up into
the womb and meets the woman’s egg. The egg and seed together form a baby that grows
inside the womb.
oaE<<om;jzpfay:yHt
k qifq
h ifh
ud,
k 0f efqo
kd nfrmS uav;&jcif;[k qdEk ikd o
f nf? a,muFsm;.okwyf ;kd ESihf rde;f r. rsK;d Owd@k aygi;f pyfonft
h cgwiG f
oaE<om;avmif; jzpfay: jcif; tajctaeudk oaE<om;jzpfay:yHk tqifq
h if[
h k ac:Edik o
f nf?
trrsK;d O Ojcif;ESihf okwyf ;kd jzpfay: jcif; qdo
k nfrmS rde;f r. O tdrf 2 ck wd@k rSm rrsK;d Oa=uGjcif;ESihf a,muFsm;.a0S;aphrS
okwyf ;kd xkwv
f yk jf cif;jzpfonf?
oaE<atmifjcif;/ om;orD;jzpfxeG ;f jcif;
rde;f r. cE<mud,
k rf S r rsK;d Oudk a=uGap+yD; om;tdrjf yGet
f wdik ;f om;tdru
f ,
kd x
f nfyikd ;f od@k a&muf&adS ponf? zcif.
cE<mud,
k rf S tzdo
k w
k yf ;kd udk jzpfay:aponf? a,muFsm;ESihf rde;f r vdiq
f ufqv
H #if tzdo
k w
k yf ;kd onf trrsK;d OESihf
om;tdrw
f iG f awG@q+kH yD; om;orD; jzpfxeG ;f aponf?
1. a,muFsm;okwyf ;kd ESirhf rsKd ;O
Sperm and ovum
2. oaE<atmifjcif; Fertilisation
om;tdrftwGif;ydkif;
om;tdrftwGif;ydkif;
oaE<atmifjcif;
rrsKd;O
okwfydk;
rrsKd;O
om;tdrftajrS;
om;tdrftajrS;
om;tdraf cgi;f
om;tdraf cgi;f
om;tdrftwGif;ydkif;
oaE<atmifjcif;
oaE<wnfjcif;
okwfydk;
rrsKd;O
Implementation
om;tdrftajrS;
om;tdraf cgi;f
3. oaE<tjzpfom;tdrx
f aJ &mufykH
Zygote (egg+sperm) implemented inside uterus
14
trSwf=23 rwfmv 2004 ckESpf?
usef;rma&;apwref
EMERGENCY CONTRACEPTION
It refers to contraceptive methods that can be used by women in the first few days following
unprotected intercourse for various reasons (rape, condom’s breakage, women forgetting to
take their pills, etc..) so as to prevent an unwanted pregnancy. They are effective and safe for
the majority of women who need them, as well as being simple to use.
Methods for emergency contraception are:
(1) Increased doses of Combined Oral Contraceptives (COC) - ethinylestradiol &
levonorgestrel
- Eugynon 50/ Marnon First dose 2 tablets ......Second dose (12 hours later) 2 tablets
or - Microgynon/ AnNa First dose 4 tablets ......Second dose (12 hours later) 4 tablets
(2) High doses of Progestogen-Only Pills (POP)
- Madonna/ Postinor First dose 1 tablet ...... Second dose (12 hours later) 1 tablet
or- Microlut/ Norgeston First dose 25 tablets ......Second dose (12 hours later) 25 tablets
or- Ovrette
First dose 20 tablets ......Second dose (12 hours later) 20 tablets
(3) Copper-releasing intrauterine devices (IUDs)
- Copper-releasing IUD can be used within 5 days of unprotected intercourse as an
emergency contraceptive. It should be kept in mind that the insertion of an IUD in nulliparous
(having never given birth) women may be painful so pill may be better choice for them. IUDs
should be inserted by the trained staff.
ta&;ay:oaE<<wm;jcif;
ta&;ay:oaE<wm;jcif; qdo
k nfrmS rvdv
k m;onfu
h ,
kd 0f efukd umuG,w
f m;qD;&ef ta=umif;trsKd ;rsK;d a=umifh (t"rRjyK
usichf &H jcif;/ uGe'f ;kH uGo
J mG ;jcif;/ oaE<wm;aq; aomuf&efarhavsmjh cif;) tumtuG,rf v
hJ id q
f ufqchH +J yh ;D aemuf&uft
enf;i,ftwGi;f toH;k jyKEikd af om oaE<wm;enf;rsm;udq
k v
kd o
kd nf? tqdyk genf;rsm;onf &d;k +y;D vG,u
f o
l uJo
h @kd oH;k pG&J ef
vkt
d yfot
l rsm;pktwGuv
f nf; tusKd ;&d+S yD;pdwcf s&onf?
ta&;ay:oaE<wm;enf;rsm;rSmatmufygtwdik ;f jzpfonf?
(1)
a[mfrek ;f 2 rsKd ;ygoaE<wm; pm;aq;udw
k ;kd jriS o
hf ;kH pGjJ cif; (tDoEdik ;f tufpw
f &m'Datmvf ESihf vDAEkd *kd supf w
f &,fv)f
- ,l*ikd Ef eG f 50ΠrmEGef
yxr t}urd f 2 jym; 'kw,
d t}urd f (12 em&Dt=um) aemufxyf 2 jym;
- rdik u
f &d*k ikd Ef eG Œ
f tifem
yxr t}urd f 4 jym; 'kw,
d t}urd f (12 em&Dt=um) aemufxyf 4 jym;
(2)
y&d*k suw
f *kd siw
f rsKd ;wnf;ygprG ;f tm;jriS o
hf aE<wm;pm;aq;
- ruf'edk mŒaygph wDem
yxr t}urd f 1 jym; 'kw,
d t}urd f (12 em&Dt=um) aemufxyf 1 jym;
- rdik u
f &dv
k yG Œ
f aemf*supf w
f eG f
yxr t}udrf 25 jym; 'kw,
d t}udrf (12 em&Dt=um) aemufxyf 25 jym;
- tdAk &f ufwf (Ovrette)
yxr t}urd f 20 jym; 'kw,
d t}urd f (12 em&Dt=um) aemufxyf 20 jym;
(3)
a=u;eD"gwyf gaom om;tdrx
f x
J nfo
h nfyh pPnf; (om;tdr*f iG ;f )
- tqdyk gypPnf;onftumtuG,rf v
hJ id q
f ufq+hH y;D aemuf 5 &uftwGi;f ta&;ay:oaE<wm;aq;tjzpftoH;k jyKEikd o
f nf?
uav;rarG;bl;onfhtrsdK;orD;rsm;twGufom;tdrf*Gif;xnhf&mwGifemusifapEkdifonfhta=umif;udkowdjyK&rnf?/
tqdo
k l wd@k twGupf m;aq;onfyrkd t
kd qifajyvdrrhf nf? om;tdr*f iG ;f onfoifwef;f &&d+S y;D olrsm;omxnfo
h ifo
h nf?
ta&;ay:oaE<wm;enf;jzpf&yfavhvmjcif;udk use;f rma&;apwrmef r8~Zif; trSwf 21 wGi=f unf&h _ yg?
rl&if;/ rdom;pkprD u
H ed ;f ESiv
hf l OD;a&/ 'bvsL/ tdwcf s/f tdk 1998
ISSUE 23, MARCH, 2004
15
t"duoaE<wm;enf;rms ;.tm;omcsufESifhtm;enf;cu
s frsm;
usef;rma&;apwrmeftzGJ@
trsK;d rsK;d aom ud,
k 0f efwm;enf;rsm;.tm;omcsuf tm;enf;csurf sm;udo
k ;kH pGo
J rl sm;ESihf
ulnaD qmif&u
G af y;aomolrsm; aoaocsmcsm em;vnfoifo
h nf? TZ,m;onf tm;omcsuEf iS hf
ab;xGuf qd;k usK;d rsm;udv
k nf; wifjyxm;onf
az: jycsuf
tm;omcsurf sm;
tm;enf;csurf sm;
a[mfrek ;f 2
rsK;d ygoaE<wm;pm;aq;
• tvGex
f ad &mufr&_ o
Sd nf • qD;csK/d aoG;wd;k / ESv;kH /
• vpOfaoG;qif;r_enf;jcif;/
• aoGtm;enf;jcif;udk
toJa&m*gEiS t
hf ouf 40
tcsed w
f jkd cif;ESiahf oG;qif; r_
av smeh nf;apekid o
f nf
txuf trsK;d orD;rsm;
yHrk rkejf cif;aoG; tuGujf y
odk@r[kwf umuG,fekdif
twGuf roifah vsmyf g
jcif;
onf
• rdcifE@kd wdu
k af u|;onfh t • tefcsijf cif;/rsm;aom tm;
• om;OtdrEf iS o
hf m;tdrf
&nftaoG;udak vsmah p
jzifh 1 vod@k r[kw2f v
twGi;f ykid ;f uifqmjzpfymG ;
onf
twGi;f aysmufEikd o
f nf
r_ukd avsmah pEdik o
f nf
• ae@pOfaq;aomuf&ef vdk • tenf;i,facgi;f rl;jcif; jzpf
onf?
avh&o
Sd nf
• umvom;a&m*gEiS t
hf w
d f
cst
f ikd Af /DG attdik 'f t
D ufpf
udu
k muG,rf r_ ay;
• ae@pOfaq;aomuf&efvkd
y&d k * suf p wd k * sif w rsKd ; • xda&mufr&_ Sd
• "rRwmaoG;rrSejf cif;jzpfEik d f
•
rd
c
if
E
@
k
d
w
u
k
d
p
f
Of
o
if
a
h
v#
m
f
wnf;ygoaE<wm;
• [krd ek ;f 2 rsK;d ygoaE<wm; • a[mfrek ;f 2 rsK;d ygoaE< wm;
pm;aq;
xufxad &mufenf; onf
aq;tm;cHEikd &f nfr&dS aom
trsK;d orD;rsm;twGuf
ay;oifh onf
• aq;&yf&yfjcif;uk,
d 0f ef&
ab;xGuq
f ;kd usK;d rsm;
ta&;}u;D onfrh w
S cf suf
az: jyygab;xGufqdk;usKd;rsm;
onftE W&m,fr&dyS g/ rsm;aom
tm;jzifv
h tenf;i,ftwGik ;f
aysmufuif;jcif;od@k r[kwf tjzpf
enf; oGm;r_&w
Sd wfonf
atmuf y gwd k @ ud k a wG @ &d S v #if
usef ; rma&;0ef x rf ; rsm;ES i f h
wdik yf if+y;D aq;ud&k yfyg
• yif;xefpmG acgi;f udu
k jcif;od@k r
[kwt
f jrif0g;jcif;(aoG;wd;k )
• ajc/ vufrsm;wGix
f jkH cif; od@k r
[kwt
f m;enf;Iro,f
vdjk cif;(qD;csK)d
• touf&=_ uyfIjyif; xefpmG
&ifatmifjh cif; (ESv;kH )
• ajcwacsmif;wnf;jyif; xef
pGmemusijf cif; (aoG;cJ)
• aoG;cJa&m*g/ ESv;kH a&m*g/ av
jzwfa&m*gEiS t
fh oJa&mif
jcif;/ rsuaf ph0gjcif;od@k r[kwf
tom; 0gjcif;&dS (toJ)v#i/f
a[mfrek ;f 2 rsK;d yg oaE<wm;
aq;r pm;ygEiS hf
• aoG;qif;yHrk rkejf cif;aoG;
tuGujf yjcif;
• vpOfreS rf eS af oG;ray: jcif;
• wcgw&Hacgi;f udu
k jf cif;
• udk,ftav;csdefwdk;
a[mfrek ;f 2 rsK;d yg
oaE<wm;xd;k aq;
• tvGex
f ad &mufr&_ o
Sd nf? • a[mfrek ;f 2 rsK;d ygoaE< wm; • txufaz: jyyga[mfrek ;f 2 • rdcifE@kd wu
kd pf Of a[mf rke;f 2rsK;d
• aoG;tm;enf;r_uekd nf;
pm;aq;twkid ;f jzpfonf
rsK;d ygoaE<wm;pm;aq;
ygoaE<wm;xd;k aq; rpygEiS hf
• vkt
d yfonfah q;tm;xd;k
apjcif;od@k r[kwf
twkid ;f jzpfonf
od@k aomfE@kd jzwf+yD;v#io
f ;kH Edik f
ay;&efusG r;f usio
f nfo
h if
umuG,jf cif;
wef;wuf+yD;olvt
kd yf.
y&d*k supf w *kd siw
f rsK;d
wnf;ygoaE<wm;
xd;k aaq;
• tvGex
f ad &mufr&_ o
Sd nf
• aoG;tm;enf;r_uu
kd m
uG,fonf
• rdcifE@kd wu
kd rf cd ifrsm;ESihf
oifhavsmfonf
16
• ud,
k 0f ef&&efaemufq;kH xd;k •y&d*k supf w *kd siw
f rsK;d
aq;jzwf+y;D tenf;qH;k 3 v wnf; ygoaE<wm;pm;
apmif&h rnf
aq;t wdik ;f jzpfonf
• vkt
d yfonfah q;tm;xd;k
ay;&efusG r;f usio
f nfo
h if
wef;wuf+yD;olvt
kd yf.
trSwf=23 rwfmv 2004 ckESpf?
usef;rma&;apwref
az: jycsuf
tm;omcsurf sm;
tm;enf;csurf sm;
om;tdrfxJxnfhaom
ypPnf; (tdik ,
f 'l )D
• tvGex
f ad &mufr_ &do
S nf
• tdik ,
f 'l x
D w
k +f y;D v#i+f y;D jcif;
uk,
d 0f ef&Edik o
f nf
• Ed@k wu
kd rf cd ifrsm;twGuf
oifh avsmfonf
atmuf y gtrsKd ; orD ; rsm; • yxrtywfwiG af oG;
twGuf roifah vsmyf g
tenf;i,fqif;jcif;
• uav;wa,mufr#r&dS
• yxrvrsm;twGi;f rD;
olrsm;
,yfaoG;ay:csed w
f iG f em
• rsK;d yGm;t*F gwiG u
f ;l puf
usirf &_ Sd wwfonf
a&m&&d&S eftcGihf
tvrf;&do
S l rsm;
• ESv;Hk tqd@k &iS af &m*g&Sd
olrsm;
• aoG;tm;enf;olrsm;
• rD;,yfaoG;ay:v#ief musif
r_&o
Sd rl sm;
aemfyvef@
• tvGex
f ad &mufonf
• Ed@k wu
kd rf cd ifrsm;ESio
hf ifh
avsm f.
• a[mfrek ;f 2 rsK;d ygaomoa
E< wm;aq;rsm;.'%frcH
Edik af o molrsm;tm;
ay;&efaxmufco
H nf
• xJo
h nfyh pPnf;ukx
d w
k +f y;D
+y;D jcif;uk,
d 0f ef&ESd ikd o
f nf
• xHak q;vdt
k yf+y;D oif wef; • yxrvwGiaf oG;ray:
&&do
S x
l nfo
h ifo
h nf
jcif;ok@d r[kwaf oG;rrSef
• tcsed w
f w
kd ESpo
f @kd r[kw
k f
jcif; jzpfrnf
d rf nf
2ESpw
f m;vdo
k t
l m;ray; • wcgw&Hacgi;f uku
• y&d*k supf wd*k siw
f rsK;d
oifah y
wnf;ygoaE<wm;xd;k
aq;.ab;xGuq
f ;kd
usK;d rsm;twkid ;f jzpfonf
uGe'f ;kH
trsKd;orD;
om;a=umjzwfjcif;
trsK;d om;
ta=umjzwfjcif;
ab;xGuq
f ;kd usK;d rsm;
• ud,
k cf E<mESiq
hf ikd af om
• avwufa&mfbmESi "hf gwf
ab;xGuq
f ;kd usK;d rsm;enf;
rwJjh zpfEikd o
f nf
• xda&mufr&_ o
Sd nf
• tdwfcsftdkif AGD/at tdkif'D
tufpf tygt0if umv
om;a&m*grsm;udk tum
tuG,af y;onf
tvG e f x d a &muf r _ & d S o nf ? xm0pOf uav; r&&dES idk af om • ab;xGuq
f ;kd usK;d rsm;
aq;bufyikd ;f qdik &f mt&ud,
k f tajctaejzpfomG ;onf
enf;yg;
0ef,l&efroifh aom olrsm;
• pdwcf pH m;r_urkd xdcu
dk f
ES i f h u av;tvH k t avmuf
apyg
&&dS+yD; olrsm;twGuf oifh
avsmfonf
tvGefxda&mufr_ &dS onf? xm0pOf uav; r&&d S E k d i f • ab;xGuq
f ;kd usK;d rsm;
uav;tvHk tavmuf &&d+S y;D aomtajctaejzpfomG ;onf enf;yg;
oLtrsKd ; om;rsm;twG u f
• pdwcf pH m;r_o@kd r[kwf
oifhavsmfonf
vdiq
f ufqv
h rdk u
_ rkd xd
cku
d af pyg
ISSUE 23, MARCH, 2004
ta&;}u;D onfrh w
S cf suf
atmuf y gtrsKd ; orsKd ; orD ;
rsm;wGirf oH;k ygEiS hf
• ud,
k 0f ef&aSd ev#io
f @kd r
[kw &f ESd ikd v
f #if
• umvom;a&m*g&&d&S ef
tEW&m,f&v
S d #if
• arG;+y;D aemufo@kd r[kwf
ud,
k 0f efysu+f y;D ESijhf yeG o
f @dk r
[kwo
f m;tdrw
f iG u
f ;l puf
a&m*gwckc&k cSd b
hJ ;l v#if
• vpOfaoG;ay: pOfjyif;
xefpmG emusijf cif;ESiahf oG;
rsmpGmay: v#if
• tvGeaf oG;tm;enf;v#if
tusKd;oufa&mufr_&dSap&ef
r eS rf eS u
f efuefo;kH pG&J rnf
trsK;d orD;om;a=umjzwf
jcif;onftw
d cf st
f ikd Af aDG ttdik 'f D
tuf p f t ygt0if u mvom;
a&m*guu
kd muG,rf r_ ay;yg
trsKd;om;a=umjzwfjcif;onf
tdwfcsftdkifAGDattdkif'Dtufpf
tygt0ifumvom;a&m*gudk
umuG,rf r_ ay;yg
17
Advantages & Disadvantages of the
Main Contraceptive Methods
Health Messenger Team
Advantages and disadvantages of the different contraceptive methods should be well
understood by both users and providers. This table presents the advantages and also the
side effects of these contraceptives.
Description
Advantages
Disadvantages
COC
• highly effective
• can reduce or
prevent anaemia
• reduces risk of
developing
endometrial and
ovarian cancer
• Not appropriate for • Irregular bleeding or
women above 40
spotting: monthly
years and those
bleeding are often
with hypertension,
shorter and lighter
heart or liver disease • Nausea, usually
or diabetes
goes away after 1 or
• Reduce quality of
2 months
breast-feeding
• Mild Headaches are
• Requires daily pillcommon
taking
These sides effects
are not dangerous and
generally disappear
or become less in a
few months
• Effective
• Appropriate for
breast-feeding
• Recommended to
women who cannot
tolerate the side
effects of the
combined hormonal
contraceptives
• Women who wish
to, can get pregnant
as soon as they
stop the pill
• Requires daily pilltaking
• May cause irregular
bleeding
• Less effective than
COC
• Irregular bleeding or
spotting
• No monthly
bleeding
• Occasional
headaches
• Weight gain
• Very highly
effective
• Can reduce or
prevent anemia
• Same or similar as
COC
• Requires injections
which should be
administered by a
trained person
• Same or similar as
COC
(Combined
Oral
Contraceptive)
POC
(Progestogen
Oral
Contraceptive)
CIC
(Combined
Injectable
Contraceptive)
18
Side effects
trSwf=23 rwfmv 2004 ckESpf?
Important note
Consult a health
workers and stop
treatment if:
• Have serious headache
or blurred eyesight
(hypertension
symptoms)
• Feel weakness or
numbness in your
arms or legs (diabetes
symptoms)
• Feel severe pain in
your chest and
shortness of breath
(heart disease
symptoms)
• Have severe pain in
one leg (blood clot
symptoms)
• Do not take COC if
Have hepatitis or
yellow skin or eyes
(liver disease
symptoms)
Have had sign of
stroke paralysis or
heart disease
Have ever had a blood
clot
• Do not begin
combined injections
while breast-feeding
but after breast
feeding
usef;rma&;apwref
Description
Advantages
PIC
• Same as POC
• Very highly effective • To get pregnant
women will have to
• Prevents anaemia
wait at least three
• Appropriate for
months after the last
breast-feeding
injection
women
• Requires injections
which should be
administered by a
trained person
(Progestogen
Injectable
Contraceptive)
IUD
(IntraUterine
Device)
• Very highly
effective
• Women can get
pregnant as soon as
the IUD is removed
• Appropriate by
breast-feeding
women
Disadvantages
Not appropriate for
women
• who do not have a
child yet
• who are prone to
genital infections
• who have valvutar
heart disease
• who are anaemic
• who suffer from
dysmenorrhoea
Side effects
• light bleeding during
the first week
• may cause more
painful monthly
bleeding in the first
months
Important note
Do not use with women
who
• are pregnant or might
be
• are in danger of getting
an STD
• have ever had an
infection
- in tubes or womb
- after giving birth or
after an abortion
• have had a lot of
bleeding and pain
during monthly
bleeding
• are very anaemic
Norplant’s
• Very highly effective • Requires local
• Appropriate for
anesthesia and should
breast-feeding
be done by a trained
women
person
• Recommended to
• Not advisable for
women who cannot
short contraception
tolerate the side
time ( one or two
effects of the
years)
combined hormonal
contraceptives
• Return to fertility is
immediate upon
removal of the
implant
• Last for 5 years
Condoms
• Less systemic
• May cause allergic
side effects
reaction to the latex
• effective
• Provides protection
against sexually
transmitted diseases
including HIV/AIDS
Female
fertilisation
Very highly effective
Appropriate for
woman who have
attained the desired
number of children
Considered permanent • Less sides effects
• Does not affect
pleasure or ability
to have sex
Sterilisation doesn’t
protect against STDs,
including HIV/AIDS
Vasectomy
Very highly effective Considered permanent • Less sides effects
Appropriate for men
• Does not affect
who have attained the
pleasure or ability
desired number of
to have sex
children or those who
have medical
contraindications to
pregnancy
Sterilisation doesn’t
protect against STDs,
including HIV/AIDS
ISSUE 23, MARCH, 2004
• Irregular or no
bleeding during the
1st month
• Occasional
headaches
• Same side effects as
PIC
Must be used correctly
to be effective
19
'kQonfpcef;rsm;wGio
f ;kH aomrsKd ;rwlonfu
h ,
kd 0f efwm;enf;rsm;
xdik ;f jrefe,fpyfwiG &f aSd om 'kuQonfpcef; 8 ckwiG f toH;k jyKaeonfh oaE<wm;enf;trsKd ;rsK;d tm; jyoaom yHjk yjzpfonf?
xdik ;f Edik if aH &muf a&GŒajymif;aexdik o
f rl sm;tm; axmufyahH &;aumfrw
D rD S pkaqmif;xm;onfh 2003 ckEpS f ZEM0g&v
D rS ZGev
f
txd 'kuQonfpcef;rsm;rSay;ydk@aom tpD&ifcHpmwdk@yg&dSonfh udef;*%ef;rsm;udk tajccHxm;onfhyHkjzpfonf?
yg0ifaompcef;rsm;rSm u&ife'D u
k QQQQQQonfpcef; 2 ck/ r,fah cgicf / r,f&h r vGr/f r,fv
h / tH;k ys/H Ed@k y/k d xef;yif ESih f befa'gi;f ,rf
wd@k jzpfonf? r,fv
h 'kuQ onfpcef;rS rwfv/ {+y/D arvtwGuf tpD&ifcpH mr&I ysr;f r#wu
G cf sux
f m;&onf?
'kuQonfpcef;rsm;wGif toH;k jyKtrsm;qH;k ESiahf cwftpm;qH;k oaE<wm;enf;onf xd;k aq;jzpf+y;D 47 &mcdik Ef e_ ;f jzpfonf?
pm;aq;enf;onf ta&;ygonfeh nf;jzpf+y;D oH;k pGo
J l 24 &mckid Ef e_ ;f &do
S nf? trsKd ;orD;om;a=umjzwfjcif;ESiu
hf eG 'f ;kH wd@k 2 ckonf
11 &mcdik Ef e_ ;f jzpfonf? uGe'f ;kH rsm;onf tvGeaf cwfpm;onfeh nf;r[kwaf y? uGe'f ;kH oH;k jcif;udk ,ckwikd f roH;k vd=k ujcif;rSm
vlra_ &;ta=umif;a=umifjh zpfonf? uGe'f ;kH onf umvom;a&m*g/ tdwcf st
f ikd Af /DG attdik 'f t
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,lq=uonf? trsKd ;om;ta=umjzwfjcif;onf 5 &m ckid Ef e_ ;f cef@&do
S nf? om;tdrx
f x
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h nfyh pPnf;(tdik ,
f 'l )D ESihf
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tqdyk genf; 2 rsKd ;onf az: jyygypPnf;rsm;tm;xnf&h efEiS x
hf w
k &f ef u|r;f usirf o
_ ifwef;&&d+S y;D olrsm;vkt
d yfonf? aemfyvef@
ESit
hf idk ,
f 'l w
D @kdtm; 'kuQonfpcef;trsm;pkw@kdwiG f r&&dES ikd af y? r,fv'kuQonfpcef;wckomv#if aemfyvef@ ESit
hf ikd ,
f 'l x
D &hJ ef
oifwef;&&dx
S m;onf0h efxrf;rsm;&do
S nf?
&mcdik Ef e_ ;f pkpak ygi;f
oaE<<wm;enf;rsm;
1/ xk;d aq;
47Œ04
2/ pm;aq;
24Œ20
3/ uGe'f ;kH
11Œ5
4/ om;tdrx
f x
J nfo
h nfyh pPnf;
0Œ12
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11Œ67
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5Œ32
pkpkaygif;
20
100
trSwf=23 rwfmv 2004 ckESpf?
usef;rma&;apwref
The different contraception methods used in the camps
The chart shows the percentage of different contraception methods used in 8 refugee camps at
the Thai Myanmar border. It is based on the monthly data reported by each camp and compiled by
CCSDPT between January 2003 and June 2003. The camps are Ban Mae Surin, B. Kwai-B.Tractor,
Mae Kong Kha, Mae Ra Ma Luang, Mae La, Umpiem, Nu Poh, Tham Hin, and Ban Don Yang.
As Mae La camp was unable to give data from March to May, data has been calculated based on
averages.
The most popular method used among the camps is injection, which represents 47% of the
contraception methods used. Oral pills are also important with more than 24% of people choosing
this method. Female sterilisation and condoms are both around 11 percent. Condoms are not a very
popular choice of contraception. One of the reasons is that many people are still reluctant to use
them for social reasons. Despite preventing STD’s, HIV and AIDS and being a highly effective
contraception method, many people still associate them wrongly with commercial sex workers.
Vasectomy represents around 5% of contraception methods used. With 0.12% and 0.15% IUD
and Norplant’s are the least common method of contraception. Both require a trained person to
insert and remove them. Norplant and IUD are not available in most refugee camps. Mae La is
one of the few camps that trained health workers to insert Norplant and use IUD.
% of contraception methods
used in the camps
'kQonfpcef;rsm;wGif oaE<<wm;
enf;rsm; oHk;onfh&mcdkifE_ef;
xdk;aq;
Types
1. Injection
% of total
pm;aq;
1. Injection
47.04
uGe'f ;kH
2. Oral pill
24.20
3. Condom
11.50
2. Oral pill
3. Condom
om;tdrf*Gif;
4. IUD
4. IUD
0.12
aemfyvef@
5. Norplant
0.15
trsK;d orD; om;a=umjzwfjcif;
6. Female sterilization
11.67
trsKd;om; ta=umjzwfjcif;
7. Vasectomy
5.32
Total
100
5. Norplant
6. Female sterilization
7. Vasectomy
ISSUE 23, MARCH, 2004
21
aemfyvef@
usef;rma&;apwrmef ESifh yD/ yD/ at/ wD tzGJ@wdk@yl;wGJa&;om;onf
aemfyvef@onf xdik ;f Edik if &H dS e,fpyf'Q
k onfpcef;rsm;Y toH;k enf;ao;onfh oaE<<wm;enf;wenf;jzpfonf?
Taqmif;yg;wGif yDyaD twD pDrcH suf olemjyKt&m&Sd cGeyf &m,meDrS aemfyvef@udk r,fvpS cef;wGif 1996 ckEpS rf S
pwifI oH;k pGaJ =umif; wifjyxm;onf?
rdrw
d @kd ESihf oifah wmfaom oaE<wm;aq;rsm;udk toH;k jyK
Edik af p&ef jzpfonf?
aemfyvef@qo
kd nfrmS rnfonf@t&mjzpfoenf;?
aemfyvef@qo
kd nfrmS tcsi;f 0@ 2 rDvrD w
D m&d+S y;D / t&Snf
4 pifwrD w
D m&So
d nf@yvyfpwpftjzLESihf zH;k tkyx
f m;onfh t
a=umi,fukd ac:onf/ tqdyk g aemfyvef@ukd xnfx
h m;jcif;
tm;jzifh ud,
k 0f eftm; wm;qD;Edik o
f nf? txufyg ta=um
i,fav;aygif; 6 ckwkd@wGif udk,f0efudk wm;qD;aponfh
a[mfrek ;f "gwyf pPnf;yg&o
Sd nf? az: jyyg a[mfrek ;f onf tcsed f
tykdif;tjcm;t& aoG;xJodk@ a&muf&dSEdkifpGrf;&dSonf?
aemfyvef@udk waxmifqpftxufta&jym;atmuf 6 8 pifwrD w
D m tuGmta0;wGif xnfo
h iG ;f xm;Edik o
f nf?
xnfx
h m;onfah emfyvef@onf cE<ud,
k .
f tjcm; ae&m rsm;
od@k a&muf&jSdcif;r&daS y?xnfx
h m;onfypPnf;onf tifyvefEHG
jzpfygut&G,t
f rsKd ;rsKd ;&dyS g&o
Sd nfh ta=umi,fwckjzpfonf?
use;f rma&;0efxrf;ta&twGurf nfr#oifwef;ay;+y;D yg+yv
D ?J
use;f rma&;0efxrf; 10 a,mufoifwef;ay;+yD;yg+yD?
oifwef;umvrnfr#=umoenf;? rnfuo
h J @k doify@k dcsygoenf;?
oifwef;wGif yg0ifaomoifcef;pmrsm;rSm atmufyg
twdik ;f jzpfygonf?
1? aemfyvef@qdkonfrSm rnfonfht&mjzpfa=umif;
odap&efEiS hf rnfonfyh &kH aSd =umif; tygt0if rnfonht
f a&
taoG; *k%o
f wWdw@kd &So
d nfukd odapygonf?
aemfyvef@ukd r,fvpcef;wGif rnfonftcsed rf S pwif toH;k
jyKcJyh goenf;?
aemfyvef@udk r,fvpcef;wGif 1996 ckESpfrSpwif
toH;k jyKcJyh gonf? (tqdyk g tcsed o
f nf yD/ yD/ at/ wD r,fv
pcef;wGif tvkyrf vkyrf DS tufp/f trf/ tm/ ,l vufxuf
wGif jzpfonf)? tufpt
f rftm,lonfro
d m;pkvakH vmufol
rsm;twGuaf &&Snw
f m;aq;aemfyvef@upkd wifo;kH ay;cJo
h nf?
jf refjynftwGi;f ESiph f cef;rsm;wGiu
f av;aoE_e;f rsm;aoma=umifh
uav;aov#iaf emufxyf&Edik &f efppD Ofay;jcif; jzpf onf?
r,fv pcef;wGifaemfyvef@xJhaeyHk
r,fvpcef;wGif oifwef;ay;&ef rnfonfhta=umif;
a=umifh qH;k jzwfco
hJ enf;?
r,fvpcef;wGif oifwef;ay;&efq;kH jzwf&jcif;ta=umif;
rSm aemfyvef@ta=umif; A[kokwudk 0efxrf;rsm;tm;
jzef@a0vkjd cif;ESihf pcef;&dt
S rsKd ;orD;rsm;taejzifh oH;k pGv
J v
dk #if
oHk;pGJEdkif&ef jzpfonf? xkda=umifhtrsdK;orD;rsm;taejzifh
tjcm;aom ud,
k 0f efwm;aq;rsm;ta=umif; vnf; od&+Sd y;D
22
Norplant insertion at Mae La Camp
2? [email protected];omcsu/f tm;enf;csuEf iS hf aemfy
vef@xnfph OfwiG f a&Smifusi&f ef tcsurf sm; yg0ifygonf?
3? oH;k pGrJ nfo
h rl sm;tm; aemfyvef@ta=umif; owif;
pum;ay;Edik af p&ef yg0ifonf?
4? udef;*%ef;rsm;pkaqmif;+yD; vlemrsm;tm; ESpf
odrahf qG;aEG;ay;Edik af p&ef jzpfonf?
5? aemfyvef@xnfonfhypPnf;ud&,
d mrsm;tm;jyifqif
trSwf=23 rwfmv 2004 ckESpf?
usef;rma&;apwref
Norplant
Health Messenger Team in collaboration with PPAT
Norplant is a method of contraception still little used in the Thai border refugee camps. In
this article Khun Pranee, PPAT project nurse officer, presents this contraceptive which has
been used in Mae La camps since 1996.
Why did Mae La Camp decided to run this
training?
What is norplant?
Norplant is an implant contraceptive
contained in a white plastic tube, 4 cm in length
and 0.2 mm in diameter. There are 6 tubes each
one contains a contraceptive hormone. The
hormone is slowly released over a period of time.
The tube cannot travel to any other part of the
body (it is implanted in the arm 6-8 cm above
the elbow).
When did norplant started to be used in Mae
La camp?
The reason Mae La camp decided to run this
training was to give information about Norplant
to the staff in order to distribute it to women
who want to use birth control. Also so the woman
can learn about other methods of contraception
and choose what is the most suitable for them.
How many health workers are being
trained?
There are 10 health workers being trained.
Norplant started to be used in Mae La camp
in 1996 (before PPAT started to work in this
camp by receiving the service from SMRU).
SMRU introduced norplant as a long term
con-traceptive for women who think they have
finished their families but not yet ready for
sterilisation. Infant mortality in the camps and in
Burma remains higher than in Thailand. If a child
dies then there is still option to have another one.
ISSUE 23, MARCH, 2004
What dose the training involve?
The object of the training are:
1. to give the trainees an understanding of
what Norplant is.
2. To give an understanding of
the positive and negative effects
of Norplant, what should be
avoided when implanting
Norplant in patients etc.
3. How to give information
about Norplant to the patients.
4. How to gather data and give
counseling to the patients.
5. How to prepare the
equipment for Norplant.
6. How to prepare the patient beforeNorplant.
7. Demonstration of how to insert and
remove Norplant.
23
wwfaf p&ef jzpf onf?
6? aemfyvef@rxnfrh DS vlemtm; rnfuo
hJ @kd jyifqif
xm;&ef tcsurf sm; yg0ifygonf?
7? aemfyvef@xnfyh kH xnfeh nf;ESihf xkwyf x
kH w
k ef nf;wk@d
udv
k nf; jyoygonf?
8? aemfyvef@xnf+h yD; rnfuo
hJ @kd aexdik jf yKrl&efvnf;
yg0ifonf?
oifwef;onf tcsed u
f mvtm;jzifh 2 &uf=umonf?
aemfyvef@ESiyhf wfouf+yD; rnfonft
h csuo
f nf ta&;t
}uD;qH;k jzpfoenf;?
aemfyvef@ESiyhf wfouf+yD; ta&;}uD;onft
h csuo
f nf
vlemtm; tcsut
f vufreS u
f efpmG ay;Edik af &;ESix
hf nfo
h iG ;f
enf; rSeu
f efpmG toH;k jyKEdik af &;wd@k jzpfonf?
use;f rma&;0efxrf;rsm;xHrS rnfonft
h csut
f vufrsm;
jyefvnf=um;&ygovJ?
jyefvnf=um;&onft
h csurf sm;rSm/ aemfyvef@xahJ om
tcsKd @vel mrsm;taejzifh ab;xGuq
f ;kd usKkd ;rsm; tenf;i,f
cHpm;&ojzif/h jyefxw
k v
f akd =umif;od&ygonf? xdak =umifh
aemfyvef@EiS yhf wfoufonfh tcsut
f vufrsm;udk &Si;f vif;
+yD; vG,u
f pl mG em;vnfapoifo
h nf?
oif.tawG@t}uHKt&/ tjcm;'kQonfpcef;rsmrSusef;
rma&;vkyo
f m;rsm;udv
k nf; aemfyvef@EiS yhf wfouf+y;D oif
wef;ay;v#if tusKd ;rsm;rnf xifygovm;?
[kwu
f yhJ g/ tjcm;'kuQonfpcef;f rsm;wGiv
f nf; oif
wef;ay;v#if trSet
f usKd ;&drS nf xifygonf?
ysr;f r#tm;jzifh wESpv
f #if oif.pcef;wGif trsKd ;orD;OD;a&
rnfr# oH;k pGyJ govJ?
2001 ckEpS w
f iG f trsKd ;orD;OD;a& 57 a,muf/ 2002
ckEpS w
f iG f 162 a,mufEiS hf 2003 ckEpS w
f iG f 50 a,mufw@kd
jzpfygonf??
aemfyvef@onf tvGefay: jyLvmjzpf+yD; acwfpm;onfh
oaE<<wm;enf; wenf;jzpfygovm;?
aemfyvef@onf tvGeaf y: jyLvmjzpfjcif; acwfpm;jcif;
r&daS omfvnf; tv,ftvwfavmufawm@ vdu
k yf gonf?
ay: jyLvmjzpf+y;D acwfpm;aomenf;rsm;rSp+y;D wpwpenf;
oGm;onfeh nf;rsm;rSm/ xd;k aq;/ oaE<wm;pm; aq;/ uGe'f ;kH /
aemfyvef@/ trsKd ;orD;om;a=umjzwfjcif;/ trsLd ;om; om;
a=umjzwfjcif;ESihf om;tdr*f iG ;f xnfjh cif;wd@k jzpfonf?
aemfyvef@ Norplant
24
trSwf=23 rwfmv 2004 ckESpf?
trsdK;orD;rsm;taejzifh
aemfyvef@ta=umif;udk,ckxuf
yd+k y;D odoifo
h nf[x
k ifjrifyf g ovm;?
[k w f u J h / ud k , f 0 ef wm;enf ;
toH k ; jyKvd k o nf h r d w f a qG r sm;ud k
a0iSajymjy&eftrsKd;orD;rsm;tae
jzifhaemfyvef@ta=umif; udk,ck
xuf o d o if h o nf [ k u |ef r xif
ygonf?
ol w d k @ taejzif h u d k , f 0 ef w m
;enf;aemufxyfwenf;od+yD;rnf
uJo
h @kd u,
kd 0f efuu
kd muG,Ef ikd af =umif;
em;vnfygvrd rhf nf? olw@kd onfukd
enf;od+yD;rnfuo
hJ @kd tvkyf a=umif;
udv
k nf;od&rnf? a&G;enf; ydrk sm;vm
rnf?5ESpfcH+yD;/jyefvmjy&efom&dS
onf?
usef;rma&;apwref
8. Instructing patients how to take care of
themselves after Norplant
The training lasts 2 days.
What is the most important thing to
remember about Norplant?
The most important thing to remember is to
give the right information to patientS and to
implant Norplant correctly.
What has been your feedback from health
workers about it?
Some patients have experienced some side
effects and want to have it removed. It is
therefore very important to to give very clear
informations to patients to ensure understanding.
According to your experience, would it be
useful to train health workers on Norplant
in other camps?
Yes, it would be really useful to have the
training in other camps.
On average how many women are using it
every year in your camp?
There were 57 women in 2001, 162 women
in 2002, and 50 women in 2003*.(*The figures
are only known for 3 months)
Is Norplant a very popular methods of
contraception?
Norplant is not a very popular method. In
order of preference we can find the following
methods (from the most popular to the least
popular) - injection, birth control pill, condom,
Norplant, female sterilisation, male sterilisation
and IUD.
Do you feel women still need to know more
about it?
Yes, I think women need to know more about
it to be able to distribute the information to their
friends who want to use birth control. They will
then know about another method of
contraception and understand the way it works
It gives them more choice. Norplant lasts for 5
years and they only need to visit health workers
for follow up.
r,fvpcef;wGifaemfyvef@xJhaeyHk Norplant insertion at Mae La Camp
ISSUE 23, MARCH, 2004
25
h f ifah vsmaf omoaE<wm;enf;rsm;
? trsKd ;orD;rsm;.use;f rma&;ESio
usef;rma&;apwrmeftzGJ@
oaE<<wm;enf;udk a&G;cs,&f mwGif use;f rma&;0efxrf;rsm;onf oH;k pGo
J rl sm;. use;f rma&;udk
ta&;ay;avhvmoifo
h nf? tcsK@d enf;rsm;onf trsK;d orD;rsm;a&m*gcpH m;ae&ygu use;f rma&;ESihf
oifah vsmjf cif;r&Sad y? azmfjyygaqmif;yg;onf use;f rma&;0efxrf;rsm; a&m*gtajctaeESiu
hf u
kd n
f aD tmif
oifah wmfaomenf;rsm;udk a&G;cs,Ef ikd &f ef ulnaD y;vdrrhf nf?
aoG;tm;enf;jcif;a&m*g
TtajctaewGif vlemonf jzLazsmt
h m;enf; ae
onf? vuQ%mrsm;rSm vufonf;/ ajconf;rsm; jzLazG;
aejcif;/ atmufrsucf /HG vufzgG ;ESit
hf a&tjym;rsm; tm; vH;k
jzLzwf jzLa&mf jzpfaernf? aoG;tm;enf; &jcif;onf
aoG;qHk;&_H;r_a=umifh jzpfonf? tjcm;ta=umif; rsm;rSm
iSufzsm;/ oefaumifa&m*gESifh tm[m&csKd@wJhjcif;wdk@
jzpfEikd o
f nf?
- a[mfrkef; 2 rsKd;yg udk,f0efwm;aq;(xdk;aq;ESifh
pm;aq;)onf vpOfay:onfh aoG;qif;r_udk enf;apI
aoG;tm;enf;jcif;udk ydrk q
kd ;kd &Gm;r_ r&Sad y? a[mfrek ;f rygonfh
om;tdrx
f J xnfah omypPnf;( tdik ,
f 'l )D onf vpOf aoG;
qif;rsm;r_apaoma=umifh aoG;tm;enf;jcif;udk ydkqdk;
aponf? cGpJ yd rf _ jzifh oaE<wm;enf; jyKvkyEf ikd &f eftwGurf l
aoG;tm;enf;jcif; t&ifuo
k ifo
h nf?
aoG;a=uma&m*gtE W&m,fyrkd sm;aponf? y&d*k supf ud&k if
wrsK;d wnf;yg oaE<wm;aq;ESihf om;tdrx
f x
J nfah om
ypPnf; (tdik ,
f 'l )D udk aoG;wd;k a&m*g&o
dS rl sm;twGuf oH;k Edik f
onf?
ESvHk;a&m*g
az: jyyg a&m*gvuQ%mESihf prf;oyfawG@&v
Sd #if ESv;kH
a&m*g [k qdEk ikd o
f nf? tqdyk gw@kd onf touf&LS r0jcif;/
rsufESmESifh ajcusif;0wf azga&mifjcif;/ ESvHk;wHkjcif;/
aoG;cHEk e_ ;f aES;jcif; od@k r[kwf jrefjcif;ESihf jymESr;f jcif; ( vuf
acsmif;ESihf Ekwcf rf;) wd@k jzpfonf?
a[mfrek ;f 2 rsK;d yg oaE<wm;aq;onf ESv;kH ESihf aoG;
a=uma&m*gtE W&m,fyrkd sm;ap+y;D a=u;eDygonfh tdik ,
f 'l D
onf ESv;kH a&mifra_ &m*g ydjk zpfaponf? oaE<wm;enf;
tm;vHk; q&m0ef (orm;awmf). qHk;jzwfcsufjzifhom
oHpk &JG ef vdt
k yfonf?
qD;csKda&m*g
aoG;xJwiG f o=um;"gwf (uvl;udpk )f yHrk ek x
f ufrsm;+yD;
xdt
k ajctaeonf qufvufwnf&adS ev#if qD;csKad &m*g[k
ac:onf? qD;csKad &m*g oufwrf; tESpf 20 xuf rsm;ae
onft
h ajctae od@k r[kwf &_waf xG;aom qD;csKad &m*g&o
dS l
trsK;d orD;rsm;onf a[mfrek ;f ygonfh oaE<wm;&ef oH;k v#if
ESv;kH ESihf aoG;a&m*g tE W&m,fyrkd sm; onf?
aoG;wdk;a&m*g
aoG;zdtm;E_e;f onf yHrk eS x
f uf rsm;+y;D qufvufwnf&dS
aeygu aoG;wd;k a&m*g[k ac:onf? txufaoG;zdtm; 140
ESihf atmufaoG;zdtm; 90 xufyv
kd #if aoG;wd;k &So
d nf[k
qd=k uonf?
a[mfrkef; 2 rsKd;yg udk,f0efwm;aq;onf ESvHk;ESifh
26
ajcusif;0wf azga&mifjcif; swelling of ankles
tqkww
f b
D ED iS o
hf mrmefiu
S zf sm;
tqkww
f b
D o
D nf rdu
k u
f b
kd ufw;D &D;,m; usLbmulv;kd
ppfEiS hf wcgw&H tjcm; rdu
k u
f b
kd ufw;D &D;,m; a&m*gy;kd rsm;
trSwf=23 rwfmv 2004 ckESpf?
usef;rma&;apwref
The Suitable Family Planning
Methods According to Women’sHealthHealth
Messenger Team
?
When choosing a method of contraception health workers should always take into account
their client’s health. Contraceptives can sometimes affect women’s health and are not
appropriate if the client suffers from certain health conditions. The following article
will help health workers to choose suitable family planning methods
according to the condition of a woman’s health.
Anaemia
In this condition the patient is pale and weak.
The signs of anaemia include whiteness of finger
nail beds, lower eyelids, palms of the hand. One
of the causes of anaemia is blood loss and other
causes are malaria, worm manifestation, and
nutritional deficiency.
Combined hormonal contraceptives will
decrease the menstrual blood loss that would
increase the severity of anaemia, and are
therefore appropriate. Non-hormonal copper
IUD (Intra-Uterine Device) will increase the
menstrual blood loss, and are not recommended
in this situation. Severe anaemia should be
treated first before a surgical method is used.
Diabetes
Diabetes mellitus occurs when there is more
glucose (sugar) in the blood than normal and the
blood sugar stays at these abnormally high
levels.
Use of hormonal methods in women with
complicated diabetes and/or over the duration
of more than 20 years may increase the risk of
heart and blood vessel complications.
Hypertension
If the blood pressure remains much higher
than normal, the condition is called hypertension
(high blood pressure). It is said to be present
when the blood pressure is 140 systolic (upper
ISSUE 23, MARCH, 2004
number) or higher and/or 90 diastolic (lower
number).
Combined hormonal contraceptives may
increase the risk of heart and blood vessel
complications with this condition. Progestogen
(Progestin) contraception and IUD are
recommended in this case.
Heart disease
Clients with the following symptoms could
be suffering from heart disease: abnormal
shortness of breath, swelling of ankles and face,
chest pain, palpitation (consciousness of heart
beat), fast or slow pulse and cyanosis (blue
coloration of fingers and lips).
The use of hormonal methods in women with
heart disease may increase the risk of heart and
vessel complications and the use of copper IUD
27
?
a=umifh jzpfonf? vuQ%mrsm;rSm acsmif;qd;k jcif;/ zsm;jcif;
ESihf cE<mud,
k t
f av;csed af vsmu
h sjcif;wd@k jzpfonf? ukor_
aESmifhaES;v#if vlemtm; xdka&m*gu owfvdrfhrnf?
iSuzf sm;a&m*gonf aoG;eDOrsm;xJo
h @kd y&dw
k Zkd &kd mG tkypf 0k if
yvyfpyf 'kd ,
D rfy;kd 0ifa&mufu;l pufaoma=umifh jzpfonf?
tqdyk ga&m*gonf &kww
f &ufEiS hf emwm&Snt
f zsm; trsK;d
pm;udk jzpfap.? wcgw&H csr;f wH+k yD; wcgw&H rcsr;f wHyk g?
aoG;tm;enf;jcif;ESihf abvH;k }uD;jcif;wd@k awG@&wwfonf?
wDbDESifh iSufzsm;a&m*gukoaq;wdk@onf a[mfrkef;
ygonfh oaE<wm;aq;. tmedoifukd avsmah pEdik o
f nf?
vlemonf wDbo
D @kd r[kwf iSuzf sm;aq;rsm; t+rpJ m;aeygu
tjcm;oaE<wm;enf;rsm;udk oH;k &ef t}ujH yKoifo
h nf?
tvHt
k zkrsm; awG@&So
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k f .wae&m&m
wGif awG@&Sv
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h @kd ul;
ajymif;oGm;Edkifonf? trsKd;tpm;/ obm0/ ae&mESifh
awG@&adS om tzktusw
d t
f vdu
k f oaE<wm;aq;udk a&G;cs,f
&ef n$ef=um;oifhonf? tzktusdwftvdkuf pdwfcspGm
oH;k Edik o
f nf wm;enf;rsm;&So
d uJo
h @kd roH;k Edik af om oaE<wm;
enf;rsm;&So
d nf? cGpJ yd ef nf;jzifh oaE<wm;jcif;onf txufyg
tajctaewGif pdwcf s&aomenf; jzpfonf?
a[mfrek ;f a=umifh tusw
d yf rkd }kd uD;r_ jzpfapwwfonf?
tdwfcsf tdkifAGD/ attdkif'DtufpfESifh tjcm; umvom;
W&m,f&o
a&m*grsm; tE
tEW
dS nfh tajctae
tdwcf st
f ikd Af DG Adik ;f &yfpyf ;kd 0ifa&mufjcif;. aemufq;kH
&v'frmS attdik 'f t
D ufpf jzpf&jcif;[k tajz&onf? aoG;
od@k r[kwf cE<mud,
k rf S xGuaf omt&nfwiG f tdwt
f ikd Af yDG ;kd
yg+yD; wOD;rS wOD;od@k ul;puf+yD; a&m*g &Edik o
f nf? Oyrm
pdwfrcs&aom vdifqufqHr_/ aq;xdk;tyftwl oHk;pGJr_/
aoG;oGi;f ukor_EiS hf rdcifrS &ifaoG;i,fo@kd a&muf&rdS w
_ @kd
jzpfonf?
umvom;a&m*g odk@r[kwf vdifqufqHr_rSwqifh
ul;aoma&m*gonf vdit
f r_upd Pa=umifh jzpfonf? wcgw&H
vd i f u d p Prygaomf v nf ;
jzpfonf? Oyrm ta=umaq;
xd;k jcif;enf;a=umifh jzpfonf?
t"du vuQ%mrsm;rSm
qD;vrf;a=umif; odk@r[kwf
arG;vrf;a=umif; rderf t*F gem
usifjcif;/ t&nfqif;jcif;/
a&mif & rf ; jcif ; ES i f h aygif + cH
tusd w f rsm; }uD ; }uD ;
tygt0if trsK;d orD;rsm;wGif
0rf ; Ad k u f a tmuf yd k i f ;
emusijf cif;wd@k jzpfonf?
tdik ,
f 'l o
D ;kH pGv
J #if rde;f rt*F ga&mif&rf;jcif; tE W&m,f
ydrk sm;onf/ okwyf ;kd owfaq;onf arG;vrf;a=umif;tm;
vH@_ aqmfI tdwcf st
f ikd Af DG / attdik 'f t
D ufpf ydrk kd ul;pufapEdik f
onf? TtajctaewGif uGef'Hk;oHk;pGJr_udk txl;tm;
ay;onf? tjcm;oaE<wm;enf;oH;k xm;v#iv
f nf; uGe'f ;kH udk
xyfqifh oH;k pGo
J ifo
h nf? uGe'f ;kH onf tdwcf st
f ikd Af EDG iS hf tjcm;
umvom;a&m*grsm;udk umuG,Ef ikd o
f nf? uGe'f ;kH oH;k jcif;
tm;jzifh oaE<wm;jcif;tjyif umva&m*grsm;udv
k nf;
umuG,Ef ikd o
f nf?
&ifom;tusw
d f
yrm%rsm;pGmESih f &uf=umjrifph mG vpOf aoG;ay: jcif;tajc tae?
tusdwfwck odk@r[kwf tusdwfrsm; trsKd;orD; w
a,muf. &ifom;wGif awG@&jdS cif; od@k r[kwf prf;oyfI&v#if
wdusaom prf;oyfr_rsm;t& uifqmr[kwfa=umif;
tajzr& rjcif; uifqm[k pOf;pm; qH;k jzwf&rnf?
uifqmr[kwf aom tusw
d rf sm;twGuf a[mfrek ;f ygo
oaE<wm;enf;rsm;oH;k v#if pdwcf s&onf? uifqm jzpfygu
28
yHrk eS yf #r;f r# trsK;d orD;wa,muf. vpOf aoG;r_rmS 3
&ufrS 5 &uftxd =umwwf+yD; yrm%tm;jzifh 40 pDpD
a&aEG;=urf; yk*HwvHk;cef@ &Sdonf? xdk&ufxuf ydk=um
v#iaf omfvnf; tqdyk g yrm%xuf ydrk sm;v#iaf omfvnf;
yrm%rsm;pGmESihf &uf=umjrifph mG aoG; ay:onf[k owfrw
S f
trSwf=23 rwfmv 2004 ckESpf?
usef;rma&;apwref
?
may increase the risk of endocarditis
(inflammation of the heart). A decision by a
physician is a necessity for the use of all types
of contraceptive in this case.
Pulmonary Tuberculosis and Malaria
(uncomplicated)
Pulmonary Tuberculosis is caused by an
infection from a bacterial bacillus called
Mycobacterium tuberculosis and occasionally by
other mycobacteria. The symptoms of
pulmonary tuberculosis are cough, fever and
weight loss. It will kill the client if treatment is
delayed.
Malaria is a disease caused by infection of
the red blood cells by a protozoal organism called
Plasmodium. Infection sometimes causes acute
and chronic types of fever with or without chills
and rigors, anaemia and enlargement of the
spleen.
abvHk;}uD;jcif; enlargement of the spleen.
Anti-tuberculous and anti-malaria drugs may
reduce the effectiveness of hormonal
contraceptives. If the client is taking this
medication regularly, advise the use of other
methods.
Lumps of all types
All lumps or masses or tumours found
anywhere in human body have the potential to
transform (change) into a stage of cancer at any
time.
ISSUE 23, MARCH, 2004
The recommended contraceptive method will
depend on the type, nature and location of the
tumour. There are tumours where some
contraceptive methods can be safely used and
there are tumours where specific methods may
not be recommended. Surgical methods are a
safe option in this situation.
Breast Lumps
Mass(es) seen or palpable anywhere on a
woman’s breast should be regarded as malignant
(cancer) unless otherwise proven non-malignant
by a specific test.
The hormonal methods may be used if the
breast lump is benign (not cancer). If the breast
lump is malignant (cancer), the lump growth may
be increased by hormonal methods.
Risk of HIV/AIDS and other STD
The end result of Human Immunodeficiency
Virus (HIV) infection is Acquired
Immunodeficiency Syndrome (AIDS). Infection
occurs when the blood or body secretions from
a person with HIV infection pass into the body
of another person during unsafe sexual practices
or pregnancy or from transfusion of infected
blood.
Sexually Transmitted Diseases (STDs), also
called veneral diseases (VD), are usually spread
by sexual intercourse. Sometimes they are
spread by non-sexual (intravenous drug use)
means. The common symptoms are discharge
or pain in the urethra or vagina, sores and/or
swelling of genitalia, lymph nodes enlargement
in the groin and lower abdominal pain in women.
Use of IUD may increase the risk of pelvic
inflammatory disease. Spermicide may cause
irritation in the vaginal canal which may hasten
HIV/AIDS transmission. Use of condoms is
highly recommended even if the woman is
already using a contraceptive method as it can
prevent transmission of HIV and other sexually
transmitted diseases. Condoms are preventing
transmission of diseases and are very highly
29
?
Edik o
f nf?
a[mfrek ;f 2 rsK;d yg oaE<wm;aq;onf aoG;ay:yrm%
enf;apEdik o
f nf? tdik ,
f 'l D (uGif om;tdr)f onf &uf=umjrifh
pGmESihf yrm%rsm;pGm vpOf aoG;ay:r_ukd jzpfapwwf.?
a[mfrek ;f 2 rsK;d yg oaE<wm;aq;onf ud,
k 0f efwm;jcif;
tjyif aoG;ay:vnf; enf;aponf? xyfqifhtusKd;&Sdr_
ud&k &SEd ikd o
f nf?
yHrk eS rf [kwf arG;vrf;a=umif;rS aoG;qif;jcif;
vpOfay:aeus aoG;rSvI
J$ aoG;qif;jcif;udk qdv
k o
kd nf?
tqdkyg tqdkygaoG;qif;jcif;onfwdusaoma&m*gt
a=umif; &if; udk &Sm&ef cufco
J nf? uifqma&m*g r&Sv
d #if
a[mfrek ;f yg oaE<wm;aq;udk oH;k Edik .
f ? a[mfrek ;f onf
rsKd ; yG m ;t*F g uif q m&S d v #if a&m*gwd k ; yG m ;Ed k i f o nf ?
cGpJ yd ef nf;jzifo
h aE<wm;jcif;onfvnf;oifah wmfaom enf;
wenf;jzpf onf ?
aoG;r[kwo
f nft
h jcm;t&nfrsm; arG;vrf;a=umif;rS qif;jcif;
trsK;d orD; vdit
f *F gEw
k cf rf;ESihf arG;vrf;a=umif;a&mif
&rf;jcif;onf rD;,yfuk aq;cef;od@k vmjyonfh vlemrsm;
apwwfonfh ta=umif;wck jzpfonf? vdit
f *F gEw
k f crf;
wckwnf;a=umifv
h nf; jzpfEikd o
f nf? jzpfymG ; apwwf aom
ta=umif;rsm;rSm/ w&dik u
f rkd ekd yfpt
f ,m; a&m*g/ uif''D gr_d
a&m*g/ *Edt
k jzLqif;a&m*g/ vdiaf &,Hak &m*gEiS hf qpfyvpf
umvom;a&m*gwdk@ jzpfonf? uGef'Hk;onf vdift*F grS
wqifh ul;pufonfah &m*grsm;udk umuG,o
f nf? okwyf ;kd
owfaq;/ 'dik ,
f mz&rf/ om;tdraf cgi;f tzH;k wd@k vnf; wpdwf
wa'o umuG,af y;Edik o
f nf? a[mfrek ;f yg oaE<wm;aq;
ESifh uGef'Hk;yl;wGJ oHk;pGJv#if a&m*gumuG,fjcif;ESifhtwl
oaE<wm;r_ukd &&SEd ikd o
f nf?
toJajcmufa&m*gvuQ%m
sign of cirrhosis of liver
toJrw
S qifh pGe@f xw
k &f onfh ypPnf;rsm; jzpfonf? a[mfrek ;f
ygaq;onf toJukd tvkyrf sm;ap+y;D toJtvkyf rvkyf
Edkifaomtajctaeodk@a&mufapwwfonf? tdkif,l'DESifh
cGpJ yd ef nf;jzifh oaE<wm;jcif;onfoifah wmfaomenf; jzpf onf?
acgi;f udu
k jf cif; ( jyif;xefpmG )
acgi;f udu
k jf cif;onf OD;acgi;f wGif emusiu
f u
kd cf ufaom
cHpm;r_jzpfonf? xdo
k @kd jzpf&ef ta=umif;t&if;cH rsm;pGm
&So
d nf? aoG;tm;enf;jcif;/ tpmvrf;a=umif; (tl)/ acsmif;
qd;k jcif; rsuaf phEiS hf ud,
k w
f iG ;f a&m*gr&Sb
d J acgi;f udu
k jf cif;
ponfjzifh jzpfEikd .
f ? Ttcsuw
f iG f aoG;a=uma&m*g tajc
cHut
kd av;xm;&rnf? a[mfrek ;f onf acgi;f udu
k jf cif;udk ydrk kd
qd;k &Gm;ap+y;D aoG;a=uma&m*gtE W&m,fuv
kd nf; rsm;ap
wwf.? a[mfrek ;f rygonfh tdik ,
f 'l ED iS hf cGpJ yd ef nf;rsm;onf
oH;k &efoifah vsm.
f ?
uav;rarG;bl;olrsm;
toJa&m*grsm;
&kwfw&ufESifh emwm&SnftoJa&mifa&m*grsm;wGif
oaE<wm;aq;oH;k pGv
J #if owdxm;&onf? rsm;aomtm;jzifh
Adik ;f &yftoJa&mifjcif;ESihf toJajcmufjcif;( emwm&Sn)f wd@k
jzpfonf? TtajctaewGif rsufaph0gjcif;/ tom;
0gjcif;ESihf c|t
J arS;( yg;pyftwGi;f ydik ;f tv$m)0gjcif; jzpfaom
*|e'f pfonf t"du vuQ%mjzpfonf?
tqd k y gtajctaewG i f a[mf r S e f ; aq;oH k ; jcif ; ud k
owdxm;rnf? a[mfrek ;f tDpwd*k siEf iS hf y&d*k supf wH;k onf
30
uav;rarG;bl;olq&kd mwGif uav;t&Sit
f arG;zGm;r_
rjyKb;l olukd &nfne$ ;f onf? uav;rarG;bl;ol[k qd&k mwGif
ud,
k 0f efaqmifb;l jcif; &Srd &SEd iS hf roufqikd af y?
uav;rarG;bl;ol trsKd;orD;rsm;.om;tdrfonf
ao;i,faoma=umifh tdik ,
f 'l D (uGi;f )udk tvdt
k avmuf
nSpx
f w
k o
f nfh E_e;f rsm;.? cGpJ yd af omenf;jzifh oaE<wm;jcif;
onfxm0& t+rJuav;r&&Sdawmhay? uav;rarG;bl;
onf uav;vdck sipf w
d af emiftem*gww
f iG f jzpfay:wwf
onf? ( Z,m; udk =unfyh g)
trSwf=23 rwfmv 2004 ckESpf?
usef;rma&;apwref
?
recommended in this situation.
symptoms and the risk of contagion.
Heavy or prolonged menstruation
Liver diseases
The usual menstrual period for an average
woman is 3 to 5 days and the usual monthly
menstrual blood loss is about 40 ml. More than
the said duration could be classified as prolonged
and blood loss much more than 40 ml could be
categorised as heavy.
Combined hormonal contraceptives may
decrease menstrual blood loss, IUD may cause
heavier or prolonged menstruation. Determining
fertile and infertile periods may be difficult when
using natural methods. Additional benefits may
be gained apart from contraception if combined
hormonal methods are used with this condition.
Some liver diseases including acute
inflammation of the liver and long-term liver
disease need to be considered carefully when
using contraception. Most of them are viral
hepatitis and cirrhosis of the liver (chronic liver
disease). The most noticeable feature in this case
is jaundice, which is yellow coloration of the
eyes, skin and mucus membrane (inner aspect
of the mouth).
In this situation, hormonal drugs such as
Oestrogen and Progestogen are unsuitable as
they are eliminated through the liver. Uses of
hormonal contraceptives may over load the
function of the liver leading to liver failure. IUD
and surgical methods are suitable for family
planning in this case.
Abnormal vaginal bleeding
This is any bleeding that occurs outside of
the normal menstrual cycle. Dysfunctional
uterine bleeding is one of the forms of abnormal
uterine bleeding where the cause is difficult to
identify. Hormonal methods may still be used
only if malignancies are ruled out. The risk of
growth of some types of pelvic cancers may be
increased. Surgical methods are one of the most
suitable family planning options in this case.
Abnormal vaginal discharge other than
bleeding
Vulvovaginitis is one of the most common
reasons to attend a gynecological clinic.
Excessive, noticeable discharge is usually vaginal
in origin but, in rare instances, may arise from
the vulva only. Potential causes of abnormal
vaginal discharge include infection of the female
genital tract with Trichomonas, Candida,
Chlamydia, Gonorrhoea, Herpes simplex or
Syphilis.
Condoms prevent sexually transmitted
diseases. Spermicide, diaphragm and cervical
caps may also prevent sexually transmitted
diseases to some extent. Combining hormonal
contraceptives and condoms will reduce both the
ISSUE 23, MARCH, 2004
Severe Headache
Headache is a sensation of pain in the head.
The causes of headache are numerous. It could
be due to anaemia, gastro-intestinal tract, cough,
eye problems etc…. When it comes to
contraception it is headaches which may be
caused by vascular diseases that give rise to the
greatest concern.
Hormonal methods may worsen headache
and/or increase the risk of complications. IUD
copper (non-hormonal) type and surgical
methods are suitable in cases of severe
headache.
Nulliparity
Nulliparity means that a woman has never
given birth to a viable infant. She may or may
not be pregnant to be a nulliparous woman.
In nulliparous women the uterus is still small
and the risk of spontaneous expulsion of IUD is
high. Surgical methods are considered
permanent, a woman who has not borne a child
yet is likely to want children in future.
31
?
trsdK;orD;.usef;rma&;tajctaet&oHk;pGJ&efoifhawmfaomrdom;pkpDrHudef;enf;rsm;
uGef'Hk;
okwfydk;owfaq;
'dik ,
f mz&rftwm;om;tdraf cgi;f tzH;k
ą
a[mfrkef;rygonfh (a=u;eD)
ą
vDAGef*sufp&,fygonfh
ą* ą* ą
xdk;oGif;pdkufonfhaemfyvef@
aoG;tm;enf;jcif;
xdk;aq;toGif toHk;jyKEdkifonf
ą
ą
ą
ą
obm0
enf;rsm;
cGJpdyfenf;rsm;
a[mfr;kH 2rsKd ;yg y&d*k supf wd*k siw
f rsK;d om;tdrx
f o
J @kd twm;tqD;enf;rsm;
udk,f0efwm; wnf;ygudk,f0efwm; xnfhaom
aq;
aq;
ypPnf;
yg;pyfjzifh pm;oHk;Edkifygonf
tajctaersm;
yg;pyfjzifh pm;oHk;Edkifonf
*
= use;f rma&;tajctaeonf ud,
k 0f efwm;enf;rsm;udk [ef@wm;aESmuf,u
S jf cif; r&dS ouJo
h @kd
wm;enf;rsm;onfvnf; use;f rma&;tajctaeudk xdcu
kd rf r_ jyKay?
= ud,
k 0f efwm;enf;rsm;rSxyfqift
h usKd ;&drS a_ wG@&onf?
xdk;aq;toGif toHk;jyKEdkifonf
ą
ą
ą
qD;csKd
aoG;wd;k 140Œ90
ą
ą
ą
ą
ą
ą
ą
ą
ą
ą
ESv;kH a&m*g
- tqkwfwDbD
- iSufzsm; (omref)
ą
ą
ą
ą
tzktudswftrsKd;rsKd;
ą
&ifom;tudswf
tdwftdkifAGD/ attdkif'Dtufpf
ul;pufEdkifonfhtajctae
=umjrifhpGmESifhyrm%rsm;
jym;pGm&moDaoG;ay: jcif;
ą
ą
ą
ą
ą
ą
ą
ą *
ą* ą* ą
ą
ą
ą
ą
ą
ą
ą
ą
ą
ą
ą
ą
rdef;rudk,frSobm0r[kwfonfhaoG;qif;r_
rdef;rudk,frSobm0r[kwfonfh
t&nfrsm;qif;r_
ą* ą *
ą
ą
ą
ą * ą
ą
ą
toJa&m*g
ą
ą
acgi;f udu
k jf cif;Œqd;k &Gm;jyif;xefpmG
ą
ą
uav;rarG;bl;jcif;
32
ą
ą
ą
ą
ą
trSwf=23 rwfmv 2004 ckESpf?
ą
ą
ą
ą
usef;rma&;apwref
?
Suitable Family Planning Methods according to woman’s Health
ą
Disphragm +Cervical cap
ą
ą
ą
ą
ą
Natural
methods
Surgical
methods
Barrier
methods
Spermicide
Implant
ą
IUD
Condom
Injectable
ą * ą *
Oral
Anaemia
Injectable
Combined Progestogen
hormonal contraceptive
contraceptive
Oral
Conditions
Levonorgestrel
*
= The health condition will not disturb with use of the contraceptive method and
the contraceptiven method will not affect the condition.
= Additional benefit gained from contraceptive
Non-hormonal (copper)
ą
ą
ą
Diabetes
Hypertension above 140/90
ą
ą
ą
ą
ą
ą
ą
ą
ą
ą
Heart disease
- Pulmonary Tuberculosis
- Malaria (uncompli-cated)
ą
ą
ą
ą
Lump all types
ą
Breast Lumps
Risk of HIV
AID and other STDs
ą
Heavy or prolong menstruation
ą * ą *
ą
ą
ą
ą
ą
ą *
ą
ą
ą
ą
ą
ą
ą
ą
ą
ą
ą
ą
ą
ą
Abnormal vaginal bleeding
Abnormal vaginal discharge
ą * ą *
ą
ą
ą
ą * ą
ą
ą
Liver disease
ą
ą
Headache/severe type
ą
ą
Nulliparity
(have never given birth)
ą
ą
ą
ISSUE 23, MARCH, 2004
ą
ą
ą
ą
ą
ą
33
?
ud,
k 0f efr&Sad =umif;twnfjyK&efypkH H
rdom;pkprD u
H ed ;f 0efaqmifrv
_ yk if ef;rsm;vkyaf y;aeolrsm;onf vlrsm;ua[mfrek ;f enf;rsm;jzpfap/ om;tdrx
f o
J @kd
yPnf;xJhaomenf;jzpfap oHk;rnfqdkygu xdkolrsm;wGif udk,f0efr&Sdfa=umif;udk od&Sd&rnf? udk,f0ef&Sda=umif;
prf;oyfaomprf; oyfcsuf(Pregnancy test) onf wdus&iS ;f vif;aom tajzudak y;Edik af omfvnf; trsm;tm;
jzifh r&&SEd ikd yf g/ od@k r[kwf toH;k jyKrnfo
h t
l wGuf wefz;kd =uD;onf?
Edik if w
H umrdom;pkuse;f rma&;tzJ@G (FHI) rS ud,
k 0f ef&w
dS mr[kwaf =umif;udk od&EdS ikd o
f nfh vG,u
f pl mG toH;k jyKEdik f
aom ar;cGe;f yHpk H(Questionnaire) udk wnfxiG cf o
hJ nf?
trsKd ;orD;wpfO;D onf xdak r;cGe;f rS tenf;qH;k ar;cGe;f wpfcu
k kd “[kwo
f nf” [kajzEdik v
f #i/f olronf “ud,
fk 0f efr&S”d
Edik af y? xdt
k cg 0efaqmifrv
_ yk af y;olu olrvdck siaf omenf;udak y;Edik yf gonf? tu,fI trsKd ;orD;uar;cGe;f tm;vH;k udk
“r[kwyf g” [kajzqdck v
hJ #i/f ud,
k 0f efr&S[
d k rajymEdik f awmhyg? xdt
k cg olronfaemufwpfcg &moDvmonftxdapmifh
&rnf/ od@k r[kwf olr.ud,
k 0f eftajctaeudo
k &d ef ud,
k 0f ef&adS =umif;prf;oyfaomprf;oyfcsuf udo
k ;kH &rnfjzpfonf?
trsKd ;orD;u ar;cGe;f wpfcu
k kd “[kwo
f nf” [kajzv#i/f “[kwo
f nf”
tuGu.
f atmufzufaumfv.
H wnfw
h nfh
yxrtuGuo
f @kd qufvufar;oGm;yg?
r[kwf
ar;cGe;f
[kwo
f nf
1) oifveG cf ahJ om 6 vtwGi;f uav;i,f&cdS o
hJ vm;? oifuav;udk rd
cifE@kd wpfrsKd ;wnf;wku
d af eovm;? xdu
k av;&Su
d wnf;u &moDrvm
ao;bl;vm;?
2) oifaemufqHk;&moDvmcJhaomtcsdefrS tcktcsdeftxd vdifquf
qHjcif; a&SmifusOo
f vm;?
3) oifveG cf ahJ om &ufoWywf 4 ywf twGi;f uav;i,f&cdS o
hJ vm;?
4) oifaemufq;kH &moDvmcJw
h m vGecf ahJ om 7 &uftwGi;f uvm;?
5) oifveG cf ahJ om 7 &uftwGi;f u uav;ysuu
f sco
hJ vm;?
6) oifonfpw
d cf s&aom ud,
k 0f efwm;enf; wpfrsKd ;rsKd ;udk rSerf eS Ef iS hf enf;
vrf;rSeu
f efpmG oH;k aeovm;?
34
trsKd ;orD;uar;cGe;f tm;vH;k udk
“r[kw”f [kajzv#if
trsKd ;orD;u tenf;qH;k ar;cGe;f wpf
ckukd “[kwo
f nf”ajzv#if
ud,
k 0f efr&S[
d k rajymEdik /f
trsKd ;orD;onfu,
kd 0f ef&o
Sd nfh
vuQ%mrsm;r&Syd g/
trsKd ;orD;aemufwpfcg&moDvmonft
xdapmifo
h if(h od@k )ud,
k 0f efprf;oyfcsuo
f ;kH /
trsKd ;orD;udk olvckd siaf om
ud,
k 0f efwm;enf;vkyaf y;yg/
trSwf=23 rwfmv 2004 ckESpf?
usef;rma&;apwref
?
Check list to rule out pregnancy
Family Planning service providers should always rule out pregnancy for people choosing
hormonal methods and IUD. However, a pregnancy test, which can give the clear-cut
answer is not often available or too expensive for the client.
FHI (Family Health International) has designed an easy to use questionnaire that helps
to exclude pregnancy.
If a woman answers YES to at least one question, she can NOT be pregnant and the
provider can give the desired method. On the contrary, when the clients answer NO to all
of these questions, pregnancy cannot be ruled out and the client should await menses or
use a pregnancy test to know her condition.
If the client answers YES to any question,
proceed to the first box directly below the YES column
NO
QUESTION
YES
1. Did you have a baby less than 6 months ago, are you fully
breastfeeding, and had no menstrual period since then?
2. Have you abstained from sexual intercourse since your last
menstrual period?
3. Have you had a baby in the last four weeks?
4. Did your last menstrual period start within the past 7 days?
5.Have you had a miscarriage or abortion in the last 7 days?
6. Have you been using a reliable contraceptive method
consistently and correctly?
Client answered NO
to all of the questions
Client answered YES
to at least one question
Pregnancy cannot be
ruled out
Client is free of signs or
symptoms of pregnancy
Client should await menses
or use pregnancy test
Provide client
with desired method
ISSUE 23, MARCH, 2004
35
oaE<wm;jcif;oHk;pGJolrsm;tm;a&G;cs,fr_rSefuefap&efulnDjcif;
yD/ yD/ at/ wD tzGJ@ESifhusef;rma&;apwrmeftzGJ@yl;wGJa&;om;onf
pum;ajymjcif;ESiq
hf ufo,
G af &; u|r;f usirf o
_ nf rdom;pkprD u
H ed ;f . ESpo
f rd ahf qG;aEG;jcif;tydik ;f wGif aomhcsu=f u
ta&;ygonf? Taqmif;yg;onf yDyaD twDuiG ;f qif; 0efxrf;wa,muf r,fvpS cef;wGif u|r;f usipf mG
ESpo
f rd ahf qG;aEG;ay;yHu
k kd az: jyxm;onf?
oaE<wm;jcif;udk oH;k pGo
J rl sm;tm; oifah wmfaomenf; onftoGm;tjyef owif;pum;zvS,fjcif; jzpfonf?
J .
l ar;cGe;f rsm;ESihf qENrsm;udk
rsm;udk ay;Edik &f ef ESpo
f rd ahf qG;aEG;jcif;onf ta&;ygaom wenf;tm;jzifh wm;aq;oH;k pGo
tcsuf wcsujf zpfonf? touf// use;f rma&;tajctae/ em;axmif+yD;// olw@dk tm; a&G;cs,pf &mta=umif;rsm;udk
d yf
aq;bufEiS yhf wfoufonfh &mZ0ifEiS u
hf ,
dk yf ikd f ESpo
f ufr_ today;&rnf? aqG;aEG;r_onf wOD;csi;f tajctae/ vkt
ay:rlwnf+yD; trsdK;orD;wOD;csif;tvdkufvdk aq;GaEG;&ef csuEf iS fh wefb;kd xm;r_rsm;udk tav;xm;aqG;aEGay;&rnf?
vdt
k yfygonf? aumif;rGef aocsmpGm ESpo
f rd ahf qG;aEG;ay;
jcif;tm;jzifh oaE<wm;enf;rsm;.pGr;f &nfukd jrSiw
hf ifEikd f today;a&G;cs,fr_onf rnfonfht&mjzpfoenf;??
_ nf ud,
k yf ikd v
f w
G v
f yfaocsmpGm qH;k
ygonf? a&G;cs,ef nf;udk aocsmpGm rodv#iaf omfvnf;/ today;a&G;cs,rf o
oaE<wm;jcif;rnfuo
hJ @kd tvkyv
f yk o
f nfukd em;rvnfv#if jzwfcsucf s&efjzpfonf? ta=umif;t&mrsm;udk em;vnfod
aomfvnf; od@k r[kwf wm;aq;rsm;.qd;k usKd ;rsm;udk rodv#if &d+S y;D a&G;cs,&f efenf;rsm;udk tajccHIqH;k jzwfEikd &f efjzpfonf?
k f vGwv
f yfpmG / em;vnf+y;D oaE<wm;enf;
aomfvn;faumif;/ oH;k pGo
J o
l nfwm;aq;udk &yfvu
dk jf cif; wOD;csi;f tvdu
odk@r[kwf tv$JoHk;pm;jyKEdkifonf? onftwGufa=umifh oHk;pGJvdkjcif; &dSr&dSudk qHk;jzwfEdkif&rnf? oHk;vdkv#ifvnf;
f kd qH;k jzwfEikd &f efjzpfonf?
usef;rma&;vkyfom;wkd@onf taumif;qHk;ESpfodrfhaqG; rnfonfeh nf;udk oH;k pGrJ nfu
oaE<wm;enf;udk rdru
d ,
kd w
f ikd af &G;cs,cf iG o
hf nf tajc
aEG;r_ukd aqmif&u
G &f ef vkt
d yfayonf?
cHvt
l cGit
hf a&;jzpfonf? oaE<wm;
enf;udk oH;k pGo
J rl S a&G;cs,&f rnfjzpf+yD;/
use;f rma&;vkyo
f m;rS a&G;cs,af y;jcif;
r[kwaf y? oH;k pGo
J t
l aejzifh a&G;cs,Ef ikd f
ap&eftwGuf use;f rma&;0efxrf;rsm;
taejzifh ta=umi;ft&mrsm;ukd &Si;f
vif;pGm tajymqdk &Si;f vif; ta=umif;
=um;ay;&rnf?
ESpo
f rd ahf qG;aEG;jcif;qdo
k nfrmS rnfonft
h &mjzpfoenf;??
ESpfodrfhaqG;aEG;jcif;qdkonfrSm wm;aq;oHk;pGJrnfholrsm;
tm; odoifo
h nft
h a=umif;t&mrsm;tm; odapjcif;ESihf
wOD;jcif;vGwv
f w
G v
f yfvyf rdru
d ,
kd rf rd d oH;k oyf+yD; qH;k jzwf
csuf csEikd af p&ef tultnDay;jcif;jzpfonf? aqG;aEG;jcif;
36
aumif;rGeaf omESpo
f rd ahf qG;aEG;jcif;wGif
yg0ifaomtcsufrsm;
h uf
• aqG;aEG;oltm;oufawmifo
omtaetxm;cHpm;r_&ySd g ap?
• wOD;csi;f tvdu
k f vdt
k yfonfh t
csurf sm;ukd aqG;aEG;ay;yg?
• wdusaomowif;ESit
hf a=umif;
l l
t&mrsm;udak jymjyyg/ aqG;aEG;r_c,
H o
em; vnfa=umif;ao csmygap?
• aqG;aEG;oltm; qH;k jzwfcsucf sEikd &f efun
l yD g/ qH;k jzwf
csut
f m; a&G;cs,rf ay;ygEiS ?hf
• aqG;aEG;ol.ar;cGe;f ESirhf w
S cf suu
f ekd m;axmifyg
trSwf=23 rwfmv 2004 ckESpf?
usef;rma&;apwref
Helping Clients
to Make the Right Choice
Health Messenger Team in collaboration with PPAT
Communication skill is one of the key factors in counselling sessions for family planning
programmes. In this article we look at how skilful field staff from PPAT (Plan Parenthood
Association of Thailand) provide counselling at Mae La camp.
Counselling has a crucial role in providing
clients with the most appropriate contraception
methods. Each woman has different needs
depending on her health, age medical history, and
personal preferences. Providing good counselling
will increase the efficiency of methods. If a client
feels unsure about the method chosen, if they
haven’t understood properly how the what the
contraceptive works or what can be the side
effects, chances are she will interrupt it or misuse
it. This is why heath workers have to be able to
provide the best counselling.
What is counselling: Counselling means
helping clients to make informed and voluntary
decisions about their individual care. It is a two
way exchange of information that involves
listening to the client’s questions and wishes and
informing them about their options. Counselling
takes into account (is responsive) to each client's
individual situation, values and needs.
What is informed choice: Informed choice
is a voluntary, well considered decision that an
individual makes based on choices, information
and understanding. The individual should make a
free and informed decision about whether or not
she wishes to use a contraception methods and if
so, what she or he wishes to use.
Being able to choose their own method of
contraception is a basic human right. Ultimately
it is the client who must choose her method of
contraception and not the Health Worker. Health
workers have to provide the clearest information
ISSUE 23, MARCH, 2004
to help the client make the right decision.
•
•
•
•
•
The elements for a good counselling:
Help the client feel at ease
Give a personal counselling adapted to each
person's need
Give accurate information and make sure
the clients understand
Help the clients to take the decision but do
not choose for him/her
Listening to the client’s questions and
remarks
The following methods can help health
workers to provide the right counselling. It is
called in English GATHER methods and it is
based on 6 elements.
1. G REETING the client
2. A SK clients about themselves and listen to
the answer
3. T ELL clients about their choices
4. H ELP the clients choose
5. E XPLAIN what to do
6. R ETURN for follow up
37
atmufygenf;rsm;onfusef;rma&;vkyfom;rsm;udkrSef
uefaomrdom;pkpDrHudef;ESifhywfoufonfhESpfodrfhaqG;
aEG;r_ay;Edkif&ef ulnDygvdrfhrnf? t*FvdyfpmvkH;aygif;
taejzifh G A T H E R [kac: jyD;tydik ;f 6 ydik ;f yg&o
Sd nf?
G REETING - aqG;aEG;&efvmoltm; Ekwcf eG ;f quf
pum;jzifh &if;ES;D r_ &&ef ajym=um;yg?
ar;Edik yf gw,f? usru &SiEf iS w
hf uG &Si&f rhJ o
d m;pkukd ulnD
&rSmudk 0rf;omaeygw,f?”
rzDzD “aus;Zl;wifygw,f tr&,f? 'Dwpfcg usrvmwm
'kw,
d t=udrjf zpfygw,f? usr t&iftywfuvnf;
vmygao;w,f? tckusru jzpfEidk &f if ud,
fk 0f efwm;
xd;k aq;udk vufczH @kd qH;k jzwfvmjcif; jzpfygw,f”?
A SK - aqG;aEG;&efvmol.ta=umif;udk pHkvifpGm
ar;jref;yg?tajzuked m;axmifyg
T ELL - a&G;&ef&aSd omenf;rsm;udjk ynfph akH tmifajymjyyg?
H ELP - enf;wrsKd ;rsKd ;udk a&G;cs,Ef ikd &f efun
l yD g?
E XPLAIN - rnfuo
hJ @kd jyKrlaqmif&u
G &f rnfu&dk iS ;f jyyg?
R ETURN - aemufxyfjyefvm&rnf&h ufEiS hf qufvuf
vky&f rnfv
h yk if ef;udak jymyg?
aqG;aEG;oltm;vk;H wd@k twGuf t}udrw
f ikd ;f txufyg
tcsurf sm;tm;vH;k t+rv
J t
dk yfcsirf S vkt
d yfayrnf? tqdyk g
tcsurf sm;onf use;f rma&;vkyo
f m;trsm;pkw@kd toH;k
jyK=u+yD; wefbkd;xm; tav;ay;aqmif&Gufavh&dSonf?
tjrwftpGe;f twGurf [kwo
f nfh (yDyaD twD) rdbjzpf&ef
jyifqifa&;toif;/ xkid ;f Edik if H tzG@J onf/ r,fv
h 'kuQonf
pcef;wGif tqdyk genf;udk toH;k jyK+y;D ESpo
f rd ahf qG;aEG;a=umif;
awG@&dS&onf? at/ trf;/ tdkiftzGJ@onf (yDyDatwD)
pDrcH su0f efxrf; aemft,fazgEiS v
hf u
kd yf g+y;D atmufygtwdik ;f
avhvm =unf&h =_ uonf?
vlemudEk w
_ q
f ufjcif; (GREETING)
vlemtrSwf 1 rzDzt
D ouf 20 ESpf
tvkyt
f udik f – rScD kd
olrwGif 4 vausmu
f av; 1 a,muf (touf&iS )f
&So
d nf/
vkyif ef; - 'Dyykd &dAk &D m ud,
fk 0f efwm;xd;k aq;vufc&H ef
ESpo
f rd yhf nmay;aqG;aEG;jcif;/
aemft,fazg “aeaumif;&Jhvm;/ &Sifaeaumif;r,fvdk@usrxif
ygw,f/ &Sio
f yd gw,f/ usreHr,fu aemft,fazgjzpf
ygw,f? yDyw
D aD t&Jph rD cH su0f efxrf;jzpfygw,f? usru
'D'kQonfpcef;rSm&SdwJh 'kQonfawGtwGufaqmif
&Gufay;aewJh rdom;pkpDrHudef;vkyfief;rsm;udk wm0ef
,l&oljzpfygw,f? xdik yf g&iS ?f ud,
k 0f efjcm;jcif;ESiyhf wf
oufwhJ ar;cGe;f rsm;udk pdw&f o
dS vdk vGwv
f w
G f vyfvyf
38
Tpum;ajymydik ;f udk E_wq
f ufjcif; (Greeting)
[kac:ygonf? ESpfodrfhaqG;aEG;ynmay;jcif;&Jh
Greeting tydkif;jzpfygonf? Ttydkif;onf
vlemudk oufawmifo
h ufom&Sad p&ef ulnyD gonf?
oifw@kd owd&rnfrmS olw@kd onf oifu
h kd ud,
k af &;
ud,
k w
f mESiyhf wfoufonfh owif;tcsut
f vuf
tcsdK@udk ay;&efvdktyfrnfjzpfygonf? olwdk@udk
vdkvdkvm;vm;=udKqdkonf[k cHpm;&ygu olwdk@
twGuf oufawmifo
h ufom jzpfrnfjzpfygonf?
xd@k twGuaf =umifh vlemvmygu E_wq
f ufjcif;ESihf
,Ofaus; odraf rG@jcif;onf yxrqH;k tqifh tae
ESihf vdt
k yfaomtqifh jzpfygonf?
ar;cGef;ar;jcif; odk@r[kwf ppfaq;jcif; (ASKING/
ASSESSING)
aemft,fazg –
“usru &Siu
hf kd &SiEf iS o
hf ifah wmfrnfh rdom;pkprD u
H ed ;f enf;
wpfenf;udk a&G;&mrSm ulnrD mS jzpfygw,f? usru &Sio
f ;kH
EdkifwJhenf;vrf;rsm;ta=umif;udk ydkrdk&Sif;jyrSm jzpfyg
w,f? 'gayrJh usr &Sit
hf a=umif;ydo
k cd siyf gao;w,f/
oifbmvkycf siw
f ,fqw
kd mudv
k nf; odcsif ygw,f? usr
&Siu
hf kd ud,
k af &;ud,
k w
f mESiq
hf ikd w
f hJ ar;cGe;f tenf;i,f
udk ar;csiyf gw,f
rzDzD –
“[kwu
f ?hJ ar;Edik yf gw,f&iS ?hf ”?
trSwf=23 rwfmv 2004 ckESpf?
usef;rma&;apwref
Not all clients need to be counselled in this
order and not all them need the 6 elements. This
method is used and appreciated by many health
workers. In the camp of Mae La, the GATHER
method is being used by Plan Parenthood
Association Thailand (PPAT), a non-profit
organisation working on family planning for the
refugees. AMI team followed project staff Naw
Eh Paw during her counselling session applying
GATHER method.
Client 1. Ma Phi Phi
Age —20 years
Occupation — dependent
She has one child alive about 4 months old
Activity: counselling for receiving
contraceptive injection Depo Provera
GREETING
Naw Eh Paw:
How are you? Hope you are well and
fine. My name is Naw Eh Paw, I’m
working with PPAT. I am responsible for
family planning activities for the refugees
residing in this camp. Please take your
seat and feel free to ask me information
on birth spacing. I am pleased to help
you and your family.
Ma Phi Phi:
Thank you, my sister. This is my second
visit and I came here last week. Now, I
have decided to receive birth spacing
Injection if possible
ASKING/ ASSESSING
Naw Eh Paw:
Well, I am here to help you to choose the
family planning method that is
appropriate for you. I will explain you
more about various methods you can use.
But before I need to know more about
you and what you want to do, may I ask
you a few personal questions.
Ma Phi Phi:
Yes, of course.
Naw Eh Paw:
What is your name?
Ma Phi Phi:
My name is Ma Phi Phi.
Naw Eh Paw:
Where do you live?
Ma Phi Phi:
I live in Nu Po camp.
Naw Eh Paw:
How old are you?
Ma Phi Phi:
I am twenty years old.
This part of their conversation is named as Greeting component of counselling session. It
is to help the clients to feel at ease. Remember that they will need to share with you some
personal information. It will be easier for them to do it if they feel welcome. Therefore
greetings and politeness when clients arrive is a necessary first step.
ISSUE 23, MARCH, 2004
39
aemft,fazg –
“&Siehf rH ,fb,fvakd c:ovJ?”
rzDzD –
“rzDzyD g&iS ?hf ”?
aemft,fazg –
“&Sib
f ,frmS aeovJ?”
rzDzD –
“Elz'kd Q
k onfpcef;rSmaeygw,f&iS ?hf ”?
aemft,fazg –
“&Sit
hf oufb,favmuf&+dS yDv?J ”
rzDzD –
“usrtouf 20 &Syd g+yD”?
aemft,fazg –
“&Sib
f mtvkyf vkyo
f vJ?”
rzDzD –
“usrrScD ykd g?”?
aemft,fazg –
“&Sirhf mS uav;b,fEpS af ,muf&o
dS vJ?”
rzDzD –
“usr 4 vt&G,f uav;wpfa,muf&ydS gw,f”?
aemft,fazg –
“&Sirhf mS &moDvmjcif;ESiyhf wfouf+yD; jy\emrsm; &Sd
ovm;?”
rzDzD – “usrrSm r&Syd gb;l ”?
em;vnf&J@vm;
Do you understand?
[kwfuJh
Yes, I do
ajymjyjcif; (TELLING)
vlemtrSwf 2 rxef
touf 26 ESpf
tvkyt
f udik f – rScD kd
olrwGif uav; 2 a,muf? t}u;D qH;k 5 ESpf ESihf ti,f
qH;k 4 ESp?f
vkyif ef; - ud,
k 0f efwm;pm;aq;vufc&H ef ESpo
f rd yhf nm
ay;aqG;aEG;jcif;? Tt}urd o
f nf olrtwGuyf yD w
D aD t
aq;cef;od@k 'kw,
d t}udrv
f ma&mufjcif; jzpfonf?
aemft,fazg “aumif;ygw,f? &Siu
f tcsKŒ
d aomud,
k 0f efjcm;enf;rsm;
txufaz:jyyg pum;ajymcef;onf ESpo
f rd ahf qG;aEG;ynmay;jcif;&Jh ar;cGe;f ar;jcif; od@k r[kwf ppfaq;jcif;
(ASKING/ASSESSING) tydkif;jzpfygonf? ar;cGef;ar;jcif;onf pdwfyg0ifpm;pGm em;axmifjcif;ESifh
twljyKvkyyf gonf? oifar;cGe;f rsm; ar;awmhrnfqykd gu –
• vlembma=umifh vmovJukd od&rnf?
• vlemuol.ud,
k af &;tajctaeESiv
hf t
kd yfcsuu
f kd &Si;f jy&mwGif ulnaD y;yg?
• vlem.ud,
k 0f efjcm;jcif;ESiyhf wfoufonfh A[kow
k b,favmuf&o
dS nfukd avhvmyg?
• vlemuol.cHpm;csurf sm;/ a=umuf&Œ
HG r_rsm;ESihf em;vnfrmS ;aeonft
h csurf sm;udk az:jy&mwGif ulnyD g?
• vlemudk oifu *&kpu
kd af =umif;udk jyoyg?
em;axmifjcif;onf ar;cGe;f ar;jcif;uJo
h @kd ta&;}uD;vSygonf?
oifuar;cGe;f ar;+yD; ol.tajzrsm;udk *&kwpdu
k ef m;axmifrnfqykd gu oifuvlem.tajctaeESihf vdt
k yf
csurf sm;udk &Si;f vif;pGmem;vnfrnf jzpfygonf? ppfaq;ar;jref;jcif;onf vlrsm;udk olw@kd .tŒ&m,frsm;udk
olwdk@bmomodvm&ef ulnDay;jcif;jzpfonf? olESifhol.vdifqufqHaz:[email protected];b0 odk@r[kwf
tjyKtrlonf olw@kd ukd vdiq
f ufqjH cif;a=umifh ul;pufEikd af oma&m*grsm; ul;pufEikd &f ef tŒ&m,fy&kd o
dS vm;? wzef
ar;cGe;f ar;jcif;jzifh vlemudk ol.a&m*grsm;ul;pufEikd af omtŒ&m,fukd rSe;f qEdik &f efun
l aD y;Edik o
f nf? vlem. vdif
qufqrH b
_ 0ESiyhf wfoufI wdu
k &f u
kd af r;cGe;f ar;&ef cufcyJ gonf? od@k &mwGif oG,0f u
dk af omar;cGe;f ar;jcif;jzifh vlem
wGif a&m*grsm; ul;pufEikd af omtŒ&m,f&rdS &Su
d kd od&EdS ikd &f ef ulnED ikd o
f nf? tzGiahf r;cGe;f rsm;ar;&efta&;}u;D onf?
Oyrm b,fvv
dk /J bma=umifv
h ?J tydwaf r;cGe;f onf/ [kwu
f /J r[kwyf g [ktvG,w
f ulajzEdik o
f nf?
40
trSwf=23 rwfmv 2004 ckESpf?
usef;rma&;apwref
Naw Eh Paw:
What is your job?
Ma Phi Phi:
I am dependent.
Naw Eh Paw:
How many children do you have?
Ma Phi Phi:
I have only one four month old child.
Naw Eh Paw:
Do you have menstrual problems.
Ma Phi Phi:
No, I don’t have any.
of these birth spacing methods. Now I
would like to tell you some important
information about various methods you
can use. This will help you to choose the
method that you think is the best for you.
Do you agree to listen to me carefully?
Ma Htan :
Yes, I agree with you.
Naw Eh Paw:
Oh, very good! Thank you for your
attention. There are mainly two methods:
the modern and the natural birth spacing
The above mentioned conversation indicates the ASKING/ ASSESSING component of
counselling procedure for family planning. Asking questions goes together with active listening.
When you ask questions you should:
• Know why the client comes
• Help the client explain personal situation and needs
• Learn what is the client’s knowledge on birth spacing
• Help the client express feelings, fears and misconceptions
•
Show the client that you care
Listening is as important as asking questions. If you ask questions and listen carefully to
the answers you will have a clear understanding of the client’s situation and needs. Assessing
is to help people to be aware of the risks for themselves. Does their sexual life or behaviour
or that of their partner(s) put them at risk of getting or transmitting an STI. Again it is by
asking questions that you can help client to assess this risk. It is difficult to ask direct questions
about client’s sexual life. But indirect questions can help us know if a risk exists.It is also
important to use "open" questions, meaning questions using How? or Why rather than "close"
questions which can be easily anseered by yes or no.
TELLING
Client 2. Ma Htan
Age —-26years
Occupation — dependent
She has two children alive. The eldest one is
5 years and youngest 4.
Activity: counselling for receiving
contraceptive pills.
This is second visit for her to
PPAT clinic.
Naw Eh Paw:
Well, it’s good that you already know some
ISSUE 23, MARCH, 2004
methods. With the modern methods you
need either to take a medicine or to use a
device to avoid pregnancy. These methods
are safe and effective. They can cause
41
udo
k x
d m;+yD;om;jzpfaewm? tckusru ud,
k 0f efwm;
enf; trsKd ;rsKd ;&Jh ta&;}uD;aomtcsut
f vufrsm;udk
ajymjycsiyf gw,f? 'D[mu &Siu
hf kd &SiEhf iS t
hf oifh awmf
qHk;jzpfr,fvdk@ xifwJhenf;vrf;udk a&G;cs,f&mrSm
taxmuftul jyKygvrd rhf ,f? usrajymwmudk aoao
csmcsmem;axmifz@kd oabmwl&v
hJ m;?”
rxef “[kwu
f /hJ usr oabmwlygw,f?”
aemft,fazg “tdk/ odyfaumif;wmaygh? oifem;axmifwJhtwGuf
aus;Zl;wifygw,f? ud,
k 0f efwm;enf;-enf; 2 enf;&Syd g
w,f? acwfraDS omwm;enf;ESihf obm0ud,
k 0f efjcm;
enf;rsm; [lI jzpfw
f ,f? acwfraDS omwm;enf;rsm;wGif
&Siu
f ud,
k 0f efukd a&Smif&mS ;&eftwGuf aq;pm;&rnf
od@k r[kwf yPnf;wpfcu
k kd oH;k &rnf? Tenf;rsm;onf
pdwfcs&+yD; xda&mufr_vnf; &Sdygw,f? wpfcgwpf&H
rSmawmh tenf;i,faom uoduatmufrsm; jzpfEikd f
ygw,f? obm0ud,
k 0f efjcm;enf;uawmh &Siu
f ,
kd f
0ef&SdEdkifaom&ufrsm;rSm vdifqufqHr_a&Smif&rSm
jzpfygw,f? Tenf;udk oifaq; rpm;vdak omtcgrmS
oH;k Edik w
f ,f? 'gayrnfh &Siu
f ,
kd 0f ef&Edik zf @kd tŒ&m,fyrkd sm;
w,f? tckusru udk,f0efwm;pm;aq;vHk;rsm; t
a=umif;udk ajymjyrSmjzpfw,f? tJ'gajym+yD;&if uGe'f rG f
rsm;/ om;tdrx
f x
J nfah omyPnf;rsm;/ ud,
k 0f efwm;
xd;k aq;rsm;/ vufarmif;.ta&jym;atmufxJ xnfh
xm;&aomudk,f0efwm;aq;rsm;ESifh om;a=umjzwf
jcif;rsm;ta=umif;udk ajymrSmjzpfw,f? yxrqHk;
ud,
k 0f efwm;pm;aq;vH;k rsm;ta=umif;udk pajymwm
ayg?h pmaq;vH;k udk &Siaf e@wikd ;f wpfv;kH wpfv;kH pm;&rSm
jzpfw,f? wu,fawmh ud,
k 0f efwm; pm;aq;vH;k trsKd ;
tpm;tm;jzifh 2 rsKd ;&Syd gw,f? a[mfrek ;f 2 rsKd ; ygaom
udk,f0efwm;aomufaq;vHk; (COC) ESifh y&dk*suf
pwdk*sifa[mfrkef; 1 rsdK;wnf; ygaomudkf,f0efwm;
aomufaq;vH;k (Progestin Only Pill - POP)
wd@k jzpfw,f? uav;udEk @kd wu
kd f aomtrsKd ; orD;rsm;u
'kwd,trsdK;tpm;udk ydktoHk;rsm;w,f? wm;aq;
vHk;rsm;onf tvGefxda&mufr_ &Sdonf? Œonf
a,musfm;.okwfydk;udk om;tdrftwGif;odk@ r0ifEdkif
atmif wm;qD;umuG,o
f nf? a[mfrek ;f 2 rsKd ;ygaom
udkf,f0efwm;aomufaq;vHk; oHk;ygu &SifhudkysdK@jcif;/
tefjcif;/ acgi;f udu
k jf cif;ESihf ud,
k t
f av;csed f tenf;i,f
wd;k jcif; paomtenf;i,faom uoduatmufrsm;
txufaz:jyygpum;ajymcef;onf ESpo
f rd ahf qG;aEG;ynmay;jcif;&Jh ajymjyjcif; (TELLING) tydik ;f jzpf ygonf?
yxrESpo
f rd ahf qG;aEG;ynmay;olu vlemudq
k ;kH jzwfEikd &f ef owif;tcsut
f vufay;onf? xdt
k csut
f vufonf
vlemudk a,mufsm;ESirhf ed ;f rwd@k .rsKd ;yGm;r_qikd &f mtzG@J ta=umif;ESihf vkyaf y;Edik af omud,
k 0f efwm;enf; trsKd ;rsKd ;
ta=umif;udk tusO;f tm;jzifh ajymjyonf? enf;wkid ;f udk tao;pdwaf jymjy&ef roifyh g? tb,fa=umifq
h akd omf
vlemtwGuf &_yaf xG;apEdik af oma=umifh jzpfonf?
tcsuftvufonf vlemESifhoufqdkifaomtcsuftvufrsm; jzpfoifhonf? t"d`g,frSm vlemwpf
a,mufjcif;.vdt
k yfcsuEf iS t
hf ajctaetay:wGif rlwnf+yD; tcsut
f vufrsm;udk udu
k n
f aD tmif ajym&rnf
jzpfonf? xdt
k wGuu
f kd ESpo
f rd ahf qG;aEG;ynmay;olu vlem bmrsm;od&efvt
kd yfonfukd em;vnf&rnf? xdo
k @kd
vky&f ef vG,u
f al omenf;rSm 1) vlemudk b,fenf;=udKufovJ[ak r;yg? trsm;pkrmS olbm=udKufonfukd pdwx
f rJ mS &S+d yD;om; jzpfonf?
vlemrsm;udk olw@kd =udKufwehJ nf;udk vkyaf y;jcif;onf taumif;qH;k jzpfonf? tb,fa=umihq
f akd omf olw@kd
xdkenf;udk =um=umoHk;Edkifaomtajctae&Sd+yD; xda&mufpGmvnf; toHk;csrnfjzpfonf? ESpfodrfhaqG;aEG;
ynmay;olu vlemu oH;k rnfeh nf;udk jynhjf ynfph pkH kH em;vnfrvnfEiS hf xdv
k el mtwGuf oH;k rnfeh nf;onf
roH;k oifah om tajctae (Contraindication) jzpfrjzpfukd ppfaq;ay;&efvt
kd yfonf?
2) vlemu xdek nf;udk roH;k Edik yf gu vlemudk bmta=umif;rsm;a=umifh xdek nf;udk a&G;ovJqw
kd m ar;jref;&rnf?
+yD;awmhvel m.ta=umif;jycsurf sm;t& olEiS t
hf oifah wmfq;kH jzpfrnfh tjcm;enf;udk aqG;aEG;wdik yf ifyg?
3) vlemub,fu,
kd 0f efwm;enf;rS pdwx
f w
J iG rf &Syd gu ol@twGuf rdom;pkprD u
H ed ;f wGif rnfonft
h csuo
f nf
ta&;}uD;qHk;jzpfa=umif;ESifh xdkrdom;pkpDrHudef;rS bmrsm;ar#mfvifha=umif; ar;jref;yg? ol.tajzrsm;rS
olbmrsm;vdt
k yfonfukd n$ejf yEdik af omtajzrsm; jzpfEikd o
f nf?
42
trSwf=23 rwfmv 2004 ckESpf?
usef;rma&;apwref
sometimes a few discomforts. For natural
method, you need to avoid sexual
intercourse during the days you can get
pregnant. You can use this method if for
example you do not want to take medicine,
but there are more risks of getting
pregnant. Do you have any questions so
far?
Ma Htan :
No I understand, please carry on.
Naw Eh Paw :
There are several contraception methods
such as the PILS, CONDOMS, IUDs,
INJECTIONS, IMPLANTS AND
STERILISATIONS. But lets start first with
the PILLS. You have to take the pill every
day. In fact there are two types of pills the
COC (Combined Oral Contraceptives) and
POP (Progestin Only Pill). Women who are
breast-feeding more often use the second
one. The pill is very effective. It prevents
the sperms of the man from entering the
womb. With COC you might have a few
discomforts such as nausea, vomiting,
headache and a little weight gain. But it
will progressively disappear after some
time. Do you have any questions? Is there
anything unclear for you? I’m happy to
answer your questions Have you ever
heard of rumours regarding the pill?
Ma Htan :
Well I’m not sure about the pill. I heard of
rumours about the pill..
The above dialogue is about the TELLING section of family planning counselling activity.
First, the provider tells the client the information needs to reach a decision. The information
should first describe briefly the male and female reproductive system and the various methods
available. Every method should not be explained in detail, because it can be very confusing
for the client. Before telling, ask the client what she already knows about contraception and
let the client speak first before telling.
The information should be personalised. It means that the provider adapts the information
given to each client’s needs and situation. For that the provider has to understand what the
client needs to know. There is an easy way to do it:
1. Ask the client the method he likes. Most have a method in mind. It is better to provide
the clients with the method they chose because most probably, they will use it longer and
longer and more effectively. The provider needs to check that the client understands fully
the method, that there is no medical contraindication.
If the client cannot use the method, ask about the reasons for choosing this method, and
discuss with the client about another available method that fits the best with the reasons
of the client’s first choice.
2. If the client has no method in mind, ask what is the most important in family planning
for the client and what the client expects from it. The answers will give an idea about the
client’s needs.
ISSUE 23, MARCH, 2004
43
cHpm;&rnfjzpfw,f? 'gayrJh tJ'D[mrsm; tcsdef=um
vmwmESifhtr# ajz;ajz; aysmufoGm;rSmjzpfw,f?
&Siaf r;cGe;f ar;p&m&So
d vm;? &Siu
f ,
kd 0f efwm; aomuf
aq;vH;k rsm;ESihf ywfoufwahJ umv[mvrsm; =um;zl;
ovm;? ”
rxef “[kwfuJh? udkf,f0efwm;aomufaq;vHk;rsm;[m
uoduatmufEiS rhf rSeaf om&moDaoG;vmjcif;udk jzpf
apw,f qdw
k ahJ umv[mvrsm;ud=k um;zl;ygw,f? ”
ulnjD cif; HELPING
aemft,fazg “aumif;w,f? &Siaf r;p&m&So
d vm;? &Sio
f ;kH csiw
f ehJ nf;
udk aoaocsmcsm rodao;&if usruln&D iS ;f jyEdik w
f ,f?
'grrS [kwf &Sio
f yd rf &Si;f wm&S&d ifvJ usruln&D iS ;f jyEdik f
ygw,f?”
rxef “ar;p&mr&Sdawmhygbl;/ usrqHk;jzwf+yD;yg+yD? usr
ud,
k 0f efwm;aq;vH;k udk ,lygrh ,f?”
aemft,fazg “tJ'D[mu udk,f0efjcm;&mrSm tvGefxda&mufwJh
enf; jzpfygw,f? 'gayrJh aq;vH;k awGrmS raumif;usKd ;jzpf
apwJh tcsdK@tcsufrsm;vJ&Sdygw,f? &Sif&moDaoG;u
rSecf sirf S rSerf ,f/ 'grrS [kwf &moDaoG;tpufavmuf
bJ vmcsiv
f mr,f? vpOf&moDaoG;rvmwmvJ jzpfEikd f
w,f/ wcgwav acgi;f udu
k rf ,f? &Sif vdirf qufq&H if
awmifrS ae@wikd ;f ae@wikd ;f aq;vH;k 1 vH;k pm;&r,f?
&Siu
f ,
kd 0f efwm; enf;tjcm;enf;udak jymif; oH;k csiw
f ,f
jzpfap/ udk,f0efvdkcsifw,fjzpfap udk,f0efwm;aq;
vH;k uyfuek w
f meJ@ &yfypfvu
kd yf g/ aemufxyf qufrpm;
yge@J awmh?”
rxef “[kwu
f /hJ usr &Siu
f n
l w
D mudk em;vnfyg+yD?”
aemft,fazg “tckusr &Siu
hf kd ar;cGe;f tenf;i,far;zd@k e@J &Siu
hf o
kd u
G f
oGupf rf;oyfz@kd vykd gw,f? 'grS &Sit
f m;vH;k aumif;&Jv
h m;/
ud,
k 0f efwm;aq;vH;k udk &Sio
f ;kH Edik &f v
hJ m;qdw
k m odcsif
vd@k yg? tJ'gjzpfygh rvm;?”
rxef “[kwu
f /hJ jzpfygw,f/ vkyyf gq&mr?”
&Si;f vif;jyjcif; (EXPLAINING)
vlemtrSwf 3 rulul
touf 19 ESpf
tvkyt
f udik f – rScD kd
olrwGif uav; 1 a,muf/ touf 4 ESp?f
vkyif ef;-vufarmif;.ta&jym;atmufxx
J nfah om
ud,
k 0f efwm;aq; aemfyvef@vufc&H ef ESpo
f rd hf ynmay;
aqG;aEG;jcif;? Tt}udro
f nf olrtwGuf yDyw
D aD t
aq;cef;od@k 'kw,
d t}udrf vma&mufjcif; jzpfonf?
aemft,fazg “vufarmif;.ta&jym;atmufxx
J nfah omud,
k 0f ef
wm;aq;aemfyvef@qdkwm aysmhajymif;aomjyGefao;
txufaz:jyyg pum;ajymcef;onf ESpo
f rd ahf qG;aEG;ynmay;jcif;&Jh ulnjD cif; (HELPING) tydik ;f jzpfygonf?
a&G;cs,fjcif;udk vlemua&G;cs,fydkifcGifh&Sdonf? ESpfodrfhaqG;aEG;ynmay;olu vlemudk a&G;cs,fEdkifatmif
ulnDwmjzpfw,f? ESpfodrfhaqG;aEG;ynmay;olu ESpfodrfhaqG;aEG;ynmay;csdefrSm vlemudk atmufygtwdkif;
ulnyD gw,f –
• vlem.tajctae/ vdt
k yfcsurf sm;/ ud,
k 0f efjcm;jcif;ESiyhf wfoufonfAh [kow
k b,ftqift
h xd&w
dS ,f
qdw
k mrsm;udk ppfaq;ar;jref;jcif;?
• vlemu ol.vdt
k yfcsurf sm;/ cHpm;csurf sm;ESihf xifjrifc,
H cl surf sm;udk az:jywJt
h cg vG,u
f al tmifv@kd EpS o
f rd hf
aqG;aEG;ynmay;olu OD;aqmifar;cGe;f rsm;udak r;jcif;?
• owif;tcsut
f vufrsm;udk vlem.tajctae/ vdt
k yfcsurf sm;ESihf udu
k af tmifvyk af y;jcif;?
• qH;k jzwfcsuu
f kd vlemtm;ud,
k w
f ikd v
f yk af pjcif;?
vlemudk ola&G;cs,faom(udk,f0efwm;)enf;ESifhywfoufonfh wdusrSefuefaomtao;pdwf tcsuft
vufrsm;ESihf toH;k jyKyHu
k kd &Si;f vif;jyjcif;?
44
trSwf=23 rwfmv 2004 ckESpf?
usef;rma&;apwref
Naw Eh Paw:
What kind of rumours have you heard
about it?
Ma Htan:
Some people say that the pill causes
discomfort and bleeding irregularly
Naw Eh Paw:
Let me explain to you …
HELPING
Naw Eh Paw:
Fine. Do you have any questions? I can
help you if you are not sure about the
method you want to use or if there is
anything you do not understand well.
Ma Htan :
No, I have already decided; I want to take
the pill.
Naw Eh Paw:
It is a very effective birth spacing method.
But the pills also have some disadvantages.
You may have irregular bleeding or
spotting, no monthly bleeding and
occasional headache. You must take one
pill every day, even if you do not have
sex. If you want to change methods or get
pregnant, stop taking pills when you finish
a packet.
Ma Htan :
Well, I understand.
Naw Eh Paw:
Now I need to ask you a few questions
and do a quick examination to check if
everything is normal and that you can use
the pill. Is this fine with you?
Ma Htan :
Yes, please do so.
EXPLAINING
Client 2. Ma Ku ku
Age —19years
Occupation — dependent
She has one four years child.
Activity: counselling for receiving
contraceptive Norplant
This is second visit for her to PPAT clinic.
Naw Eh Paw:
The implants are small soft tubes, which
The above talk is the HELPING component of counselling session of family planning
activity. The choice belongs to the client and the provider helps the client to make a decision.
The provider helps the client during counselling by:
• Assessing the client’s situation, needs and level of knowledge on birth spacing
• Asking questions leading the client to express needs, feelings and opinions
• Personalising the information to the client’s situation and needs
• Leaving the decision to the client
Explaining to the client precise and detailed information on the use of the chosen method.
ISSUE 23, MARCH, 2004
45
ao;av;rsm;jzpfw,f? xdjk yGeaf v;xJrmS y&d*k supf wif
a[mfrek ;f ygw,f? xdjk yGeaf v;rsm;udk ta&jym;atmuf
rSmxnfx
h m;v#if ud,
k 0f efwm;&eftwGuf y&d*k supf wif
a[mfrek ;f udk eJepJ ED iS ahf jz;ajz; xkwaf y;aerSmjzpfw,f?
tJ'D[mxnfhzdk@twGufESifh jyefxkwfzdk@twGufudk &Sifh
vufarmif;&JhtwGif;zuf ta&jym;rSm t&G,fao;
i,faomcJpG w
d jf cif;vky&f rSmjzpf w,f? 'Dvckd pGJ w
d x
f nfh
&rSmeJ@ywfouf+yD; &Siu
hf kd xyf&iS ;f jyzd@k vykd gao;vm;? ”
rulul “rvdyk gb;l q&mr/ usr q&mr&J&h iS ;f vif;wmudk em;
vnfygw,f?”
aemft,fazg “tckusr vufarmif;.ta&jym;atmufxJxnfh
aomudk,f0efwm;aq;aemfyvef@-tifyvef@ (implants) eJ@ywfouf+yD; xyf&Sif;jycsifygao;w,f?
tifyvef@xnf+h y;D yxrydik ;f vawGrmS &Si&hf moDaoG;[m
rrSefjzpfEdkifw,f (&Sifh&moDaoG;puf0kdif;&Jhtv,f
jyefvmjy&r,f
Visit our clinic again
avmufrmS ) 'grrS [kwf vpOf&moDaoG;qif;wJt
h cgaoG;
qif;wJ&h ufyrkd sm;vmEkid w
f ,f? 'Dvrkd [kw&f ifvJ &Siv
f ;kH
0&moDaoG;qif;rSm r[kwfbl;? 'Dvdkjzpf&wm[m
a&m*gwpfcck jk zpfw,fv@kd rqdv
k ykd gb;l / &Si&hf chJ Œmud,
k u
f
r=umcif 'Dy&d*k supf wif a[mfrek ;f udk usio
hf m;&oGm;
+yD;wJhtcg 'D&moDaoG;eJ@qdkifwJh ajymif;vJr_rsm;[m
aysmufomG ;rSmjzpfw,f? wu,fv@kd aoG;qif;wm[m jy
\emtaeeJ@jzpfw,fq&kd ifusrwd@k u tifyvef@e@J t
wl aq;tcsKd @uv
kd tenf;i,f ay;pm;rSmjzpfygw,f?”
rulul “[kwfuJhq&mr/ usr tifyvef@xnfh+yD;&if usr&Jh
tajctaeudk q&mrudt
k oday;ygrh ,f? usr q&mr
wd@k aq;cef;udk b,f&ufrmS jyefvm&rvJ?”
aemufwpfcgjyefvmjcif; (RETURNING)
aemft,fazg “usr &SifhtwGufaemufwpfcgjyefvmzdk@csdef;wJhuyf
jym;jznfhay;vdkufr,f? aemufwpfcg&Sifjyvm&r,fh
&ufu 2003 ckESpf Zlvdkifv 9 &ufae@jzpfygw,f?
tJ'aD e@rmS xnfah y;vdu
k w
f hJ tifyvef@upkd pfaq; =unfh
rSmjzpfw,f? tJ't
D ifyvef@a=umifh jy\emwpf ckc&k cdS hJ
&if aq;cef;udk tcsed rf a&G;jyefvmEdik yf gw,f? aq;cef;udk
vmwdik ;f vmwdik ;f csed ;f wJu
h yfjym;ud,
k cl &hJ rSm jzpfw,f?
aemufwpfcgjyef vmzdk@csdef;wJh&ufra&mufao;&if
awmif jy\em&Sd&ifjzpfjzpf/ ar;p&m&Sd&if jzpfjzpf
'Daq;cef;udk jyefvmzd@k 0efrav;yge@J ? usru &Siu
hf kd 0rf;
ajrmufpmG eJ@un
l rD mS yg? &Siaf r;p&m&Sad o;vm;/ 'grrS
[kwf &Sief m;rvnfwmrsm; &Sad o;vm;?”
rulul “r&Sad wmhygb;l q&mr/ q&mr&JŒ ulnrD t
_ wGuf trsm;
}u;D aus;Zl;wifygw,f?”
txufaz:jyyg pum;ajymcef;onf ESpo
f rd ahf qG;aEG;ynmay;jcif;&JΠ&Si;f vif;jyjcif; (EXPLAINING) tydik ;f
jzpfygonf? ESpo
f rd ahf qG;aEG;ynmay;olu vlema&G;cs,x
f m;aom ud,
k 0f efwm;enf;ta=umif;&J@ tao;pdwu
f kd
&Si;f jy&efvkd tyfygw,f? em;vnfo&d +dS yD;a&G;cs,jf cif;qdo
k nfrmS vlemu olo;kH rnfeh nf;ESiyhf wfoufwmrsm;tm;
vH;k udak umif;pGmod+y;D / em;vnfoabmaygujf cif;udk qdv
k ykd gonf? 'Dtcsu[
f m vlem&JΠ&ydik cf iG w
hf pfcjk zpfygw,f?
atmufygtcsurf sm;udk vlemudpk eH pfwus&iS ;f jy+yD; aqG;aEG;wdik yf if&rSm jzpfw,f• vlema&G;cs,af omenf;vrf;onf b,fvkd cŒmud,
k x
f rJ mS tvkyv
f yk o
f nf/ b,fvo
kd ;kH pG&J rnf?
• Œ.aumif;usdK;rsm;ESifh qdk;usdK;rsm;?
• Œ.ab;qdk;usdK;oufa&mufr_rsm;?
• tdycf st
f ikd Af /DG attdik 'f t
D ufpt
f ygt0if vdiq
f ufqjH cif;a=umifh jzpfaomul;pufa&m*grsm;udk umuG,jf cif;?
46
trSwf=23 rwfmv 2004 ckESpf?
usef;rma&;apwref
The above mentioned discussion is the EXPLAINING component of family planning
counselling session. The provider needs to explain clearly the details of the method chosen
by the client. An informed choice means also that the client knows and understands well
everything about the use of the method. This is one of the client’s rights. The following points
should be systematically explained and discussed with the client:
• How the method works and how to use it
• Advantages and disadvantages
• Side effects
• Protection against STIs including HIV/AIDS
contain the hormone progestogen. They
are placed under the skin for slow release
of progestogen to prevent pregnancy. You
need to have a minor operation that is a
small cut in the skin of your inner aspect
of arm to insert and remove the implants.
Do you need to explain more about
implant insertion operation more?
Ma Ku Ku
No, I understand your explanation.
Naw Eh Paw:
Now, I would like to explain more about
implants. During the first months, the
implants may cause irregular bleeding (in
the middle of your cycle) or more days of
monthly bleeding. Or you may have no
bleeding at all. This does not mean
something wrong. These changes will go
away as your body becomes used to
having more progestogen if bleeding is a
problem, we will let you take some drug
along with the implants for a few months.
Ma Ku Ku:
Yes, I will let you know my condition after
insertion of implants and when shall I
come back to your clinic?
RETURNING
Naw Eh Paw:
I will fill out an appointment card for you.
Your next visit to our clinic would be on
9 th July 2004 to check your implant
insertion and please feel free to come any
time if you have problem with these
implants. You have to bring your
appointment card with you at each visit.
Please if you have any problem or
question even before the next visit do
not hesitate to come back here. I will
be happy to help you. Do you have any
question or is there anything you do
not understand?
Ma Ku Ku:
No, thank you very much for your help.
(The names of the client are changed to keep
anonymous)
ISSUE 23, MARCH, 2004
47
txufaz:jyyg pum;ajymcef;onf ESpo
f rd ahf qG;aEG;ynmay;jcif;&JΠaemufwpfcgjyefvmjcif; (RETURNING) tydik ;f jzpfygonf? vlem[m aemufwpfcgtcsed rf a&G; jyefvmzd@k olrudk }udKqdv
k ckd sif wJch pH m;r_&o
dS ifyh gw,f?
vlemonf tatmufwiG af z:jyxm;aom t"duta=umif;rsm;a=umifh jyefvmzd@k vt
kd yfEikd o
f nf • olronf aq;/ oH;k onfyh Pnf;rsm;xyfvjkd cif;/
• owif;tcsut
f vuf xyfro
H &d v
dS jkd cif;
• &ufcsdef;a=umifhjyefvmjcif;/
\emrsm; od@k r[kwo
• oH;k aeonfeh nf;ESiyhf wfoufI jy\
f o
H ,rsm;&Sad ejcif;?
• oH;k aeaomenf;.ab;qd;k usKd ;oufa&mufrr_ sm;?
aemufwpfcgjyefvmaomvlemrsm;onf yxrqHk;vmpOfutwdkif; *&kpdkufr_ay;&ef vdktyfonf? xdkodk@
jyefvmonfhtcg jyKpkr_onf vlemrsm;qufvuf (udk,f0efwm;enf;udk)toHk;jyK&eftwGuf ta&;}uD;onf?
jyefvmonft
h cgrsm;onf vlemrsm;onf Tenf;tay:auseyfr&_ &dS v
hJ m;/ olw@kd jy\emrsm;&So
d vm;/ ab;qd;k usKd ;
oufa&mufrr_ sm;ESiyhf wfoufI pd;k &dryf yl efrr_ sm; &So
d vm;ponfw@kd ukd ppfaq;=unf&h efaumif;rGeaf omtcGit
hf a&;
tcsdeftcgjzpfygonf?
ESpo
f rd ahf qG;aEG;ynmay;olonf aqG;aEG;r_+yD;cge;D wdik ;f wGif vlemrsm;bmta=umif;a=umifrh qdk jyefvmjy&ef
vdt
k yfonf[ck pH m;&ygu b,ftcsed rf qdk jyefvmjyEdik af =umif;udk pHepfwus&iS ;f jyay;& rnfjzpfygonf? ar;cGe;f rsm;/
jy\emrsm;/ oH;k aeaomenf;.ab; qd;k usKd ;oufa&mufrr_ sm; ponfjzifh tu,fIvlema&G;cs,af om rdom;pkprD u
H ed ;f
enf;udk vkyrf ay;Ekid yf gu (Oyrm - om;tdrx
f o
J @dk xnfah omyPnf;( IUD) xnfv
h jkd cif;/ om;a=umjzwfjcif;)
aemufwpfcgjyefvmv#if xdek nf;udk vkyaf y;Edik af om Xmewpfcck o
k @kd vaJ$ jymif;ay;oiho
f nf? (vlemrsm;.emrnfukd
ajymif;vJxm;ygonf)?
yD/ yD/ at/ wD aq;cef; r,fv pcef; PPAT Clinic at Mae La Camp
48
trSwf=23 rwfmv 2004 ckESpf?
usef;rma&;apwref
Above conversation is the RETURNING element of family planning counselling session.
The client should feel welcome to return anytime. A client may need to return for the main
following reasons:
• Need more supplies
• Demand more information
• For follow up
• Problems or doubts about the method
• Side effects
Returning client deserve as much attention as the first time. The care provided at return
visits is also important because it helps clients to continue. Return visits are good opportunity
to check if clients are satisfied if they have any problems or concern about side effects.
Providers at the end of the counselling session should systematically explain to the clients
that they can return anytime they feel they need it and for whatever reasons: Questions,
problems. Side effects…
In case the method chosen by the client cannot be provided (e.g. for an IUD insertion or
a sterilisation), the return step should be a referral to a facility which has the capacity to
provide it.
r,fv pcef;&dS yD/ yD/ at/ wD tzGJ@ PPAT Team at Mae La Camp
ISSUE 23, MARCH, 2004
49
jzpf&yfavhvmjcif;
jzpf&yfavhvmjcif;? ? =unf=unfoef;onf touf 21 ESpft&G,f&dS+yD; 1 ESpfcGJcef@uav;i,fwOD;.
rdcifjzpfonf? yxr uav;arG;+yD;aemuf tcsed t
f wdik ;f twmwcktxd uav;vkcd sipf w
d rf &daS y? uk,
d 0f efr&&dS
ap&ef om;zGm;q&mronf olrtm; uav;arG;+yD;aemuf 45 &uft=umwGif 3 v w}udrx
f ;kd &onfw
h m;aq;
xk;d ay;onf? od@k aomf tqdyk gx;kd aq;onf rnfu
f o
hJ @kd oaE<wm;a=umif;olr aocsmpGmrodyg? wvw}udrf
aoG;ray:ojzifh olr a=umuf&@HG aeonf? xdak =umifh xd;k aq;ud&k yf+y;D aemufxyfaoG;ay:onftxd apmifah eonf?
aemufxyfv
f nf; aoG;ray:yg? oaE<wm;aq;toH;k jyKjcif; r&dI
S olrvnf; tqdyk gumvrSmyif uk,
d 0f ef&&djS yefonf?
aemufxyf uav;vkcd siaf omfvnf;/ ,ck ud,
k 0f efonfapmvGe;f onf[k cHpm;&onf? olrwGif uav;arG;&efvnf;
aiGr&do
S jzifh v,fxw
J iG f tvkyv
f yk &f onf?
ud,
k 0f ef 4 v&v#if &GmxJrS tzGm;}uD;wa,mufukd oGm;IawG@onf? tqdyk gtzGm}uD;onf olr. twGi;f
ydik ;f od@k aq;&nfxnhafh y;vdu
k o
f nf? aemuf 4 &uf=umaomf jyif;xefpmG aoG;qif;avonf?
,ck olroaE<wm;aq;xkd;aq;udk jyefoHk;onf? ,ckt}udrfaq;udk oHk;&onfrSm pdwf&$ifvef;onf?
ta=umif;rlum; om; zGm;q&mrud,
k w
f ikd f tdro
f @kd vm+y;D aoG;ray:aomfvnf; tE W&m,fr&daS =umif;ajymjyonf?
xdak =umihf olronfaoG;ray: aomfvnf; pdwrf ylawmhay?
=unf = unf . Zwf
vrf;onf oaE<wm;
aq;ta=umif;ESpfodrfh
aqG;aEG;r_vt
kd yfa=umif;
axmufjyonf? oaE<
wm;aq;oHk;olwdk@tm;
aq;onf rnf u J h o d k @
tmed o if & d S a =umif ;
ajymjyoifhonf? odvkd
onfhtcsuf&dSv#ifjyef
vmar;jref;&efESifhaq;
udk rdro
d abmESihf r&yf
&ef ajym=um;&rnf ?
oaE<wm;enf;rsm; t
a=umif;udo
k v
d dk ar;vkd
v#iv
f nf; vG,f ulr&_ &Sd ef
vnf;ta&;}uD;onf?
t,ltq rSm;,Gi;f jcif;/
odoifh odxu
kd af omt
a=umif;t&mrsm; rodI
oaE<wm;aq;tm;
&yf +yD ; toH k ;rjyKv#if
rvdv
k m;onfh ud,
k 0f ef
tm; &&dv
S rd rhf nf?
50
trSwf=23 rwfmv 2004 ckESpf?
usef;rma&;apwref
CASE STUDY
Case Study: Kyi Kyi Tan is a 21-year old married woman with one child, aged 18
months. After the birth of her first child, she didn’t want to get pregnant for a while. To
avoid pregnancy the midwife gave her a three-monthly injection, 45 days after her delivery.
But she didn’t understand well what the injection would do, and how the contraception
worked. When her period stopped she became scared. She felt it wasn’t healthy not to have
her monthly bleeding. She decided by herself to stop using the injection and to wait for her
next period. Her next period didn’t come and because she didn’t use any contraception
methods, she became pregnant again during this time. Although she eventually wanted to
have another child, she felt that this pregnancy came too soon. She had no money to deliver
and needed to work on the fields.
When she was four months pregnant she went to see an old lady in the village, who put
a liquid medicine inside her, and four days later she had heavy bleeding.
Now she is using the injectable again, but this time she is happy using it as the midwife
visited her and explained that having no period was safe for her health, and she did not
worry about not having them.
Kyi Kyi’s story illustrates the need to counsel women properly about methods of
contraception. They should be informed clearly what the methods do and told to come back
if they have any
questions. It is
important that
women understand
their contraceptive
methods and feel at
ease to ask any
questions they
might have about
the
methods.
Misconceptions
and lack of
information can
often lead a
woman,
to
discontinue her
contraceptive
method, which then
leads to unwanted
pregnancies.
ISSUE 23, MARCH, 2004
51
vdRmyg;eyfpmG ESpo
f rd ahf qG;aEG;jcif;
rdom;pkprD u
H ed ;f ESiyhf gwo
f ufI ESpo
f rd ahf qG;aEG;&mwGif wcgw&H txdrcHEikd af omta=umif;t&mrsm; jzpfwwfonf?
rdom;pkprD u
H ed ;f udv
k nf; oH;k pGo
J rl sm;rS jiif;qefr_ jyKEikd o
f nf? xdak =umifh vdrRmyg;eyfpmG ESihf owdxm;+y;D ESpo
f rd ahf qG;aEG;oifo
h nf?
Taqmif;yg;wGif tar&duef'u
k Qonfrsm;qdik &f m aumfrwDEiS hf tvkyv
f yk v
f su&f adS om rsK;d qufymG ; use;f rma&;vkyo
f m;
eef;=unf0if;onf olr. 10 ESpt
f awG@t}uHKudk a0iSay;xm;onf?
rdom;pkprD u
H ed ;f ESiyhf gwo
f ufI 'kQonfpcef;Y ESpo
f rd ahf qG;aEG;&mwGif rnfuo
hJ @kd aom tcuftcJrsm; awG@&cdS &hJ ygoenf;?
rsm;aomtjzifh T'kuQonfpcef;wGif aeolrsm;onf tpGet
f zsm;usaomae&mrsm;rS vmcJ&h +y;D ynmoifciG hf enf;cJI
h
ynmtqift
h wef;vnf; enf;cJyh gonf? oaE<wm;enf;udk a&G;cs,af omolw@kd onf aemufqufwJG vmjy&ef vdt
k yfygonf?
rsm;aomtm;jzifh rvm=uyg? od@k r[kwf tcsed rf aDS q;xd;k &ef ra&muf&ydS g? wcgw&H olw@kd onf oaE<wm;aq;udk aocsmpGm
roH;k =uyg? Oyrmtm;jzifh aq;pm;&ef arhavsmjh cif;wd@k jzpfonf?
pcef;wGi&f o
dS rl sm; oH;k pGaJ om oaE<wm;enf;onf tjcm;enf;rsm;xuf vlord sm;ay: jyLvmjzpfr_ enf;ygovm;?
tcsK@d orl sm;onf uGe'f ;kH oH;k pG&J ef 0efav;ygonf? olw@kd em;rvnfjcif; od@k r[kwf em;vnfrv
_ rJ$ mS ;jcif;a=umifh jzpfEikd o
f nf?
Oyrmtm;jzifh olw@kd taejzifh ,m;jcif;/ tjzLqif;jcif;wd@k onf uGe'f ;kH a=umifh jzpfonf[k xif=uonf? uGe'f ;kH a=umifh
r[kwaf =umif;udk od&&dS ef &Si;f jyr_onf ta&;}u;D onf? tqdyk gvuQ%mrsm;onf oef@&iS ;f r_enf;jcif;a=umifh jzpfa=umif;
ajymjyoifo
h nf? uGe'f ;kH onf vdiq
f ufqrH r_ S ul;pufaom a&m*grsm;rS umuG,Ef ikd af om wckwnf;aom enf;jzpfonf?
uGe'f ;kH ta=umif; aocsmpGm &Si;f jyv#if trsK;d orD;rsm;taeESihf oH;k pG&J ef jiif;qHvrd rhf nfr[kw[
f k usrxifygonf? rsm;aom
tm;jzifh trsK;d om;rsm;onf obm0[k rxifaoma=umifh uGe'f ;kH udk oH;k pG&J ef pdwrf ygyg?
uGe'f ;kH onf oaE<wm;jcif;ESihf tdycf st
f ikd Af /DG attdik 'f t
D uftyg0ifumvoma&m*gukd umuG,rf _ w+yKd iw
f nf;ay;onf?
wcsK@d olrsm;onf uGe'f ;kH udk oH;k pG&J ef 0efav;onf[k xifjcif;udk eef;=unf0if;taejzifh b,fvakd qmif&u
G yf goenf;?
ar;cdkifumuG,faq;vma&mufxdk;aom trsKd;orD;rsm;udk yxrqifhtjzifh usef;rma&; ynmay;ygonf?
usrwdk@taejzifh uav; 4 a,muf txuf rdcifrsm;ESifh touf 15 ESpf rS 45 ESpf t&G,ftrsKd;orD;rsm;udk
rdom;pkprD u
H ed ;f udpPrsm; aqmif&u
G af y;ygonf? tpyxrydik ;f wGif olw@kd onf rdom;pkprD u
H ed ;f udk vufrcH=uyg? olw@kd
jiif;qefjcif;rSm ,H=k unfr_ r&Sjd cif;a=umifh jzpfonf? wcsK@d vnf; uav;&&Sjd cif;onf obm0vufaqmifEiS hf bk&m;rS ay;jcif;[k
,lqonf? uav;rsm;onf &wem[k ,lq=uonf? od@k aomfvnf; olw@kd uav;rsm;pGm&vmaomtcg usrwd@k xH jyefvmI
usrwd@k ajymaompum;udk em;axmif=uygw,f? uav;rsm;pGm &&Sv
d #if pD;yGm;a&;tajctaeESihf use;f rma&;tajctae
ydrk ckd ufcaJ wG@Edik af =umif; usrwd@k }udK;pm;+yD; &Si;f jyygw,f?
oif.tawG@t}uHKt& rdom;pkprD u
H ed ;f udk olw@kd yd+k yD; vG,v
f ,
G u
f u
l l oH;k pGv
J m=uygovm;?
[kwu
f &hJ iS /hf rdom;pkprD u
H ed ;f udk ta&twGuf ydrk o
kd ;kH pG=J uonf[k usr xifygonf? olw@kd onf rdom;pkprD u
H ed ;f ta=umif;udk
ydrk o
kd &d +dS y;D / ydrk ,
kd =kH unfum oaE<wm;enf;rsm;udk ydrk kd oH;k pG&J ef tqifo
h ifh jzpfvm=uonf?
tk;H zs'H u
k Qonfpcef;wGif aeaom touf 45 ESpt
f &G,&f d S raemf(emrnft&if;r[kw)f [kac:aomtrsK;d orD;vlemwa,muf?
t&ifusraecJhaom 'kuQonfpcef;wGif rdom;pkpDrHudef;r&Sdyg? usrvnf; oaE<wm;enf;rsm;udk wcgrS
oH;k bl;jcif;r&Scd yhJ g? xdak emuf usr uav; 5 a,mufarG;+y;D aemuf'u
k Qonfpcef;wckukd ajymif;a&$@+y;D oaE<wm;enf;
wckcu
k kd oH;k pG&J ef qH;k jzwfw,f? tdrw
f ikd ,
f ma&muf use;f rma&;a&Smufapmifo
h w
l a,mufonf oaE<wm;enf;oH;k rsK;d udk
ajymjycJyh gw,f? Œif;wd@k rmS pm;aq;/ uGe'f ;kH ESihf xd;k aq;wd@k jzpfygw,f? usrvnf; pm;aq;udk oH;k pG&J ef qH;k jzwfygw,f?
od@k aomfvnf; pm;aq;. qd;k usK;d rsm;udk rESpo
f ufI qufvufo;kH pGjJ cif; rjyKygb;l ? tckawmh usrrSm uav; 11
a,muf&v
dS mawmh uGe'f ;kH udk p+y;D oH;k pGv
J mygw,f? usra,muFsm;uawmh rnfonfh jy\emrS rvkyyf g? usrwd@k twGuf
rnfuo
hJ @kd r# rxl;jcm;yg? olueG 'f ;kH &oIawmh oH;k pGyJ gw,f? ol@taejzifh uGe'f ;kH udk awmif;awmhrawmif;yg? usrtaejzifh
uGe'f ;kH oH;k pGjJ cif;udk pdwu
f oduatmuf rjzpfygb;l ? usrtouft&G,t
f aejzifh txl;cHpm;vdpk w
d v
f nf; r&Syd gb;l ? usrrSm
uav; 11 a,muf&o
dS nft
h wGuf oaE<wm;enf; oH;k pG&J jcif;udk txl;aus;Zl;wifryd gw,f? use;f rma&;ynmuvnf;
tvGet
f oH;k =uygw,f?
52
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usef;rma&;apwref
Counselling with tact
Conselling on family planning can sometime be a sensitive matter. Family planning can
sometimes face resistance from clients. More than ever it is important to counsel with care
and tact. In this article Khun Nan Kyi Win, reproductive health worker for (American Refugee Commitee International) in Umpien camps, shares her 10 years experience on getting
message across.
What kind of difficulties do you come across when counseling on Family Planning in the camp?
Most Karen in this camp come from remote area and their level of education is generally low.
When they choose a method of contraception they often need to come back again. Very often they
don’t come on back or they don’t come on time for their injection for example. Sometimes they do
not take their contraception properly, they would often forget to take their pill for example.
Are their methods of contraception that are less popular than others?
Some people are reluctant to use condoms. They might misunderstand or have misconceptions
about them. Some, for example, they may complain of itchiness or white discharge and think it is
because they use condoms. It is then very important to explain to them that it is not due to the use
of condoms, but to other reasons such as the lack of hygiene. Condoms are the only method of
contraception that protect from STDs.
Condom is the only method that provides contraception and prevention of sexually transmitted diseases including HIV/ AIDS.
I think that women generally don’t refuse to use them if they are explain properly about them,
but it is often the men who are not willing to use them because they don’t find it natural.
Some people still might feel reluctant about using family planning, how do you deal with that?
We first started giving health education for women when they came to attend a tetanus toxoid
vaccination. Women between 15 and 45 year old came and we gave Family planning to women
having more than 4 children. At the beginning they didn’t all accept Family Planning. For example
if we gave family Planning to 10 women, 8 would accept it and 2 would refuse. They often refuse
because they didn’t believe in it. Also they thought that having children was a natural gift and a
blessing from god. In Karen they say children are a precious stone. But then they started having too
many children and they came back and listened to us! We try to explain to them that if they have too
many children they economical situation both economical and in terms of health would become
more and more difficult.
According to your experience do you think people are more easily using Family planning?
Yes I think the number of people coming to get family planning is increasing. People know more
about it and they trust the methods of contraception more and are more ready to use them.
A patient : Ma Naw (not her real name) is a 45 year old woman living in Umpien camp.
‘’In the previous camp I use to live in, there wasn’t any family planning and I never used any
method of contraception. Then I moved to another camp and after I had 5 children I decided to
use a contraception method. A home visitor came and talked to me about three types of contraception: the pill, condoms and the injection. I decided to use the pill, but I didn’t like the side
effect and I stop using it. I have now 11 children and I have started using condoms. My husband
doesn’t complain about it, and really it didn’t make any difference to us. As long as he receive
the condoms, he will use them, but he won’t ask for them. I didn’t feel embarrassed about using
condoms, because at my age I have no special feeling about it. I have had 11 children and I’m
very grateful to be able to use a contraception method. Health education is very useful.’’
ISSUE 23, MARCH, 2004
53
rSm;,Gif;aomt,ltqrsm;ESifhrdom;pkpDrHudef;
usef;rma&;apwrmeftzGJ@
Taqmif;yg;wGif om;qufjcm;enf;rsm;ESihf ygwo
f ufaom rSm;,Gi;f onfh t,ltqrsm;udk xkwaf z:wifjyxm;onf?
tqdyk gt,ltqrsm;udk od&jdS cif;jzifh use;f rma&;ESihf vlra_ &;vkyo
f m;rsm;tm; oH;k pGo
J rl sm;. arG;cGe;f rsm;udk
ajz=um;Edik &f ef ulnyD gvrd rhf nf?
rdom;pkprD u
H ed ;f udt
k oH;k jyKaeaomtrsKd ;orD;rsm;wGif
,ckwikd o
f m;qufjcm;enf;rsm;ESiyhf wfoufonfrh mS ;,Gi;f
aomt,ltqrsm;&dSojzifh tqdkygolwkd@onf udk,f0ef
wm;enf;rsm;udjk iif;qefjcif; od@k r[kwf qufvuftoH;k
rjyKjcif;tqifo
h @kd a&muf&o
dS mG ;Edik o
f nf? tqdyk gorl sm;tm;
olw@kd .t,ltqrsm;/ a=umuf&@HG rr_ sm;udk ar;jref;+yD; jywf
om;rSeu
f efaom&Si;f vif;csuaf y;I todjzifh ,SOaf omqH;k
jzwfcsurf sm; csrw
S Ef ikd &f ef use;f rma&;vkyo
f m;rsm;rS ulnD
&rnf? Taqmif;yg;onf tqdyk g ta=umuf &GŒ
H r_rsm;ESihf
trsKd ;orD;.ar;cGe;f rsm;udk wifjyygvrd rhf nf?
om;tdrx
f w
J iG f xnfah om(*Gi;f )yPnf;-tdik ,
f 'l D
r[kwyf g? om;tdr*f iG ;f onfom;tdrf rSarG;vrf;a=umif; od@k
oma&mufEikd +f yD; tjcm;ae&mrsm;od@k ra&mufEikd yf g? om;
tdrf*Gif;onf om;tdrf.yHkoŒeftwdkif;txl;wnf
aqmufxm; ojzifh om;tdrfxJrSm ckdifckdif+rJ+rJae+yD;
ud,
k t
f wGi;f od@k vn
S v
hf ,f oGm;vmjcif;rjyKEdik yf g?
om;tdr*f iG ;f onftrsKd om;rsm;.vdit
f *F grsm;ukd '%f&m
&apEdik yf govm;?
'%f&mr&apEdik yf g? oif.vdiq
f ufqaH z:onfom; tdr*f iG ;f
udx
k ad wG@Edik v
f #if (tyfcsn}f udK;rSty)/ oifonf use;f rm
a&;0efxrf;ESiw
hf ikd yf ifoifo
h nf? xdt
k ajc taeonfyrkH eS f
r[kwaf y?
uGe'f ;kH
uGe;f 'H;k onfvid pf w
d u
f jkd yif;xefapygovm;?
r[kwfyg?uGef'Hk;onftwm;tqD;wckjzpf+yD;vdifquf
qHaz:tcsi;f csi;f a&m*grul;pufap&efEiS o
hf w
k yf ;kd tm;rrsKd ;OxHr
a&muf&aSd p&efumuG,af y;ygonf? oif.vdiq
f ufqaH z:
ESiv
hf id q
f ufqcH sed w
f iG o
f aE<wm;ud&,
d mtjzpfvnf; t
oH;k jyKEdik o
f nf? urBmw0Sr;f &dZS eD;armifErHS sm;vnf; uGe'f ;kH
udo
k ;kH =uonf?
om;tdr*f iG ;f onfuifqma&m*gjzpfapygvm;?
om;tdrf*Gif;onfuifqmrjzpfapyg? om;tdrf*Gif;onf
trsdK;om;.okwfydk;ESifhtrsdK;orD;.om;Oaygif;pyfjcif;
r&dES ikd af tmif wm;qD;jcif;jzifh ud,
k 0f efwnfru
_ kd umuG,f
ygonf? wckwnf;aomtE W&m,fonf tu,fItrsKd ;
orD;taejzifh wud,
k af &oef@&Si;f a&;raumif;v#if od@k r
[kwu
f mvom;a&m*gwckc&k aSd ev#if om;tdrf twGi;f ydik ;f
ESio
hf m;tdraf cgi;f a&mifonf a&m*g&wwfw,f?
uGe'f ;kH onfvid q
f ufqjH cif;ESiyhf wfoufonfch pH m;r_ukd avsmh
enf;apygovm;?
ravsmhenf;apyg? tcsdK@aomolwdk@onf uGef'Hk;oHk;v#if
cHpm;r_ enf;Edkifonf? aemufwzufrS=unfhv#ifvnf;
uGef'Hk;oHk;onfhtwGuf ukd,f0ef&rnfudk pdk;&drf&efr
vko
d nft
h jyif vdiq
f uf qHru
_ kd =umjrifah pI cHpm;r_yjdk rifrh m;
onf[k qdo
k nf?
om;tdr*f iG ;f onfcE<mud,
k t
f wGi;f od@k vn
S v
hf ,fomG ;+yD;
ESv;kH od@k r[kwt
f pmtdro
f @kd a&mufEikd yf govm;?
uGe'f ;kH onfr=umc%uGw
J wfygovm;?
r[kwyf g? aocsmpGmpepfwuso;kH v#iu
f eG 'f ;kH onfuJG avhr
54
trSwf=23 rwfmv 2004 ckESpf?
usef;rma&;apwref
Misconceptions
Health Messenger Team
Misconceptions regarding family planning methods are identified and presented in this
article. Knowing about the most common misconceptions will help health and social
workers respond to their clients’ questions.
Misconceptions regarding birth spacing
methods are still common among many women
using family planning and can lead them to refuse
or discontinue their methods of contraception.
By asking about their fears and reservations and
by providing clear explanations, health workers
will help women and couples to make informed
decisions. When possible women should involve
their partners in the counselling, by asking them
to attend the counselling session. The following
article will examine the common fears and
questions women might have.
IUD
Does IUD lead to cancer of the womb?
No, it prevents pregnancy by preventing the
fertilisation of the egg by the sperm. The only
risk is if a woman does not have good hygiene
or has a sexually transmitted disease(s), then
IUD can cause infections such as endometitis
(inflammation of womb) and cervicitis
(inflammation of the neck of the womb).
Can IUD travel inside the body to the heart
or stomach?
No IUD cannot leave the uterus except through
the vagina. It cannot travel around the body as
it stays firmly located inside the womb and its
shape is specifically design to adapt to the shape
of the womb.
Can IUD hurt men’s genital?
No, If your partner can feel the IUD (not just
the strings) during sex, you should see a health
worker to correct the situation, which is not
normal.
Condoms
Are condoms promoting promiscuity?
No, it is only a barrier not to transmit diseases
between partners and to prevent sperm from
getting access to the egg. It can be used as a
contraceptive instrument during sex with your
partner. Married couples all over the world use
condoms.
Do condoms reduce pleasure during sex?
No, some people might have less feeling during
sexual intercourse when they are using condoms.
On the other hand some say that the pleasure is
greater as intercourse lasts longer and they have
no fear of having pregnancy.
tdkif,l'D (om;tdrf*Gif;) - IUD
ISSUE 23, MARCH, 2004
55
&dyS g? uGe'f ;kH onf trsKd ;orD;.arG;vrf;a=umif; ajcmufaoG@
aev#if uG&J eftcGit
hf vrf;ykrd sm;onf? a&ESihf jyKvkyx
f m;
onfh acsmqDukd uGe'f ;kH .tjyifzufyidk ;f wGif oH;k v#if uGx
J u
G f
jcif; enf;yg;aprnf?
pm;aq;onf trsKd ;orD;trsm;pktygt0if touft&G,f
tm;vk;H ESihf aoG;qH;k onft
h &G,t
f xd oH;k &efoifyh gonf?
tdwcf st
f ikd Af ADG ikd ;f &yfpyf ;kd onfueG 'f ;kH udjk zwfxu
G Ef ikd yf govm;?
r[kwyf g? uGe'f ;kH tm; tdwcf st
f ikd Af DG Adik ;f &yfpyf ;kd tygt0if
tjcm;umvom;a&m*gukd umuG,&f eftoH;k jyKEikd o
f uJo
h @kd
oaE<wm;&efuv
kd nf; oH;k Edik yf gonf?
oaE<wm;pm;aq;oH;k v#if trsKd ;orD;wa,mufukd uav;
r&Edik o
f nf t+rHKb0 a&mufomG ;Edik yf govm;?
rjzpfEikd yf g? oaE<wm;aq;oH;k oltrsKd ;orD;onf uav;
&&dES ikd o
f nf taetxm;wGif &dES ikd o
f nf? oaE<wm; aq;udk
jzwf+yD; aemufvtenf;i,f rsm;aomtm;jzifh 4 v cef@
t=um wGi"f rRwmaoG; pwifay: avh&o
Sd nf?
oaE<wm;pm;aq;a[mfrek ;f
oaE<<wm;xd;k aq;
oaE<wm;xd;k aq;udk oH;k pGaJ eaomtrsKd ;orD;wOD;onf
&moDaoG;ay: jcif;r&dv
S #if xd;k aq;ud&k yfoifyh govm;?
r&yfoifyh g? tqdyk guo
hJ @kdjzpf&yfonf tjzpfrsm;+y;D tE W&m,f
r&dyS g? od@k aomf xd;k aq;oH;k pGo
J o
l nf tqkyd gtcsuu
f kd rESpf
oufv#if olronf tjcm;ukd,f0efwm;enf; wckckudk
ajymif;v$J oH;k pGo
J ifo
h nf?
trsdK;orD;om;a=umjzwfjcif;
a[mfrek ;f enf;jzifo
h aE<wm;onft
h usK;d ;a=umifh trsK;d orD;
wa,mufonfjzifh 0jcif;od@k r[kwf ydejf cif;jzpfEikd yf govm;?
[kwu
f yhJ g? trsKdk ;orD;wcsKd @wGif oaE<wm;aq;a[mfrek ;f
a=umifh ud,
k t
f av;csed f tenf;i,frsm;vmEdik yf gonf? ydef
oGm;onhftcsufonf wm;aq;ESifhrqdkifyg/ tjcm;t
a=umif;rsm;udk tajccHjcif;jzpfygvrd rhf nf?
oaE<wm;pm;aq;udkjzwf+yD;aemuf ukd,f0ef&dSv#ifarG;
vmrnfu
h av;wGif arG;&mygcsKd @,iG ;f csuf ygEikd yf govm;?
rygEikd yf g? oaE<wm;pm;aq;udjk zwf+yD;aemuf uk,
d 0f if&Sd
+yD;arG;aomuav;wGif arG;&mygcsdK@,Gif;csufyg&dSonfht
axmuftxm;rSww
f rf;rsm;r&dyS g?
oaE<wm;pm;aq;udkESpfaygif;=umjrifhpGmoHk;pGJv#ifab;
tEW&m,f&yS d govm;?
r&dyS g? oaE<wm;pm;aq;udk ESpaf ygi;f =umjrifph mG oH;k pGv
J #if
jy\em&daS omtaxmuftxm;rsm; rawG@&dyS g? tqdyk g
56
trsKd ;orD; om;a=umjzwfjcif;onf vdiq
f ufqrH p_ rG ;f &nfEiS hf
vdipf w
d cf pH m;r_ukd ajymif;v$aJ pygovm;?
ajymif;v$rJ r_ &dyS g? om;a=umjzwfcpJG yd +f yD;v#iv
f nf; trsKd ;
orD;rsm;onf cGpJ yd rf r_ jyKrSD tajctaetwdik ;f qufvuf+y;D
vdiq
f ufqrH E_ iS hf vdipf w
d cf pH m;r_&ESd ikd o
f nf?
trsKd ;orD; om;a=umjzwfjcif;onf trsKd ;orD;rsm;vpOf
aoG;ay:r_ukd &yfapygovm;?
r&yfapyg? trsKd ;orD;om;a=umjzwfjcif;qdo
k nfrmS rsKd ;O
tm; om;tdrt
f wGi;f 0ifa&mufrv
_ rf;udk ydwjf cif;jzpfonf?
xdka=umifh om;a=umjzwfjcif;onf trsKd;orD;.vpOf
aoG;ay:r_ukd &yfqikd ;f jcif;r&daS y?
trsdK;om;ta=umjzwfjcif;
trsKd ;om;ta=umjzwfjcif;a=umifh trsKd ;om;onf vdif
qufqrH p_ rG ;f &nf usqif;qH;k &_;H ygovm;?
vdiq
f ufqrH p_ rG ;f &nf usqif;qH;k &H;_ jcif;r&dyS g? tqdyk g om;
a=umjzwfxm;olonf vdirf u
_ pd Pudk tm&Hq
k ufvufcpH m;Edik f
+yD;/ qufvufIvdiw
f aH wmifjcif;/ okwv
f w
$ jf cif;ponf
wd@k ukd ,ciftwdik ;f qufvuf&EdS ikd o
f nf?
trSwf=23 rwfmv 2004 ckESpf?
usef;rma&;apwref
Do condoms break often?
No, if well used condoms rarely break. A condom
has more chance to break if a woman’s vagina
is dry. Water-based lubricant on the outside
surface of the condom may help reduce risk of
breaking.
Can the HIV virus pass through a condom?
No, condoms can be used for the prevention of
sexually transmitted diseases including HIV/
AIDS as well as contraceptive.
The pills
Can hormonal methods cause a woman to
become either thin or obese?
Yes, some women can experience a little weight
gain but becoming thin could be originated from
other causes rather than the effect hormones.
user should be advised that if she feels
concerned she should choose another method.
Female Sterilisation
Does sterilisation change women ability to
have sex or to have sexual pleasure?
No, after the operation women’s can be as
healthy as before and they can continue to enjoy
having sex and sexual pleasure.
Will sterilisation stop women monthly
periods?
No, sterilisation in women is just obstruction of
the pathways for the eggs to enter the womb.
So the women’s monthly period will not be
stopped due to sterilisation.
Vasectomy
Can the pill cause congenital abnormalities
in children conceived after stopping it?
No, There is no record of causing congenital
abnormalities in children conceived after stopping it.
Is it dangerous to take the pills for a long time?
No, there is no evidence of that taking the pills
for a long time causes problems. The pills are
appropriate methods for most women of all ages
until menopause.
Can the pills make a woman sterile?
No, women taking the pills remain fertile. After
stopping the pills, it may take a few months,
usually four months, to resume their
menstruation.
Injection
If a woman using injection has no more
menstrual periods, should she stop using
injection?
No, this is common and not harmful. But the
ISSUE 23, MARCH, 2004
Does a man lose his sexual capacity after a
vasectomy?
No, he can enjoy sexual activities as he continues
57
rGef
•
•
•
ta&;ay:oaE<<wm;jcif;
&Srf;
ta&;ay:oaE<wm;jcif;onf ud,
k 0f efzsucf sjcif; enf;w
enf;[kwyf govm;?
r[kwyf g? ta&;ay:oaE<wm;jcif;onf oaE<avmif;tm;
z,f&mS ;r_rjyK/ &d+S y;D ud,
k 0f eftm;vnf;ysuu
f sjcif;rjzpfapyg?
•
rJ }udK; csD jcif;? (&yf&mG &d&S ;kd &mq&mwOD;OD;rS trJa&mif
tyfcsD }uKd ;udu
k sp+f y;D ) vufxyf+y;D trsKd ;orD;.0rf;ydu
k /f
csu0f ef;usiw
f iG f t
f enf;qH;k 1 ywf 2 ywf ywfcef@
csD jcif;tm;jzifh ud,
k 0f ef&rSd u
_ kd wm;qD; Edik o
f nf?
oaE<wm;aq;pm;v#i/f om;tdraf jcmufvrd rhf nf? xkd
tjyif qHyifvnf; u|wf rnf? t&nfjym;wGiv
f nf;
tuGurf sm; xGuaf y: onfukd awG@&rSd nf?
om;tdr*f iG ;f xJw
h m;aom trsKd ;orD;rsm;ESihf vdiq
f uf
qHv#if tE W&m,f&o
S d nf?
trsKd ;om;rsm;onf om;a=umjzwfxm;onfh trsKd ;
orD;ESihf vdirf qufqo
H if[
h k wcgw&H,=kH unf=u
onf?
u&ifeD
rSm;,Gi;f aomt,ltqrsm;ESi,
hf =kH unfr_ rsm;
•
rsm;pGmaom rSm;,Gi;f aomt,ltqrsm;ESi ,
hf =kH unfr_
rsm;onf vlrsdK;pkwpkjcif;tvdkuf &dSEdkifonfjzpfonf?
bmoma&; od@k r[kwf ,Ofaus;r_ ,H=k unfcsuo
f nfvnf;
oaE<wm;enf;wckudk jiif;y,faponfhtajctaeudk
a&muf&dSapEdkifonf? xkda=umifh ESpfodrfhaqG;aEG;&mwGif
tqdyk g tcsuu
f v
kd nf; xJo
h iG ;f pOf;pm;&ef vko
d nf? oH;k pGJ
olrsm;udk em;vnf&eftwGuf olw@kd tm; oaE<wm; enf;
rsm;ta=umif; rnfo@kd em;vnfo&d aSd =umif; ar;&ef vdo
k nf
ouJo
h @kd rnfuo
hJ @kd cHpm;&onfuv
kd nf; od&efvt
dk yfonf?
atmufygtcsurf sm;onf vlrsKd ;pkjcif;tvku
d f od&aom
t,ltqrsm;. Oyrmrsm;jzpfonf?
uav;rsm;pGm&djS cif;onf csr;f omjcif;jzpfonf? u&if
eDvrl sKd ;wd@k wiG f wOD;udw
k OD;E_wq
f ufpum;qd&k mwGif aeaumif;vm;/ tckuav; b,fEpS af ,muf&aSd e+yv
D ?J
pojzifh E_wq
f ufavh&o
Sd nf?
• uav;rsm;pGm&djS cif;onf tpp&m&mtqifajy
a=umif;ukd jyojcif;jzpfonf?
(rl&if; Gathering Strength Womemn’s Health)
u&ifEiS rhf eG f
•
qD;cH&k ;kd txuf 0rf;Adu
k af tmufyikd ;f tm; EdyS af y;jcif;jzifh
ud,
k 0f efukd wm;qD;Edik o
f nf?
tdkif,l'D IUD
58
trSwf=23 rwfmv 2004 ckESpf?
usef;rma&;apwref
to have erections (hard penis) and ejaculates
(discharge semen) as before sterilisation.
Karenni Misconceptions and beliefs
•
Is emergency contraception a form of abortion?
No, it does not displace the embryo, and cannot
end an established pregnancy.
•
Misconceptions and beliefs
Many misconceptions and beliefs can belong
to a particular ethnic group. Religious or cultural
belief can lead clients to refuse a method of
contraception. It is therefore particularly
important to take these into account while
counselling. Asking what the client knows about
the method and how they feel about it are
important factors in understanding the client. The
following give an example of some of the
misconceptions that belong to particular groups
•
•
(Source Gathering Strength Women’s
Health)
Karen & Mom
•
Massaging the uterus through the supra
pubic area can prevent pregnancy
om;tdrfudk EdSyfvdkuf&ifudk,f0efwm;vdk@&w,f
Mon misconception
•
Having many children is a sign of prosperity.
In the Karenni community, when people visit
they greet each other by saying “Hello! How
are you and how many children do you have
now? “
Having many children shows that you are
comfortable.
Prgnancy can be prevented by uterine massage
Tying a ‘’Mae-kyone’’
(black colour string
prepared by spiritual
leader) tied up around
married women belly will
prevent pregnancy.
If you take the pills, the
uterus will become dry
and the woman will lose
her hair and develop skin
rashes.
It is dangerous to have sex
with women who have an
IUD.
Shan misconceptions
•
Men sometimes believe
that they shouldn’t have
sex with a woman who
has been sterilised.
ISSUE 23, MARCH, 2004
59
rdom;pkprD u
H ed ;f wGit
f rsKd ;om;rsm;.yg0ifr_
atmifoefa0
trsdK;om;rsm;onfrdom;pkpDrHudef;wGiftjynfht0 yg0ifvkyfaqmifr_rjyKyg? tqdkygta=umif;udk r,fawmfaq;cef;rS
rsdK;qufyGm;usef;rma&;vkyfom;wa,mufjzpfol cGefatmifoef;a0u tqdkygudpPudk rnfonfhta=umif;a=umifh
jyKjyif&efta&;}uD;a=umif;&Sif;jyxm;onf?
jref r mh v l r +tod k i f ; t0d k i f ; wG i f ; &S d td r f a xmif p k w ck w G i f trsd K ;om;rsm;onf td r f a xmif O D ; pD ; &mxl ; tm;
tvdktavsmufcef@tyfjcif; cH&ygonf? tdrfaxmifOD;pD;onf rdrdtdrfaxmifpk.pD;yGm;a&;/ vlr+a&;usef;rma&;udpPrsm;wGif
OD;pD;OD;aqmif&ef wm0ef&Sdonf [kqdkv#if vlr+todkif;t0dkif;u vufcH-urnfom jzpfayonf?
jref r mh v l r +tod k i f ; t0d k i f ; &S d td r f a xmif O D ; pD ; trd s K;om;trsm;pk o nf pD ; yG m ;a&;uŒ/vl r +a&;uŒwd k h w G i f
tjypfqdkbG,fr&Sdwm0ef aus-uygayonf? odk@aomfjim;vnf; rdcifESifhuav;usef;rma&;twGuf wpdwfwa'ojzpfaom/
rdom;pkpDrHudef;uŒwGifrl tdrfaxmifOD;pD;trsdK;om;rsm;.yg0ifr+rSm tm;&auseyfbG,fr&Sdao;ay? rdom;pkpDrHudef;[kqdk&mY
om;qufjcm;jcif; (oaE<wm; jcif;)udkom qdkvkdjcif;r[kwfay?vufxyf_yD;om;orD;&vdkr+wdk@wGifvnf; trsdK;om;rsm;onf
rdrdwdk@wGif wm0efr&Sdoa,mif xif-uygonf?
trsKd ;om;rsm;rdom;pkprD u
H ed ;f uŒwGif wm0ef,rl +tm;enf;&jcif;rSm/trsKd ;om;rsm;onfro
d m;pktwGuf pD;yGm;a&;uŒwGif
&ke;f uefv+y&f mS ;&jcif;/trsKd ;om;rsm;taejzifh rdrw
d iG w
f m0efr&S[
d k ,lqjcif;/tcsKd t
h rsKd ;orD;rsm;ud,
k w
f ikd f trsKd ;om;wGif wm0efr&Srd rd w
d @kd
trsKd ;orD;wGio
f mwm0ef&o
dS nf[k ,lqjcif;/trsKd ;om;rsm;taejzif/h rdom;pkprD u
H ed ;f (oaE<wm;jcif;)ESiyhf wfoufI rSeu
f efvakH vmufaom
owif;tcsut
f vufrsm; r&&Srd +wkd onfvnf; rdom;pkprD u
H ed ;f wGif trsKd ;om;rsm;wm0ef,rl +tm;enf;&aejcif; jzpfayonf?
rd o m;pk p D r H u d e f ; (oaE<wm;jcif ; )ES i f h y wf o uf I
rS e f u ef a omowif ; tcsuf t vuf r sm;
&&S d & ef r S m
atmufygtcsuftvufrsm;wGif rlwnfaeygonf?
(1)tdrfaxmifOD;pD;trsdK;om;udk,fwdkifavhvmr+/ pdwf0ifpm;r+&Sd&rnf?
(2)avhvmEdkif&ef tcsdefvHkavmufr+&Sd&rnf?
(3)avhvmEdkifaomywf0ef;usiftajctaeay;&rnf? (ynmay;vufurf;pmapmifrsm; vufvSrf;rDr+/ vlxkusef;rma&;
vkyfom;rsm;vkyfaqmifr+uŒ)wdk hjzpfygonf?
rdom;pkpDrHudef;(oaE<wm;enf;vrf;rsm;wGif),m,DoaE<wm;enf;vrf;ESifh/woufwmoaE<wm;enf;vrf;rsm;&Sd&m/
,m,D oaE<wm;enf;vrf;wGif trsdK;orD;ESifhtrsdK;om;ESpfOD;oabmwl toHk;jyK&aom/&ufwGuf(&ufjcm;)qufqHjcif;ESifh/
trsdK;om; vdifpGyf(uGef'Gef;)toHk;jyKjcif;rSvGJI usefaomenf;vrf;rsm;rSm trsdK;orD;rSwm0ef,l&aomenf;vrf;rsm;jzpfygonf?
tqdkygaz: jycsuftvHk;pHkrrSefyg? trsKd;om;rsm;onftqifhwdkif;wGifwm0ef&dSygonf? xdktqifha&mufrSatmifjrifygrnf:
ud,0f efwm;enf;vrf;rsm;.tm;omcsuEf iS w
hf uG/ab;xGuq
f ;kd usKd ;rsm;udk oH;k pGo
J t
l rsKd ;orD;rsm;ud,
k w
f ikd f od&&dS rnft
h jyif/ cifyeG ;f
onf tdraf xmifO;D pD;ud,
k w
f ikd f od&&dS efvt
kd yfygonf/ odk rh o
S mv#if rdom;pkprD u
H ed ;f ESiyhf wfoufI trsKd ;om;rsm;.yg0if vmr+rSm
ajymif;vJwdk;wufvmrnf jzpfygonf?
woufwmoaE<wm;jcif;wGifrl trsdK;orD;om;a-umjzwfjcif;ESifhtrsdK;om;om;a-umjzwfjcif;[lI r#wpGm&Sdygayonf?
od@k aomfjim;vnf; trsKd ;orD;om;a-umjzwfjcif;udo
k m todrsm;toH;k rsm;-u_y;D / trsKd ;om;om;a-umjzwfjcif;udrk l todenf;
toHk; enf;-uygonf? tb,fa-umifh Todk@jzpf&oenf;/ prf;ppf&efvdktyfygonf?
trsdK;om;om;a-umjzwfjcif;ESifhywfoufI trsdK;om;tawmfrsm;rsm;. todYtenf;i,fvGJrSm;aeygonf? om;aumjzwf _yD;ygu -urf;wrf;aomtvkyfrsm;udk rvkyfEdkifawmh[k ,Hk-unf-uygonf? Oyrm? ?
(1)vuform;tvky/f yef;&Htvky/f qdu
k u
f m;eif;jcif;/v,f,m/udik ;f /u|e;f /awmif,mtvkyrf sm;udrk vkyEf ikd af wmh[,
k q
l jcif;?
(2)tcsKd ŒrSm vdirf +upd PwGif tm;enf;vmonf[k ,lqjcif;?
(3)tcsKd ŒrSm vdirf +upd PwGif wif;wdraf &mif&h rJ +r&Sad wmh[k ,lqjcif;?
TuJo
h kd v
h rJG mS ;aomt,ltqrsm;udk ajymif;vJypf&efrmS tcsed ,
f &l rnfjzpfonf? xd@k twlvrJG mS ;aomt[ltqjzpfa-umif;
udv
k nf; use;f rma&;todynmay;jcif;/ud,
k w
f ikd (f vufawG@)-uHKbl;olrsm;ESiahf qG;aEG;apjcif;/trsKd ;om;use;f a&;vkyo
f m;rsm;ud,
k f
wd k i f rd o m;pk p D r H u d e f ; ES i f h y wf o uf I aqG ; ES p f o d r f h t -uH a y;jcif ; rsm;jyKvk y f & ef vd k t yf y gonf ? od k h r S o mv#if
rdrdom;pkpDrHudef;uŒwGif trsdK;om;rsm;.yg0ifr+rSmwdk;wufvmrnfjzpfayonf?
r,fawmf aq;cef;/ rdom;pkpDrHudef;odk@ trsdK;om; vma&mufjyor_Z,m;
ESpf / v
2000 Zef - 'DZifbm 2001 Zef-'DZifbm
rdom;pkpDrHudefokd@vma&muf 2376
3723
jyolpkpkaygif;
trsdK;orD;om;a=umjzwf 90
196
trsdK;om;ta=umjzwf
4
6
60
2002Zef-'DZifbm
3971
2003 Zef- 'DZif
6469
249
7
203
26
trSwf=23 rwfmv 2004 ckESpf?
usef;rma&;apwref
Male Involvement in Family Planning
Aung Than Wai
Men are not involved enough in family planning. Khun Aung Than Wai, a health worker
in Reproductive Health at the Mae Tao clinics, explains why it is important to change this.
Men are naturally placed as the head of a family in our Burmese society. No one will deny that
the head of a family is responsible for all socio-economic and health matters of his unit.
In our Burmese community, most of the leading male family members are dutiful in social and
economic sectors. But in family planning, which is one of the components of reproductive and child
health, men’s involvement is not in a satisfactory state. Family planning is more than birth spacing
and contraceptives, but in this field men are not taking full responsibility for having children after
marriage.
There are many reasons for men taking less responsibility in family planning. Most of the female
family members think that men are not accountable for family planning, that it is women’s responsibility
in general. Men also think that having to earn money for their family, they are not also responsible
for family planning.
To be involve in family planning the head of family must
1. Be interested to learn about family planning
2. Have sufficient time
3. Be able to learn (educational pamphlets and leading role for community
health workers).
Temporary and permanent contraceptive methods are the two most important forms of family
planning. Men have to be part of a mutual agreement when using the calendar (Rhythm) method or
condoms. Apart from these two methods, the rest of contraception is often seen as the woman’s
job. This is not correct. Men should take part in every step of family planning procedures for them
to be fully successful. The weakness and strength of all contraceptive methods available should be
well understood by women as well as men. Male involvement could be increased in family planning
by active participation in all stages.
We have female and male sterilisation as an equal opportunity for a permanent form of
contraception. But female sterilisation is better known than the male version. So vasectomy is less
common in our community. Vasectomy in not well understood by most of the men in our community.
After a vasectomy , they believe that it is not possible to do hard work like:
1. Carpentry, masonry, trishaw driver and agricultural work; and
2. Vasectomy may lead to less sexual activity;
3. Some also think they might not enjoy sexual feeling after a vasectomy.
To change these misconceptions, we have to take time to educate men and find people who
have undergone vasectomy operations and request them to participate in family planning campaigns.
Male health workers should also take part in education and counselling activities. This would help to
increase male involvement in family planning.
Male Client visit at Family Planning (at Mae-Tao Clinic)
Years/Month
Total Client visits at
Family Services
Female Tuballigation
Male Vasectomy
2000 Jan-Dec
2376
2001 Jan-Dec
3723
2002 Jan-Dec
3971
2003 Jan-Dec
6469
90
4
196
6
249
7
203
26
ISSUE 23, MARCH, 2004
61
pdwfa0'em'%f&m
usef;rma&;apwrmeftzGJ@
atmufygyjkH yifonfpw
d zf pd ;D r_.aemufqufw'JG %fa=umif;o&kyaf z:xm;onf? tqdyk gyjkH yif
onfuBmw0Sr;f &du
S av;ppfom;rsm;.xGuq
f ckd sut
f axmuftxm;ESit
hf nDziG q
hf x
kd m;onf?
use;f rma&;qdik &f mt"d`g,zf iG q
hf ckd suEf iS phf w
d af 0'em'%f&m
urBmhusef;rma&;tzGJ@tpnf;. usef;rma&;ESifh
ywfoufaom t"dy`g,zf iG q
hf ckd suf “ use;f rmjcif;qdo
k nf
rSm a&m*guif;&Sif;jcif;ESifh roefrpGrf;rjzpfjcif;omru
um,okc/ pdwWokcESihf vlra_ &;okcwd@k jzifh jznfph jkH cif;udk
qdv
k o
kd nf?” tqdyk g t"dy`g,zf iG q
hf ckd sut
f & pdwaf 0'em
'%f&monf use;f rma&;ESiyhf gwo
f ufaom t"du tpdwf
tydik ;f wck jzpfonf?
pdwaf 0'em'%f&m jzpfapwwfaomta=umif;rsm;
pd w f a 0'em'%f t rsKd ; rsKd ;
jzpf a y:aponf h
ta=umif;rsm;udk t"du tydik ;f oH;k ydik ;f cGjJ cm;Edik yf gonf?
1/ ygw0f ef;usiaf =umifh jzpfaomta=umif;t&mrsm;/
Oy rm- obm0ab;tE W&m,frsm;jzpfaom a&}u;D jcif;/
ivsiv
f y_ jf cif;/ rd;k acgiaf &&Sm;jcif;/ rD;avmifjcif;ESihf rD;awmif
ayguu
f jJG cif;?
2/ ZD0udpPta=umif;rsm;/ Oyrm- OD;aESmuftm; '%f&m
&apjcif;/ iSuzf sm;yd;k a=umifh OD;aESmufa&mifjcif;/ arG;&myg
OD;aESmufa&m*g ygvmjcif;/ touf}uD;Ijzpfjcif; (t,fvf
qdik rf m; a&m*g)?
3/ vlra_ &;ESiphf w
d yf ikd ;f qdik &f m ta=umif;rsm;/ Oyrmt&uftvGet
f u|aH omufjcif;/ pdw=f uG&;_ oGyaf q;(&mb)
oH;k jcif;/ bde;f jzLESihf udu
k if ponfw@kd oH;k jcif;/ vlra_ &;ydik ;f
qdik &f m jy\emrsm;jzpfaom pdwzf pd ;D r_'%f/ tcspq
f ;kH ol
rsm; aoqH;k jcif;/ tdrw
f iG ;f a&;t=urf;zufr/_ tvkyv
f uf
rJjzpfjcif;/ tvGet
f rif;qif;&Jjcif;ESihf vlom;wd@k jyKvyk af om
'%f&mrsm;jzpfonf?
\emrsm;a=umifh jzpf aom
vlra_ &;ESihf pdwyf ikd ;f qdik &f m jy\
pdwzf pd ;D r_. aemufqufw'JG %f&m
vlr_a&;ESifh pdwfydkif;qdkif&m [laom pum;vHk;.
t"dy`g,o
f nf vlr_ a&;&m ygw0f ef;usiEf iS hf vlwa,muf.
pdwfydkif;qdkif&mwdk@ qufpyfr_ta=umif;wdk@ jzpfonf?
pd w f z d p D ; r_ . aemuf q uf wG J ' %f & mqd k o nf r S m
62
vl t rsm;onf xd w f v ef z G , f & mtvG e f aumif;aom
tjzpftysurf sm;ESihf awG@}uKH cHpm;&aom a=umifh jzpf .?
Ttjzpftysurf sm;onfvnf; vlw@kjdyKvyk f aom ab; 'kuQ
uyfrsm; a=umifh jzpfonf? Oyrm-ppfyGJrsm;/ ajrjrSyfrdkif;
rsm;/nOf; qJ jcif; rsm;/ a&$Œajymif;jcif;rsm;/ vk,ufr_ rsm;/
rawmwqjzpfr_rsm/ rk'drf;usifhcH&r_rsm;ESifh uav;
oli,frsm;tm; rw&m;cdk;,l ESdyfpufjcif; odk@r[kwf
obm0 ab;'kuQuyfrsm;a=umifh jzpfonf?
pdwaf 0'em'%f&m[k qdak om pdwyf ikd ;f qdik &f m od@k r[kwf
OD;aESmuftydik ;f qdik &f m'%f&monf tvGepf w
d zf pd ;D apaom
tjzpftysurf sm;a=umifh ay:xGuv
f monfh cHpm;r_yikd ;f ESihf
ygwo
f ufaom '%f&mvnf; jzpfonf? tcsK@dorl sm;onf tqdk
yg'%f&mrsm;ESiyhf gwo
f ufI awG@}uKH cpH m;+y;D aemuf jyefvnf
emvHxaumif;rGeaf omfjim;vnf;/ tjcm;olrsm;onf '%f&m
&+y;D aemuf pdwzf pd ;D r_aemufqufw'J G %f. vuQ%mrsm;udk
cHpm;=u&onf?
pdwzf pd ;D r_.aemufqufwJG '%f&m.vQ%mrsm;?
• tvGex
f w
d v
f ef@z,
G af umif;aom tjzpftysufrsm;udk
t+rw
J ap pOf;pm;awG;awmjcif;
• a&mifjyef[wfjcif;? ? cHpm;cJ&h aom tjzpftysuf rsm;udk
xyfwvJvjJ zpfaeonf[k xifjrifcpH m;&jcif;?
• tdyrf ufq;k d rsm; rufI tdyrf aysmjf cif;?
• tvG,w
f ul pdw.
f taESmuf,u
S jfzpfapwwf jcif;?
• a=umuf&Œ
H $ vef@zsww
f wfjcif;/ pdwv
f y_ &f mS ;wwfjcif;
• qufqaH ygi;f oif;&cufjcif;?
• vdiu
f pd PESirfh rd b
d 0wGipf w
d 0f ifpm;r_ r&Sjd cif;?
• rSw^f m%fEiS hf tm&kpH u
kd Ef ikd rf t
_ m; csK@d wJjh cif;?
• rdrdudk rdrdtjypf&Sdonf[k xifrSwfjcif;?
owdjyK&rnfrSmtxufyguJhodk@pdwf'%f&m&&SdcJhbl;
olrsm;onf rsm;aomtm;jzifh az: jyygvuQ%mrsm;a=umifh
yifyef;EGr;f e,f tiftm;ukeq
f ;kH jcif;rsm; jzpfwwfonf? ae@
pOfae@wikd ;f owd&aer_rsm;/a&mifjyef[yfrr_ sm; ESit
hf yd rf ufq;kd
rsm;a=umifch E<mud,
k yf ik d ;f qdik &f mxdcu
k d rf r_ sm; jzpfaponf? pdwf
zdp;D r_.aemufqufw'JG %f&mta=umif;ykjH yifuakd &S@pm rsuEf mS
wGi=f unfyh g?
trSwf=23 rwfmv 2004 ckESpf?
usef;rma&;apwref
Mental Trauma
Health Messenger Team
The following story illustrates a case of Post Traumatic Stress Disorder (PTSD). This story
is inspired by testimonies from child soldiers all over the world.
Definition of health and mental trauma:
Definition of health according to World
Health Organization (WHO): “Health is a state
of complete physical, mental, social and spiritual
well-being and not only the absence of disease
or infirmity.” According to this definition, mental
trauma is an essential part of health.
Causes of mental trauma:
There are different causes to have mental
trauma, which can be identified as three
categories;
1. Environmental causes like natural
disasters; flood, earth-quake, droughts, fire outbreak and volcano eruption.
2. Biological causes like injury causing
damage to brain; illness due to cerebral malaria;
heredity disease due to congenital malformation
and aging effecting the brain (Alzheimer’s
disease).
3. Psychosocial causes like using drugs;
for example consumption of alcohol,
amphetamine (yaaba), heroin, cocaine, etc, etc;
social problems like stress at work, death of
loved one, domestic violence, jobless, extreme
poverty and man made traumas .
Psychosocial problems causing Post
Traumatic Stress Disorder (PTSD):
The word psychosocial refers to the link
between the social environment and the mind of
ISSUE 23, MARCH, 2004
a person. Post traumatic stress disorder as a
disease, which is usually experienced by the
people after enduring terrifying events. These
events can be caused by man made disasters
such as wars, landmines, torture, displacement,
robbery, accidents, rape and abduction of minors
or natural disasters.
A psychological or metal trauma refers to
deep emotional wounds resulting from the
intensely stressful events. Some people can cope
well with the said traumatic event they
experienced and thus they recover, others
become traumatized and develop symptoms.
Symptoms of PTSD
• Continuous thinking about the terrifying
events;
• Flash back: the person experiences the
events, just as if they were happening
again;
• Nightmares causing sleeplessness;
• Easily getting upset;
• Feeling afraid, anxious or jumpy;
• Difficulty in making relationships;
• Loss of interest in life and in sex;
• Poor concentration and memory;
• Feeling guilt.
It should be noted that traumatized people
usually become exhausted by the symptoms.
The daily memories, flashbacks and nightmares physically wear them out. See a story
of PSTD next page.
63
pdwfzdpD;r_.aemufqufwGJ'%fa=umifh jzpfaom pdWZyHkjyif
A story of Post Traumatic Stress Disorder
aEG&moDausmif;ydwf&ufwGif touf 6 ESpfESifh * ESpft&G,f nDtudk0rf;uGJrsm;ESifhtwl awmif,mxJrSm
tvkyv
f yk af eaom & ESpt
f &G,o
f m&daS om wGrf ukd vufeufuikd o
f rl sm;rSac:aqmifomG ;jcif;cH&onf? tqdyk gumvrSp+y;D
wGro
f nf ol.rdom; pkEiS rhf awG@qH&k awmhay?vufeufuidk w
f yfrx
S u
G af jy;+yD;aemuf pcef;wckYaepOf touf 1&
ESpt
f &G,w
f iG f awG@qHak r;jref;jcif; jyKvkycf iG &hf cJo
h nf?
Tom was 7 years old and working on his family’s farm during the summer school break with
two cousins aged 6 and 8 when they were taken away by armed group.Tom has not seen his
family since. He was interviewed when he was 17 and living in a camp, after having escaped
from the armed force.
,leDazgif;0wfxm;aomvlwpkonf aoeyfrsm;
udik af qmifv#uf a&muf&v
Sd m+yD; ‘igw@kd e@J vu
kd cf &hJ r,f’[k
ajymw,f? u|eaf wmfw@kd u ‘rvku
d Ef ikd b
f ;l / igw@kd i,fao;
w,f’vd@k jyefajymw,f? od@k aomf olw@kd u‘igw@kd aemuf
vmcJ/h xrif;aa=uG;r,f/ csKd csiaf =uG;r,f’ vd@k ajymw,f?
u|eaf wmfw@kd u i,fao;awm rh pOf;pm;bl; ? xdak emuf
armfawmfbw
k ef @J 3 navmufc&D; oGm;cJ&h w,f?
‘’Several men in uniform and with guns came
and said ‘’Come with us!’’ We said ‘’No, we
are too young ‘’ but they told us to follow them.
‘‘We will give you food and candy’’ they said.
We were young and we couldn’t think much.
We travelled by motor boat for three nights’’
“vlopfpak qmif;wJah e&ma&mufawmh/ rif;wd@k tdrjf yefv@kd
r&awmhb;l vd@k ajymw,f?”
“olwdk@u u|efawmfwdk@xGufrajy;atmifvnf; +cdrf;
ajcmufw,f? xGuaf jy;&ef}udK;pm;olawGuv
kd nf; axmifxJ
yd@k w,f/ &du
k v
f &J u
kd w
f ,f/ wcsK@d oal wGvJ ud,
k u
f kd owfaooGm;
=uw,f?”
‘’When we
reached the recruitment centre, we were
told we couldn’t go
back to our home.
They threatened us to prevent us from escaping. Some who
tried to escape were sent to prison, some were beaten, others
committed suicide. ‘’
“ u|efawmfvnf; pdwftvGefnSpfw,f? 0ufawGudkvnf; =unfh&w,f/
ig;uefrv
S nf; tvky&f w,f/ =uufEiS t
hf jcm;wd&p>mrsm;udv
k nf; =unf&h w,f? 'gayrJh
tdrjf yefv@kd r&bl;? rdbawGuakd wmh pmESiq
f ufo,
G zf @kd u|eaf wmf }udK;pm;w,f?”
‘’I felt very depressed. I took care of pigs. You could work at
the fishpond, raise chickens, breed livestock, but we couldn’t go
home. I tried to communicate with my family through letters.’’
64
trSwf=23 rwfmv 2004 ckESpf?
usef;rma&;apwref
u|efawmfvJ tJ'Dvlopfpkaqmif;wJhae&mrSm
ig;ESpaf vmuf aecJ&h w,f? rvGwv
f yfb;l ayg?h aemuf
qH;k awmh u|eaf wmf xGuaf jy;zd@k qH;k jzwfvu
kd w
f ,f?
u|efawmfxGufajy;+yD; aemuf wm0ef&SdolawGrS
u|efawmfppfwdkufpOf aoqHk;oGm;a=umif; tdrfudk
ta=umif;=um;w,f? u|eaf wmf ,cktxd rdom;pkukd
rawG@& ao;bl;?
‘’I stayed in the recruitment centre for 5
years. I felt I had no freedom. Finally I decided to flee. . After I escaped the authority told my family I had died in the fighting.
I still haven’t been able to see my family.’’
“wcgw&H pdww
f tm;qd;k awmh t&ufaomufrd
w,f? u|efawmfrdom;pkeJ@ uGJuGmaponfhtwGuf
vufpm;acsvdkpdwf &Sdw,f? tdyfrufqdk;awGvnf;
wcgw&H tdyfrufw,f? tdyfrufxJrSm towfcH
&w,fv@kd rufw,f? wcgw&H ESyd pf ufc&H w,f/ aoawmh
raobl;? wcgw&Hvnf; tdyrf uf xJrmS rdom;pkEiS hf
jyefawG@&aomfvnf; u|eaf wmfrb
d awG aeraumif;
wmudk awG@&w,f?”
‘’Sometimes my anger is so big, I drink
alcohol. I want to take revenge because I
was separated from my family. I have bad
dreams sometimes. Sometimes I dream I’m
being killed, sometimes tortured but not killed.
Sometimes I dream I finally get to meet my
parents but they are sick.’’
“u|efawmf vufeufudkifwmudk rkef;w,f?
u|eaf wmfukd 'Dvufeufuikd w
f o
hJ al wGu ac:roGm;&if
taz/ tareJ@ aysmaf ysm&f i$ &f i$ af e&rSmyJ? ynmvnf;
oif&r,f? ckawmh pmvJrwwfb;l / emrnfavmufbJ
a&;wwfw,f? cktcsed rf mS u|eaf wmf ausmif;jyef ae
csif w ,f ? uav;awG & J @ ae&m[m ausmif ; yg?
vufeufuikd w
f hJ wyfawGrmS r[kwf ygb;l ?”
‘’I feel very bitter about the arm force.
If the armed group hadn’t taken me I’d be
living with my parents happily. I ‘d be educated. I’m illiterate now. I can only write
my name. What I want now is to go back
to school. Children’s place is in school not
in the armed force’’
ISSUE 23, MARCH, 2004
65
urBmw0Srf;tjrifESifh uav;ppfom;rsm;
usef;rma&;apwrmeftzGJ@
uBmw0Sr;f vH;k wGif axmifaygi;f rsm;pGmaom uav;rsm;tm; ppfom;tjzpf vufeufuikd w
f u
kd yf rJG sm;Y toH;k jyKavh
&So
d nf? tqdyk guav;rsm;onf pdwzf pd ;D r_. aemufqufw'JG %fuv
kd nf; cHpm;ae=u&onf? Taqmif;yg;onf
uav;ppfom;rsm;ta=umif; em;vnfap&ef ulnED ikd v
f rd rhf nf[k ar#mv
f ifyh gonf?
1/ rnforl sm;udk uav;ppfom;rsm;[k ac:qdyk goenf;?
t+rJodk@r[kwf t+rJr[kwfaom vufeufudkifwyf
od@k r[kwf vufeufuikd t
f yk pf w
k @kd wiG f yg0ifygwo
f ufaeaom
touft&G,f 18 ESpfatmuf rdef;uav; odk@r[kwf
a,muFsm;uav;wd@k ukd uav;ppfom;[k ac:onf? aemuf
wenf;tm;jzifh wdu
k cf u
kd &f eftwGuf vufeufuikd af qmif
jcif; od@k r[kwf udik af qmifcb
hJ ;l jcif; od@k r[kwf xrif;csu/f
vkyt
f m;ay; ay:wm/ owif;yd@k aqmifol od@k r[kwf vdif
qufqrH j_ yK&ef od@k r[kwf rw&m; odr;f ,l vufxyfjcif;wd@k EiS hf
ygwo
f ufaom uav;rsm;udk uav;ppfom;rsm;[k ac:
onf? txufyg t"dy`g,zf iG q
hf ckd suo
f nf ppfwyf od@k r[kwf
vufeufuikd t
f zG@J w@kd . rdom;pk0ifrsm;rSty tjcm;uav;
tm;vH;k ESihf t}uHK;0ifonf?
uav;ppfom;rsm; oH;k pGrJ u
_ kd &yfqikd ;f &ef zG@J pnf;xm;
aom nGe@f aygi;f tzG@J .tqd&k urBmay:&Sd Edik if aH ygi;f 85
Edik if w
H iG f tpd;k &vufeufuikd w
f yfrsm;ESihf tpd;k &ESiq
hf ef@usif
aomvufeufuikd t
f yk pf rk sm;rS wyfom;opfjzifh pkaqmif;
xm;aomoltouf 18 ESpfatmuf uav;rsm;rSm
500,000 cef@ &So
d nf? n$e@f aygi;f tzG@J rS ajymqdck sut
f &/
wcsed w
f nf;wGif tqdyk guav;ppfom; 300,000 ausmf
txufw@kd onf tpd;k &wyfrsm; od@k r[kwf tpd;k &ESiq
hf ef@usif
aom vufeufuikd t
f yk pf rk sm;wd@k bufrS wuf=upG mG wdu
k yf 0JG if
v#u&f adS =umif; od&onf?
urBmay:&Sd uav;ppfom; av;yHw
k yHo
k nf tm&Swu
kd f
wGif &Sdonf[k cef@rSef;&onf? ta&S@awmiftm&SESifh
ypPzdwaf 'owd@k wiG f Edik if H 6 Edik if YH ,leq
D ufonf uav;
ppfom;a[mif; 69 OD;wdk@ESifh awG@qHk ar;jref;avhvmr_
jyKcJo
h nf?
66
2/ uav;rsm;tm; vufeufudkifwyfzGJ@rsm;wGif rnfuJh
od@k wyfom;opftjzifh pkaqmif;ygoenf;?
uav;rsm;wyfom;opfjzifh pkaqmif;&mwGif en;fvrf;rsm;
pGm &Syd gonf?
•
•
•
•
•
tiftm;oH;k rw&m;qifah c:cdik ;f apjcif;/ uav;
ppfom;rsm;onf tdrrf sm;/ ausmif;rsm;ESihf vlpk
vla0;rsm;rS rw&m;ac:,l+y;D ppfwu
kd &f ef twif;
t=uyfcikd ;f apjcif;jzpfonf? tqdyk g udpPrsm;udk
tpd;k &wyfrsm;/ olyek t
f yk pf rk sm;ESihf jynfo@l ppfrsm;
rS jyKvkyaf vh&o
dS nf?
wcgw&Huav;rsm;onf rdrd.rdom;pk/ tdrf
axmifpk od@k r[kwf rsK;d EG,pf w
k @kd tm; tumt
uG,af y;&ef od@k r[kwf vufeufuikd f tkypf rk sm;
rS t=urf;zufru
_ kd umuG,&f eftwGuf ppfom;
jzpfv=kd ujcif;jzpfonf?
uav;rsm;tm; OD;aESmufaq;jcif;/ a=umfjim
aumif;jcif;/ ppfwyfEiS jhf ynfo@l ppfrsm;wGif &mxl;
ay;jcif;jzifh jrLqG,jf cif;wd@k jzifh pGaJ qmifI wyfxJ
od@k 0ifa&mufwm0efxrf;aqmifaponf?
wcgw&H wjcm;a&G;cs,&f ef vrf;r&Sad om tajc
taea=umifh jzpfonf? ynmoif=um;&ef pepf
r&Sjd cif;a=umifh uav;rsm;onf ausmif; wufEikd f
jcif;r&Sad y?xd@k tjyif toufarG;0rf;ausmif;oif
wef;rsm;udv
k nf; wufEikd &f ef tcGiahf &;r&ay?
ppfxJ0ifjcif;onfomv#if olwdk@. wckwnf;
aom xGuaf ygujf zpfonf?
qif;&Jjcif;? ? rdom;pk0ifrsm;taejzifh uav;
rsm;tm; tpm;taomufESifhynmoifay;&ef
trSwf=23 rwfmv 2004 ckESpf?
usef;rma&;apwref
Chlld Soldiers - A Global Overview
Health Messenger Team
Throughout the world, thousands of children are used as soldiers in armed conflicts.
Many of them are suffering from Post Traumatic Stress Disorder( PSTD). This
article will help our readers to understand who child soldiers are.
1. What is a child soldier?
•
A child soldier is any child – girl or boy –
under the age of 18 who is part of any kind of
regular or irregular armed force or armed group.
Child soldiers are children who carry or have
carried arms as direct combatants or who are
used as cooks, porters and messengers or for
sexual purposes or forced marriage.
In about 85 countries worldwide, more than
500,000 children under-18 have been recruited
into governmental armed forces and armed
oppositions groups according to the Coalition to
Stop the Use of Child Soldiers. .
It is estimated that one fourth of the world’s
child soldiers are in Asia. In South East Asia
and the Pacific, UNICEF has carried out a study,
interviewing 69 former child soldiers in six
countries in the region.
2. How are children recruited into armed
forces?
There are several scenarios to child recruitment:
•
•
Abduction/forced conscription: child
soldiers are often abducted from their
homes, schools or communities and
forced into combat, whether by
government forces, rebels groups or
paramilitary militias.
Children sometimes want to enter
soldiering to defend their family, home
or ethnic community or to protect them
from harassment from the armed
ISSUE 23, MARCH, 2004
•
•
•
groups.
Propaganda and ideological
brainwashing can also lure them into the
ranks of armed forces/militias.
In some cases there are no alternatives.
Due to the lack of an educational system,
where children are unable to attend
school and have no opportunity for
vocational training, soldiering may seem
the only option.
Poverty: Families are too poor to provide
their children with food and education.
Children who are forced to fight are
often poor, illiterate and from rural or
otherwise marginalized communities.
Children may feel hopeless for their
future because of rampant poverty and
lack of education. They may feel
compelled to join in order to take care
of their families.
3. Why are children used as soldiers?
Children provide cheap and obedient fighters,
and are more vulnerable, because of their youth
and experience. They are easier to brainwash
into fearless killing and unthinking obedience.
In some areas which are subject to persistent
violent conflict, there is a shortage of “eligible
men or women” so belligerents widen the
recruitment base by using girls and boys.
The proliferation of small guns and light
weaponry makes it possible for very young
children to bear and use arms.
67
rwwfEikd af tmif qif;&Jjcif;/ TuJo
h @kd uav;rsm;
rw&m;ppfwdkuf&r_onf rsm;aomtm;jzifh
qif;&Jjcif;/ pmrwwfjcif;wd@k a=umifjh zpf+yD; awm
t&yfa'orsm; odk@r[kwf zdESdyfjcif;cH&aom
vltyk pf rk sm;rS uav;rsm;jzpf=uonf?
• uav;rsm;onf tvGeq
f if;&Jjcif;/ ynmr&Sd jcif;
wd@k a=umifh a&SŒtem*gwt
f wGuf ar#mv
f ifch suf
r&S[
d k cHpm;Edik o
f nf? xd@k twGuaf =umifh rdom;
pkrsm;tm; axmufyHhulnD&ef ppfwyfrsm;odk@
0ifa&muf&ef pdwu
f ;l =uonf?
3/ uav;rsm;tm; rnfonft
h wGuaf =umifh ppfom;rsm;
tjzifh toH;k jyK=uoenf;?
uav;rsm;onf aps;aygaom/ emcHwwfaom/ wdu
k yf JG
0iforl sm;jzpf=uonft
h jyif aoG;aqmif&ef vG,u
f o
l nf?
olw@kd . i,f&,
G rf E_ iS hf tawG@}uKH enf;r_w@kd a=umifh jzpfonf?
olw@kd onf a=umuf&Œ
H$ r_uif;rJph mG owfjzwfjcif;ESihf rpOf;pm;
yJ emcJwwfrw
_ @kd jzpfay:apr_twGuf OD;aESmufaq;ay;&ef
vG,u
f o
l nf? ppfbuf+ydKifwu
kd cf u
kd af eaom a'orsm;wGif
wyfom;opfpkaqmif;&ef cufcJI rdef;uav;i,frsm;/
a,muFsm;uav;i,frsm;udk toHk;jyK&jcif;jzpfonf?
tcsK@d ae&mrsm;wGif t+rJwap t=urf;zufrr_ sm; &Sad eI
oifah wmfaom trsK;d orD;ESihf trsK;d om;rsm; &Sm;yg;I jzpfonf?
vufeufi,fEiS hf aygyh g;aom vufeufrsm;aygrsm;jcif;
a=umifh tvGeif ,faom uav;rsm;tm; vufeufrsm;
udik af qmiftoH;k jyK&ef tcGit
hf a&; jzpfay:aponf?
4/ rnfuo
hJ @kd aom vkyaf qmifcsurf sm;wGif uav;ppfom;
rsm; yg0ifygwo
f ufapoenf;?
tpD&ifccH surf sm;t& vufeufuikd t
f yk pf rk sm;wGif uav;
rsm; atmufygtwdik ;f yg0ifvyk af qmif=uonf?
a&SŒwef; ppfrsuEf mS rsm;wGif wdu
k cf u
kd &f ef?
wyf&if;wyfz@JG od@k r[kwf tajccHppfpcef;rsm;wGif aexdik f
=u&onf? vufeufuikd af qmif&ef tvGeif ,fveG ;f olrsm;
tm; a&cyf&ef/ wd&p>mefrsm;udk arG;jrL&ef od@k r[kwf pdu
k yf sK;d
a&;jyKvky&f ef wyfz@JG pcef;rsm;Y xm;cJo
h nf?
68
wcgw&H olv#Kd rsm; od@k r[kwf qufom;rsm;/ tapmifh
rsm;/ ukex
f rf;olrsm;ESihf apcHrsm;tjzpf toH;k jyK=uonf?
ajrjrKyrf ikd ;f rsm;axmif&efEiS hf &Si;f vif;&ef toH;k jyK=uonf?
“ u|eaf wmf[m a&SŒwef;rSm wcsed v
f ;kH aecJ&h w,f?
&eforl sm; jzwfoef; oGm;aomae&mrsm;Y rdik ;f rsm;axmif&ef
u|eaf wmfukd wm0efay;cJw
h ,f? olw@dk onf uav;rsm;udk
uif;axmuf&efEiS hf tjcm;udpPrsm;twGuf toH;k jyK=uw,f?
&efoEl iS &hf mG om;rsm;rSm uav;qdak wmh owdrxm;rd=ubl;
S av;ppfom;a[mif;wOD;)
ayg?h ” (ta&S@awmiftm&Sru
vdiu
f |et
f jzpf toH;k jyK=u&eftwGu?f ? rde;f uav;rsm;
rdbrJrh sm; od@k r[kwf tazmfrygonfh rde;f uav;rsm;onf
tvGet
f E W&m,frsm;onf? olw@kd onf rsm;aomtm;jzifh
tzsuq
f ;D cH&jcif;/ rw&m;jyKusichf &H jcif; od@k r[kwf tEdik f
usifhcH&jcif;/ vlukeful;cH&jcif;ESifh jynfhwefqmtjzpfodk@
ydk@aqmifcH&jcif;wdk@tjyif tiftm;jzifh ZeD;r,m;tjzpf
vnf; odr;f yku
d jf cif; cH&wwfonf? qef@usib
f ufwu
dk yf 0JG if
olrsm;rS jyKvkyaf vh&o
Sd nf?
5/ uav;rsm;ESiv
hf rl sm;tay: tusK;d oufa&mufrr_ sm;?
uav;rsm;onf cg;oD;pGm jyKusifhjcif;cH&I yifyef;
aomvkyif ef;rsm;udk cdik ;f apjcif; cH&wwfonf? nSO;f qJjcif;ESihf
vlrqefaom oifwef;rsm; ay;jcif;vnf; cH&wwfonf?
uav;ppfom;rsmonf ppfwdkufaepOfESifh t&yfom;
b0od@k jyefa&mufonft
h cgrsm;wGif aq;0g;rsm; oH;k pGjJ cif;/
tdyrf ufq;kd rsm;rufjcif;/ a'go}uD;jcif;ESihf *Gusjcif;wd@k jzpf
ay:apwwfonft
h jyif pdwyf ikd ;f ESihf ygwo
f ufaom vlra_ &;
csK,
d iG ;f r_rsm; &Sjd cif;udv
k nf; tpD&ifcpH mrsm;t& od&onf?
ppfom;topfpak qmif;jcif;onf vlxv
k x
l w
k ef;pm;wck
vH;k udk xdcu
kd af ponf? uav;rsm;taejzifh pmayoif=um;r_
&_;H qH;k I pD;yGm;a&;/ vlra_ &;/ tzG@J tpnf;wd@k EiS yhf gwo
f ufaom
wd;k wufrt
_ &Sed t
f [keu
f kd aES;auG;aponf? uav;ppfom;
trsm;pkonf pdwyf ikd ;f ESihf cE<mud,
k yf ikd ;f qdik &f m a=umuf&@H$ r_
wd@k a=umifh t=urf;zufrw
_ @kd ujkd zpfay:aponft
h jyif tem
*gwt
f wGuf pdwo
f abmxm;jcif;rwdu
k q
f ikd rf r_ sm; wd;k yGm;
apI +idr;f csr;f a&;udk ysupf ;D ap+yD; wnf+idraf om 'Dru
kd a&pD
jzpfay:a&;udv
k nf; t[ef@twm;jzpfaponf?
trSwf=23 rwfmv 2004 ckESpf?
usef;rma&;apwref
4. What kind of activities are child soldiers
involved in?
Children have been reported to fulfill the
following roles in armed groups:
To fight on the frontline.
To reside in battalion camps or base camps.
If they are too young to carry guns, they are left
in the battalion camps to carry water, watch
livestock, or be assigned to plantations
To be used sometimes as spies or
messengers, sentries, porters, servants
To be used to lay and to clear landmines
"I was in the front line all the time. I used
to be assigned to plant mines in areas the
enemy passed through. They used us for
reconnaissance and other things like that
because if you’re a child the enemy doesn’t
ISSUE 23, MARCH, 2004
notice you much; nor do the villagers." (Former child soldier in South East Asia)
To be used as sexual slaves: girls, orphans or
unaccompanied girls are especially vulnerable.
They are often sexually exploited, raped or
otherwise abused, subjected to human trafficking
and prostitution, and forced to be wives by other
combatants.
5. Effects on children and on the community
Children are often subjected to brutal
initiations and hard labour, cruel training regimes
and torture.
As a result many children report psychosocial disturbances from nightmares and angry
aggression to control to strongly anti-social
behaviour and substance abuse (drug and
alcohol), both during their involvement in war
and after their return to civilian life.
M i l i t a r y
recruitment
is
harmful to societies
as
a
whole.
Children’s lose
years of schooling
reduce societal,
human
and
e c o n o m i c
development
potentials. Many
child soldiers grow
up physically and
psychologically
scarred and prone
to
violence,
increasing the
danger of future
cycles of conflict
and damaging the
chances
of
peaceful, stable
democracies.
69
Child Protection
Protection of children is crucial to their survival, health, and well-being. Everyone has a
responsibility to see that children are safe. Individuals, civic groups, governments and the private
sector must help create protective environments for them.
Thanks to the Convention on the Rights of the Child (1989), nearly universally ratified
(191 States) children have now internationally recognized human rights.
The CRC is a code of binding obligations for the States towards their children to ensure their
protection. It provides rights to children: all the rights stated in the CRC should be granted to all
persons under 18 years old age without discrimination of any kind. The CRC covers every
aspect of a child’s life, from health and education to social and political rights.
To reinforce the protection mechanism established in the CRC convention two additional
protocols have been established, one focusing especially on child soldier issues:
The Optional Protocol to the Convention on the Rights of the Child on the
involvement of children in armed conflict (2000) signed by 115 countries and ratified by
63, prohibits governments and armed groups from using children under the age of 18 in conflict;
bans all compulsory recruitment of under 18s; bans voluntary recruitment of under 18s by
armed groups and raises the minimum age and requires strict safeguards for voluntary
recruitment.
uav;i,frsm;tm; tumtuG,af y;jcif;
use;f rma&;/ touf&iS o
f efa&;ESihf om,mpGmaeEdik af &;wd@k onf uav;i,frsm;tm; tumtuG,af y;onfh
udpPwGif ta&;ygaomtcsurf sm; jzpfayonf? wOD;csi;f / Edik if o
H m;ESiq
hf ikd af omtzG@J tpnf;rsm;/ tpd;k &rsm;ESihf
uk,
d yf ikd v
f yk if ef;&Siw
f @kd onf uav;wd@k tm; tumtuG,af y;aomygw0f ef;usirf sm; zefw;D ay;&ef uln&D rnf?
Ekid if aH ygi;f 191 Edik if rH S twnfjyKay;xm;onf/h 1989 ckEpS w
f iG f usi;f yaom uav;tcGit
hf a&;qkid &f m Edik if H
tcsi;f csi;f oabmwlncD sun
f v
D mcHukd aus;Zl;wifygonf? uav;rsm;onf Edik if w
H umt odrw
S jf yKvl@t cGit
hf a&;
rsm;&cJ+h yD; jzpfonf?
uav;tcGit
hf a&;qdik &f m Edik if w
H umoabmwlncD suf ((pD tm&f pD)D onf Oya'toGif pkpnf;+yD; wm0ef&Sd
onhEf ikd if rH sm;rSuav;rsm;udk umuG,af y;&rnf[k qdo
k nf? uav;tcGik t
hf a&;rsm; ay;tyfxm;onfq&kd mwGif
uef@owfcjJG cm;r_r&daS pbJ touf 1* ESpaf tmufuav;tm;vH;k udk pDtm&fpw
D iG f az: jyxm;aom tcGit
hf a&;
tm;vH;k ukd ay;&rnf? pDtm&fpD onf uav;wOD;pD.b0udk umuG,af y;&rnf? use;f rma&;/ ynma&;/ vlra_ &;ESihf
Edik if aH &;wd@k ESiyhf gwo
f ufonfh tcGit
hf a&;tm;vH;k yg0ifap&rnf?
uav;rsm;umuG,rf a_ y;a&;pepfcikd rf map&ef/ pDtm&fpD nDvmcHwiG f oabmwlncD supf nf;urf; 2 rsKd ; xyf
wd;k twnfjyKcJo
h nf? wrsK;d rSm uav;ppfom;udpPtm; txl;tm&Hpk u
kd x
f m;jcif; jzpfonf?
tdkyDpDtm&fpD [kac:aom uav;rsm;tcGifhta&;qdkif&mEdkifiHwumoabmwlnDcsuftwGuf pdwf}udKufa&G;
pnf;urf;oabmwlncD sut
f jzpf 2000 jynfEh pS f uav;rsm;yg0ifywfoufaomvufeufuikd w
f u
kd cf u
kd jf cif;tm; Edik if H
aygi;f 115 Edik if rH sm;rS vufrw
S af &;xd;k +yD; 63 Edik if rH S twnfjyKcJo
h nf? tqdyk goabmwlncD sut
f & tpd;k &rsm;ESihf
vufeufudkiftkyfpkrsm;taejzifh touf 18 ESpfatmufuav;rsm;tm; ppfwdkufckdufjcif;wGif ryg 0ifatmif
wm;jrpf&rnf? 18 ESpfatmufuav;rsm;udk r0ifrae& wyfom;opftjzpfrpkaqmif;&/ 18ESpfatmufudk
oabmwlnrD j_ zifh wyfom;opftjzpf rpkaqmif;&/ rdro
d abmt&ppfwyfo@kd 0if&ef ti,fq;kH toufuv
kd nf;
wd;k jrifo
h wfrw
S +f yD; vkt
d yfaomvH+k cHKr_rsm; ay;&efjzpfonf?
70
trSwf=23 rwfmv 2004 ckESpf?
usef;rma&;apwref
taumif;qH;k +yKd iyf 0JG if 100 tm;'kQonfpcef;tvdu
k w
f ifjyxm;onft
h a&twGuf
(use;f rma&;apwrmef ar;cGe;f v$m 1/ 2003)
THE BEST ONE HUNDRED CONTESTANTS BY CAMPS
(HEATH MESSENGER TEST 1 FOR 2003)
tH;k ysH pcef; Umpiem Camp
Ed@k zd;k pcef; Nu Poe Camp
r,fv pcef; Mae La Camp
r,fvrvGrf pcef; Mae La Ma Lunag Camp
u&ifeD pcef; Karenni Camp
r,facgicf pcef; Mae Kong Kha Camp
xrf;[if; pcef; Tham Hin Camp
tjcm; others
tjcm; Total
40
27
12
10
3
3
2
3
100
(40)
(27)
(12)
(10)
(3)
(3)
(2)
(3)
(100)
taumif;qH;k +ydKify0JG ifol 100 tm;'kQonfpcef;tvdu
k w
f ifjyxm;onfyh kH
(use;f rma&;apwrmef ar;cGe;f v$m 1/ 2003)
The
best one hundred contestants by camps
THE BEST ONE HUNDRED CONTESTANTS BY CAMPS
45
40
35
30
25
20
15
10
5
0
ISSUE 23, MARCH, 2004
o th
tjcme;rs
xr;f [i Hin Cam
;f pce;f
p
Tham
p
Ma
r,af ecgiKong Kh
a Ca
f pce;f
m
Ma
Ka
u&ireef D nni Cam
pce;f
p
e La
r,f v
rvrGMf pa Lunag
ce;f
Cam
p
Ma
e
r,v
f pLcae Camp
;f
Nu
Um
E@kd z;kd pPcoe Cam
e;f
p
Series1
t;kH ysH ppicem Cam
e;f
p
+ydKifyGJ0ifrsm; Contestants
(HEATH MESSENGER TEST 1 FOR 2003)
71
taumif;qH;k +yKd ify0JG ifol 100 tm; tzG@J tpnf;tvdu
k w
f ifjyxm;onft
h a&twGuf
(use;f rma&;apwrmef ar;cGe;f v$m 1/ 2003)
THE BEST ONE HUNDRED CONTESTANTS BY ORGANIZATIONS
(HEATH MESSENGER TEST 1 FOR 2003)
at/ tm/ pD ARC (Ameican Refugee Committee)
tjcm; Others
at/ trf/ tdik f A M I(Aide Medicale Internationale)
ausmif;q&m/ q&mrrsm; School teachers
trf tufpf tufzf MSF(Medisins Sans Frontieres)
au/ 'bvsL/ tdk KWO(Karen Women Organization)
u&ifeD Karenni camp
tufp/f trf/ tm/ ,l SMRU (Shoklo Malaria Research Unit)
yD/ yD/ at/ wD PPAT (Plant Paenthood Association of Thailand)
pkpak ygi;f Total
31
30
11
10
6
6
3
2
1
100
(31)
(30)
(11)
(10)
(6)
(6)
(3)
(2)
(1)
(100)
taumif;qH;k +ydKify0JG ifol 100 tm; tzG@J tpnf;tvdu
k w
f ifjyxm;onfyh kH
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35
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30
72
25
20
15
10
5
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THE BEST ONE HUNDRED CONTESTANTS
(HEATH MESSENGER TEST 1 FOR 2003)
American
at/ tm/ Refugee
pD
ARC
Committee
tjcm;
Others
Others
at/ Medicale
trf/ tdik f
Aide
AMI
Internationale
ausmif;teachers
q&m/ q&mr
School
School teachers
trf/ tufp/f tufzf
MSF
MSF
au/ 'bvsLtdk
KWO
KWO
u&ifepD cef
;
Karenni
camp
Karenni camp
tuf/ trf/ tm/ ,l
SMRU
SMRU
1
yD/ yD/ at/ wD
PPAT
tzGJ@tpnf;rsm;
PPAT
Organizations
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ERRATA ( trS m ;jyif )
ISSUE PAGE PARAGRAPH LINE
18
29
1
2
18
28
1
3
SHOULD
READ
AS
The major causative organism in South-
xdak &m*gujkd zpfapaomyd;k
ar;cdkifa&m*g a=umufp&m
Tetanus is a dangerous disease
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Dr Kyaw Kyaw
=uGufeD
Kywet Ni
tylavmif&if rayghygeJ@
Don't neglect the burns
Supported by DFID
You can listen to BBC Burmese Programme every Friday, Saturday and Sunday night : Thabyegone Ywa drama.
ISSUE 23, MARCH, 2004
73
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Distance
Learning
Health
Magazine
74
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