Country: Myanmar
Closing date: 28 Mar 2016
Call for Expression of Interest
CARE International in Myanmar
Date: 14th March 2016
Terms of Reference: Consultancy for Research on causes and consequences of teenagers’ sexual, reproductive and maternal health (SRMH) behaviours in Shan State
Location of assignment: Yangon and Lashio, Shan State
Duration of assignment: Estimated 25 working days
Responsible to: Nilar Shwe (Program Director – Vulnerable Rural Women)
Main counterparts: Nang Lyan Zar (Health Adviser), Ni Lei Win, (Director of Information, Documentation, Monitoring and Evaluation)
CARE International in Myanmar
CARE is an international development and humanitarian aid organisation fighting global poverty, with a special focus on working with women and girls to bring lasting change to their communities. As a non-religious and non-political organisation, CARE works with communities to help overcome poverty by supporting development efforts and providing emergency assistance. We believe supporting women and girls is one of the most effective ways to create sustainable outcomes in poor communities.
CARE International in Myanmar’s programs focus on gender-based violence; food and livelihood security; disaster risk reduction; sexual reproductive health rights; peace-building; and policy and law reform in related areas.
Background
Information about the project:
In 2010, CARE started a project for women’s empowerment in two townships in Northern Shan State using sexual and reproductive health as an entry point for engaging communities, both men and women. The project carried out a number of interventions in different sectors including water and sanitation, maternal and child health and savings and loans to promote women’s equality and participation in community activities. A key strategy of the project was to address sexual and reproductive health including birth spacing, maternal and child health and adolescent reproductive health through training and support to auxiliary midwives, referrals and other health education activities. The project also engaged men to support women in accessing and improving their sexual and reproductive health.
Based on successes and lessons learnt from this project, GSK-CARE partnership activities in
Myanmar and elsewhere, the new project’s goal is to contribute to the reduction of maternal and neonatal mortality through increased access to, and quality of, sexual and reproductive health, and maternal and child health services. It aims to expand to 60 new villages in Northern Shan State and
introduce new and innovative tools and approaches, such as changing health behaviours and practices,
addressing the issues of retention of community health workers (CHWs); enhancing health surveillance and
reporting; improving the responsiveness of government; and better documenting successful approaches for
advocacy to influence government policy and practice.
Information about the situation in Myanmar and Shan:
There is very little data available on the sexual and reproductive health situation in the border regions of Myanmar, such as Northern Shan. Nationally, Myanmar has one of the highest infant mortality (IMR) and maternal mortality rates (MMR) in Asia. The Nationwide Cause-specific Maternal Mortality Survey estimated maternal mortality to be 316 per 100,000 live births in 2004-2005. In contested areas along the border regions, maternal mortality is much higher – estimates show that the maternal mortality is 721 per 100,000 live births in eastern Myanmar, and in conflict affected areas and areas with internally displaced populations, the MMR is estimated at 1,000 to 1,200 per 100,000 live births. In addition to structural and financial barriers, traditional social and gender norms and beliefs in many of the communities in the border areas also interact to prevent men and women from seeking appropriate sexual and reproductive health services. Communities in the border areas currently do not receive appropriate prevention and health promotion services. They have low awareness and lack information on positive health seeking behaviors resulting in poor birth spacing, ante-natal, delivery and post-natal care practices which contribute to high morbidity and mortality.
Regarding teenagers behaviours, there is even less data available. Adolescents (10-19 years) represent 18% of the Myanmar population. The 2007 Fertility and Reproductive Health Survey (FRHS) has shown that the adolescent childbearing rate Myanmar is of 17 live births per 1000 women aged 15-19 years and that about 17.2% of adolescent women (15-19 years) are not seeking antenatal care. Data from the FRHS also reveal that the proportion of married adolescents, who use contraception, remains low in Myanmar. The contraceptive prevalence rate is of 44% among 15-19 years old. Furthermore, it is estimated that approximately 8% of maternal deaths are attributed to women less than 20 years of age. In villages of Northern Shan, most girls marry at an early age and have their first child at an early age, as according to GSK End Project Evaluation Report, 62% of women married between the age of 15 and 19 years, with some girls marrying at the age of 14 (WHO 2007). The taboos surrounding pre-marital sex and adolescent sexual behaviour make access to information and reproductive health care limited and problematic, which constitutes a particular health risk for young women. In addition, unmarried girls and young women are at a particular disadvantage as reproductive health services are targeted towards married women. As a result, these women are also an at-risk group for illegal abortions and contracting HIV/AIDS .
The project aims to better understand causes of harmful SRMH behaviours of teenagers of Northern Shan and key vulnerabilities (Year 1) and develop project interventions to address them (Years 2 and 3).
Research objectives
The objective of the consultancy is to analyse SRMH behaviours of teenagers, their causes and impacts. Based on this analysis the consultant will make recommendations on how CARE Myanmar can address the underlying causes leading to dangerous SRMH behaviours in Northern Shan State.
Research Area 1: Analysis of teenage SRMH health behaviours
RQ1: What are the differences between female and male teenagers’ SRMH behaviours?
RQ2: How extensive is the understanding and knowledge of teenagers about SRMH and use of family planning?
Research Area 2: Determination of the impacts of these behaviours
RQ: What are the behaviours that impact negatively or positively on SRMH?
Research Area 3: Determination of the underlying causes leading to positive and negative SRMH behaviours
RQ1: To what extent economic factors affect teenagers’ SRMH behaviours?
RQ2: To what extent traditional beliefs and practices affect teenagers’ SRMH behaviours?
RQ3: What are the barriers and challenges to SRMH services’ accessibility?
RQ4: What are the other factors affecting teenagers’ SRMH behaviours?
Inputs
25 days, subject to methodology plan.
Outputs
• Agreed action plan for the consultancy
• Documentation of the research methodology
• Research findings report
• Briefing meeting/workshop to present preliminary findings
• Outline of proposed report
• Draft report
• Final report demonstrating consideration of feedback from CARE and CARE implementing partners on the draft. The report should be 25 to 30 pages (excluding annexes) and consist of, but is not limited to:
o Cover page
o Table of contents
o List of abbreviations and acronyms
o Executive summary (maximum two pages with recommendations)
o Introduction
o Background
o Methodology
o Limitations
o Findings and discussion
o Analysis of key issues, especially contextual issues, that may inform CARE’s implementation of the project
o Conclusion
o Recommendation
o Annexes
Methodology
The methodology will be qualitative, in order to provide a baseline analysis to develop a new project which will address harmful teenage SRMH in Shan State.
Consultancy Management
CARE Myanmar staff will ensure effective logistical support, however the consultant will need to work independently and should ensure that they are able to work in locations where English is not commonly spoken. A translator will be provided for field consultations. The consultancy will be managed by the Vulnerable Rural Women Program Director, Nilar Shwe, and involve consultation with CARE Myanmar staff.
Schedule and key activities
Schedule of the consultancy, for a total of about 25 days, will be set after discussions between the consultant and Health Advisor and IDME Director. Key activities include:
- Review of relevant program and organizational literature
- Development of a research methodology plan in coordination with the CARE Health Advisor and IDME Director
- Conduct field consultations in Shan State with appropriate stakeholders as defined in consultation with local staff
- Drafting of a research findings report, to include evidence-based programmatic recommendations
- Finalization of outputs following review by counterparts
Time/timing
The consultancy should commence in March following exchange of contracts with the successful offer.
Selection criteria
Essential areas of expertise:
a) Graduate degree in relevant social science discipline, knowledge or experience on health issues
b) Background in qualitative and quantitative research methodology design and implementation, with good experience in qualitative research
c) Excellent and demonstrable analytical and report writing skills
d) Experience conducting research related to reproductive health and teenagers would be preferred
e) Experience working in complex conflict environments
f) Familiarity with frameworks and sensitivities related to gender
g) Experience in Myanmar context highly preferred
How to apply:
Applying
Interested applicants are requested to submit a CV, a brief concept note outlining proposed research methods, and schedule of activities, including for international applicants how they will deal with cultural and language barriers. Applications should be submitted to Nilar.Shwe@careint.org not later than 28th March 2016.