Cablegate: Unfpa's Burma Scorecard Is Good, so Far

This record is a partial extract of the original cable. The full text of the original cable is not available.





E.O. 12958: N/A

REF: STATE 137010

1. (SBU) Summary: UNFPA, into the second year of its
four-year "special program" in Burma, is encouraged by its
successes. To help ensure further progress, though, the
agency's Rangoon office hopes that a chronic shortage of
contraceptives will be remedied in short order. The agency
plans to expand both the width and depth of its program in
the next two years, continuing to work with local and
international NGOs, other UN agencies, and the Burmese
government. UNFPA's programs address serious health and
social needs in Burma, and thus expansion will benefit many
underserved women and adolescents. However, we'll keep an
eye on two potential pitfalls of expansion: a deterioration
in monitoring, and an expansion in leakages. End summary.

UNFPA Spreads its Wings in Burma

2. (U) The UNFPA established itself well in the first year of
its program in Burma. Though UNFPA has worked in Burma since
1969, it only established a country office in the summer of
2002. UNFPA's representation in Burma was raised in 2003
from chief of operations to representative level. Currently
UNFPA is into the second year of its $16 million, four-year

3. (U) UNFPA's programs in Burma address behavior change,
adolescent reproductive health, and general reproductive
health services. It generally tries to build the capacity of
the decrepit rural healthcare network of health centers and
sub-centers by providing resources and training. On the
population side, UNFPA continues its work analyzing the
numbers from a 2001 fertility and reproductive health survey
it carried out with the Burmese government. UNFPA recently
took over the responsibility, normally held by UNICEF, to
provide drugs for people with sexually transmitted diseases.
The agency is also involved in HIV/AIDS education and
prevention as part of the UN country team's Expanded Theme
Group on HIV/AIDS, and is awaiting Ministry of Health
approval to begin its own HIV/AIDS programming -- centered on
education and "100 percent condom usage."

Maternal Mortality is the Key Problem, Focus

4. (SBU) There's no question that UNFPA's mission to address
maternal mortality tracks with the country's needs. In 1997,
the maternal mortality rate in Burma was about 255 per
100,000 live births. Raw statistics collected at the end of
2001 indicate that the rate has increased since then.

5. (U) There's also strong evidence of demand for UNFPA's
activities, both education and contraceptive supplies. UNFPA
estimates that only 29 percent of married women of
reproductive age use contraceptives. In its operating area,
UNFPA is only able to supply 12-15 percent of likely clients.
Consequently, urban women avail themselves of a booming
black market for counterfeit, expired, or uncertified
contraceptive devices brought over from China. In rural
areas, UN agencies, NGOs, and other commentators tell us,
women turn to illegal abortions as a contraceptive measure.

6. (U) Additionally, UNFPA, along with various INGOs, helps
fills a niche for contraceptive choice. Though the
government has focused on 100 percent condom distribution as
part of its HIV/AIDS program, there's not been much attention
on other modes of contraception.

7. (U) Through its training programs, aimed at the vastly
female rural health corps and health statisticians, UNFPA
helps build capacity among female caregivers and

Relations with NGOs, Donors, and the Government

8. (U) UNFPA carries out its work in conjunction with rural
government health workers, other UN agencies (especially the
WHO), international NGOs, and local government-controlled
NGOs (including the Myanmar Maternal and Child Welfare
Association and the Myanmar Medical Association). UNFPA's
condom distribution is contracted to PSI, with which U.S. AID
works closely to implement its nascent $1 million HIV/AIDS
program in Burma. Other partner INGOs include Marie Stopes
International, the International Planned Parenthood
Federation, and the Japanese Organization for International
Cooperation in Family Planning. Save the Children and World
Vision also provide reproductive health services here, but
are not currently affiliated with UNFPA.

9. (SBU) The INGOs with whom we spoke were generally positive
about UNFPA's operations here. Some were a bit critical of
UNFPA's, and all UN agencies', dealing with the regime and
government NGOs. However, they admitted that the UN had
little choice but to work with the government to some degree,
and UNFPA was more vigilant than others in minimizing GOB

10. (U) UNFPA's usual bilateral donors (the Netherlands and
the Scandinavian countries) are not active in reproductive
health in Burma, having put their limited Burma assistance
funds into the fight against HIV/AIDS. However, the Japanese
government is doing some work on reproductive health. UNFPA
receives some limited grassroots funding from the Japanese
Embassy in Rangoon for renovating rural health clinics. We
were told that Japan International Cooperation Agency (JICA)
was planning a $2-$3 million multi-year program to provide
reproductive health alongside UNFPA in several dozen

11. (SBU) UNFPA's relations with its two government
interlocutors, the Ministry of Population and Immigration
(MOPI) and the Ministry of Health (MOH), are generally good.
UNFPA's representative reports that MOPI has been
surprisingly helpful and efficient in collaborating to
improve population statistics (there's been no official
census taken since the one UNFPA helped organize in 1983).
The Ministry of Health (MOH) has been somewhat more
bureaucratic and slow -- a complaint heard from many UN
agencies and health INGOs. However, the UNFPA representative
reported that under the new Health Minister, Dr. Kyaw Myint,
cooperation and efficiency have increased. For example,
Minister Kyaw Myint responded rapidly to UNFPA's request to
establish 20 new clinics/information centers/social halls
aimed at adolescents. This proposal had languished for
months under the previous minister.

12. (SBU) Though UNFPA does not channel its funds through the
MOH or other government ministries, it does work directly
with local health officials and government-run clinics. It
also relies on the MOH's central distribution network to get
contraceptive devices sent to the various townships. The
UNFPA representative complained that this distribution
network is slow and inefficient, but that there is no other
alternative if the GOB is to allow UNFPA to continue its

Future Plans are Ambitious

13. (SBU) Aside from the hoped-for HIV/AIDS program, UNFPA
intends to expand its capacity-building work. The Rangoon
office intends to bring in consultants in 2003 to conduct a
thorough gender analysis. In part, the impetus for this
study is the evolving economic role for women in Burma, as
more and more men seek economic opportunities outside the
country. Following up this study, UNFPA, alongside the
Myanmar National Working Committee for Women's Affairs, plans
to do several workshops on gender issues and trafficking in
persons aimed at male policymakers at all levels of

14. (SBU) Though it is limited by its MOU with the government
to reproductive health, UNFPA is also examining a pilot
project to work with the UN Interagency Project to Combat
Human Trafficking in the Mekong Sub-Region's (UNIAP)
expanding Burma operations. Specifically, UNFPA is looking
to assist a small, local development group (headed by
Catholic and Buddhist nuns) in Mon State to provide small
loans and other assistance to women and girls who might
otherwise seek a more dangerous living over the border in
Problems and Obstacles Remain

15. (SBU) UNFPA's small operation in Burma allows it to exist
with fewer obstacles than other, larger UN agencies.
However, there are three issues worth watching. First, a
major problem faced by UNFPA in Burma is a lack of funding
for contraceptive supplies. Though condoms are not a
problem, procurement of contraceptive pills, injections,
IUDs, and the "morning after" pill has been inadequate. The
representative said that UNFPA's procurement for Burma is
$800,000 in the hole for 2003, in large part due to a drop
off of bilateral donations and a general reduction of UNFPA's
funding around the world.
16. (SBU) Exacerbating this problem is leakage and government
misuse of what contraceptive supplies UNFPA can bring into
the country. That being said, at this point leakage of
contraceptives for resale into the black market is not as
large a problem as it is for drugs and other high-value
items. There are allegations that the government hijacks
some supplies of condoms, in particular, for their own use,
or for "donation" to a government-controlled NGO. However,
the seriousness of this problem is unclear.

17. (SBU) Monitoring, always a difficult task in Burma, is
easier for UNFPA because of the small size of its program.
Currently the agency is operating in 84 townships (about 25
percent of the country's total), mostly in more heavily
populated rural areas that have better transportation
infrastructure. Thus it is easier for UNFPA staff to make
regular monitoring missions. The representative said that he
or his staff are making about four monitoring trips per month
to various program sites. However, UNFPA aims to expand to
100 townships by 2005, which could put a strain on monitoring
effectiveness without additional hiring.

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