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Cablegate: Pushing a Big Rock Up a Steep Hill: Unfpa Tries To

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

1. (SBU) Summary: The UNFPA's three-day tour through upper
Burma in mid-October for members of the diplomatic community
and INGOs presented a microcosm of life today in this
country: a graceful, capable people burdened by a Government
that takes decisions based on its own interests. End Summary

2. (U) The United Nations Population Fund's (UNFPA) local
representative (Najib Assifi--Afghan) organized and led a
October 11-13 trip to Upper Burma (Mandalay, Monywa,
Amarapura, and surrounding villages) for members of the
diplomatic corps from Rangoon and Bangkok, including poloff.
The Director of Southeast Asian affairs in the Danish Foreign
Ministry in Copenhagen also participated, as did
representatives of Rangoon-based INGOs working on public
health issues.

Expanded UNFPA Program in Burma......

3. (U) The UNFPA organized the trip to showcase its
assistance for improved reproductive health in rural areas,
and to gain additional donor support. In September 2001, the
Fund's Executive Board approved an expanded assistance
program for Burma, 2002-2005, which aims to reduce maternal
mortality, and to prevent the spread of HIV/AIDS. The Board
approved a special budget of USD 20 million for UNFPA over
the four-year life of the expanded program, thereby doubling
the amount of assistance (USD 10 million) that UNFPA Burma
had provided during the '90s. However, UNFPA Headquarters
in New York has provided only USD 12 million of the expanded
budget. The local office is expected to raise the balance.

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4. (U) Toward those ends, the Fund took the group to nine
separate medical facilities around Mandalay and Monywa--four
hours apart over a rough, washed out road--that it supports
with information about HIV/AIDS, birth control (including
distribution of condoms and advocacy for their use); and
other aspects of reproductive health, including "birth
spacing" (note: The Government advocates a pro-natal policy
which precludes "family planning.") UNFPA Burma has extended
its support for such programs to facilities in 94 townships
in 2004, and hopes to reach 100 townships by next year (note:
There are 324 recognized townships in Burma.) The UNFPA's
resident representative estimates that his agency's
assistance programs currently reach 15-20% of the relevant
population in the participating townships. Rather than
trying to expand beyond the targeted communities, he hopes to
increase the numbers of people that draw on the assistance
available in the participating communities.

.....Has Produced Positive Results....

5. (U) At several of the sites visited, smiling Burmese
teens and twenty-somethings proclaimed the values of "safe
sex" through condom use. A villager informed the visitors
that he and his wife had seven grown children, one of whom
promptly stood up and proclaimed loudly that she did not want
to have more than three children. At a youth center
supported by the UNFPA, and endorsed by the regional military
commander, a mixed group of young people performed a play
that concluded with the hero confiding sadly to his friend
that he was HIV-positive following an encounter with a
prostitute. The hundreds of villagers who watched the
performance with the UNFPA-sponsored group smiled, frowned,
and clapped at the appropriate times. Some of this was
surely staged. However, the messages were clear and
seemingly well received. At the very least, the activity
provided a positive environment for youth with little else to

6. (U) The UNFPA's guests also received briefings on
training programs for midwives, assistant midwives, and
"Community Support Groups." Members of the latter were said
to be ordinary villagers who, following one or two days of
training, are capable of serving as liaisons between
villagers and medical facilities in larger villages and
townships. At the Women's Medical Center in Mandalay, an
energetic British nurse sponsored by the WHO showed the
visiting group how she taught Burmese midwives to get women
into the most comfortable positions to give birth. The
trainees were on the floor of a hospital for this purpose as
the group entered the training facility.

.......But Probably Not Enough

7. (SBU) The obstacles to improving health care in rural
Burma, however, are enormous. Maternal mortality rates in
the country are currently around 60 per 1,000 births, 90 per
1,000 in more remote areas. Data are hard to verify, but
some 80 percent of all births are thought to occur in homes.
Morbidity rates while giving birth are considerably lower
among women in the major urban areas, but the Government's
capacity to provide medical care of any kind to village
dwellers is limited. The political will to do so in the
ethnic areas is even more tenuous. For example, a German
doctor based in Rangoon with "Malteser Germany" (INGO with
home office in Cologne) bemoaned the extreme lack of medical
care in Northern Rakhine State during an earlier conversation
with poloff, telling the latter than an entire generation of
Muslim youth in that state is growing up malnourished.

8. (SBU) The structure is not in place within the Burmese
Government to address these problems. One of the Burmese
doctors who briefed the UNFPA-organized group said, in
response to a question, that he received a salary of kyat
8,000 per month (approximately eight USD). He also said he
is one of three doctors serving a population of 150,000.
Another Burmese doctor, currently the head of surgery in
Mandalay and an outspoken critic of the SPDC, told poloff
privately on the margins of the official trip that the GoB
has diluted and shortened medical training so much that it
will adversely affect the quality of care in the future.

Beggar Thy Neighbor.......

9. (SBU) Burma's neighbors are not helping. In some cases,
they are part of the problem. The Malaysian Ambassador to
Burma confided that his government had recently reached
official agreement with the GoB to bring 100 qualified
Burmese doctors--including ten specialists--to Malaysia on
three-year assignments. This would be mutually beneficial,
stressed the Ambassador: the Burmese doctors will make good
salaries while working in modern facilities and the Malaysian
Government will be able to offer more health care to its
citizens living in rural areas. Moreover, added the
Ambassador, the Malaysian Embassy in Rangoon is issuing some
120 visas to Burmese citizens every day to take up jobs in
Malaysia. Rangoon-based recruiters identify prospective
staff to meet requirements sent by needy employers in

......While the Government Looks On

10. (SBU) Army troops, including military intelligence
officials, and police were much in evidence throughout the
October 11-13 trip. In addition, members of the Myanmar
Maternal and Child Welfare Association (MMCWA), a GONGO run
by Burmese military wives, played a prominent part in the
group's program. During a visit to a MMCWA facility
supported by the UNFPA in Amarapura, a local MMCWA official
said her organization had a total of 3.79 million members
countrywide. The MMCWA has a staff member assigned to the
UNFPA's office in Rangoon to help direct the agency's
assistance projects.

11. (SBU) Final Comments: The UNFPA trip was, in several
ways, a microcosm of life today in Burma. For three days,
members of the group saw a graceful, capable people, willing
and able to employ foreign assistance to good advantage; and
an international organization that is trying hard to
contribute to improved living conditions. These developments
are taking place under a government that controls--for its
own benefit--the way the assistance is delivered while not
supporting the related processes and doing little to
contribute to the longer-term goals. The overall result is a
declining standard of living and increasingly depleted

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