The Sex Education Problem In Myanmar

In the Karen language, spoken by an ethnic group of people living in Myanmar and Thailand, the word for "vagina" is "poe tha klayi". It literally means "the way that the baby comes out". “But it is not a polite word to say,” 34-year-old Mu Tha Paw tells me, amid some giggling. “Most Karen women and girls are so embarrassed to say it.” This is a bit of a problem, as we are here – in a bamboo-shack cafe on the edge of Mae La refugee camp on the Thai-Myanmar border, where Mu Tha Paw lives – to talk about her work as a sexual health nurse in the camp. It’s also an issue for Mu Tha Paw in her day-to-day work, as the refugee women who come to see her are embarrassed to talk about their bodies and their problems. “The first time I talk to them, it’s the first time they have ever talked about family planning or reproductive health,” she says. “People don’t talk about it.” Mu Tha Paw is (perhaps unsurprisingly, considering her role) the exception, and is breezily discussing vaginal exams, IUDs and the contraceptive implant within two minutes of sitting down. The translator has a bit more trouble, but eventually he gets into the swing of things, and we hear Mu Tha Paw’s remarkable story.

A Karen refugee, she fled civil war in her home state in 2006. She was alone and frightened, but she had no choice. She was one of tens of thousands of civilians in Myanmar caught up in bloody conflicts between, on the one hand, ethnic groups who want more autonomy, and on the other, the all-powerful Burmese military. “When I lived there, I heard guns every day,” she says. “I came here because of the wars. We had no business, we could do nothing. There was a siege, and then there was no rice. I had nothing.” The conflict in Karen State is often called the longest-running civil war in the world, although in 2015 the Burmese army and the Karen National Union (KNU) signed a ceasefire agreement. “There was a lot of violence against women,” says Mu Tha Paw. “They killed women, there was sexual violence, it was very dangerous.”

Rape is still used as a weapon of war in a number of conflicts across Myanmar, and securing long-lasting peace is one of the key aims of its new civilian government, led in all but name by global human rights icon Aung San Suu Kyi (she is barred from being the president by a military-drafted quirk in the constitution.)

As well as negotiating for peace in Myanmar, “The Lady”, as she is affectionately known by her countrymen, is keen to rehabilitate the victims of war as well. Last week, on a visit to Thailand, she pledged she would not neglect the 105,261 mainly Karen refugees who, according to the UN, still live in nine camps on the Thai border. But Mu Tha Paw is not expecting too much. “I never hope that she can help,” she says. Instead, Mu Tha Paw and thousands like her – some of whom have spent decades in the camps – have taken it into their own hands to try and improve their lives, even while their futures hang in the balance. “I give women power by giving them knowledge,” she says.

Mu Tha Paw and her colleagues at the family planning clinic in Mae La camp were trained by the Planned Parenthood Association of Thailand (supported by the United Nations Population Fund.) Executive director Montri Pekanan agrees that the programme gives women some certainty in a world of unknowns. “These people have been there for almost 20 years. They don’t know their future, although the politics of Myanmar are changing,” he says. “But this comes from them. Helping them to take control of their fertility helps them to take control of their lives.” The programme began back in 2000, and now operates across five refugee camps. The family planning services have reached an estimated 73,000 women, and the sexual and reproductive health education programme has reached another 4,200 women. They provide advice, medicine, condoms, the pill, IUDs, and the contraceptive implant, as well as support for pregnant women and consultations on other reproductive health issues and hygiene. For serious problems, they refer the women to a hospital either in the camp or in the nearby city of Mae Sot. The nurses earn 2,200 baht (roughly £43) a month. “Education, family planning and sexual health services and supplies for this community were at a very low level,” says Pekanan. “Further in [to Myanmar], you can imagine what it’s like. They use some kind of herb to prevent pregnancy, and only really stop having children when they are old.”

At first, people were suspicious of the new services – husbands thought their wives would be unfaithful, parents thought it would encourage pre-marital sex, a taboo in the mainly Christian community, and some even thought it was a ploy to control refugee numbers – but because the nurses come from within the community, these fears have been assuaged. “The nurses become motivators, working with the other women in the camp,” says Pekanan. Paw Nu, 32, takes her role as a pioneer seriously. As well as working as a nurse, she also uses the service – she and her husband have two children already, and she has had the contraceptive implant for three years – and is passionate about its potential for women.

“If I had more children I would not have the opportunity to work in our society, so it gives me more freedom,” she says. “Plus it means I can afford the school fees for my children.” Paw Nu fled Myanmar when she was just 14, accompanied only by her cousin, to get a better education. She took her life into her own hands back then – and she believes women should do the same with their fertility. “Sometimes, the husbands are angry, because if the wife wants to use a condom, it’s not nice for them,” she says, pulling an unimpressed face. “But it is very important for women. If women can stop having children, they have the opportunity to work, and go to places. They can do anything.”