by
HI a Myint Hpu, B.A. (Eco), D.S.
A thesis submitted in partial fulfilment of the requirements for the Degree of
Master of Arts (Demography) in the Australian National University
D E C L A R A T I O N
Except where otherwise indicated, this thesis is my own w o r k .
HIa Myint Hpu
ACKNOWLEDGEMENTS
I wish to express my deepest gratitude to my supervisor, Dr S.K. Jain, for his guidance and keen interest in this study.
My sincere thanks also goes to other teachers and staff of the Development Studies Centre, particularly Dr D. Lucas, Dr P.F, McDonald, and Mr A. Gray for their generous help rendered on many occasions in
helping to solve my academic problems.
Many thanks are due to Mrs Chris McMurray who went through the English corrections of the draft. I am indebted to Anne Cappello for typing the thesis very efficiently.
I also wish to extend my thanks to the staff members of the Burmese Embassy, particularly to my colleague, U Than Tun Aung and his family, for making my stay in Canberra pleasant and enjoyable.
Finally, I would like to thank the Australian Government and the Burmese Government for giving me the opportunity to study
iv
ABSTRACT
In this thesis an attempt is made to study the mortality
statistics of Burma. It is mainly based on the fourteen years [1965-1978) published vital registration data collected by the Central Statistical Organisation and the Directorate of Health. Death registration is deficient in many ways and the official death rates are found to be lower than the perceived rates. Leading causes of death are pneumonia, tuberculosis, diseases of the heart, enteritis and diarrhoea diseases, cancer, accidents, perinatal mortality and bronchitis. Burmese mortality pattern follows the pre-industrial mortality pattern with high mortality at extreme ages. There are indications of declining mortality during 1950-1978 and that mortality reduction has stabilized since 1971 and further improvement is not likely for a considerable period.
Successful implementation of death registration in Burma lies
N
CONTENTS
Page
Declaration ii
Acknowledgement s iii
Abstract iv
List of Tables vii
List of Figures ix
List of Appendices X
CHAPTER 1 INTRODUCTION 1
1.1 The Study Area and People 1
1.2 Status of Mortality Statistics 3
1.3 Topics Covered in Vital Statistics Reports 6
1.4 Irregular Reporting of Registration Towns 8
1.5 Coverage of Registration Towns 9
1.6 Definition of Towns 10
1.7 Mortality Situation 12
1.8 Sources and Limitations of Data 14
1.9 Organization of the Study 17
CHAPTER 2 MORTALITY STATISTICS 18
2.1 The Number of Deaths 18
2.2 The Crude Death Rates 19
2.3 Age Specific Death Rates 29
2.4 Infant Mortality Rates 37
2.5 Maternal Mortality Rates 46
vi
CHAPTER 3 CAUSES OF DEATH AND LIFE TABLES 51
3.1 Causes of Death 51
3.2 Causes of Infant Death 56
3.3 Causes of Maternal Death 58
3.4 Life Tables 58
3.5 Summary 63
CHAPTER 4 FUTURE PERSPECTIVES 65
4.1 The Observed Mortality Situation 65
4.2 Evaluation of Vital Rates 67
4.3 Analysis of Life Tables 73
4.4 Medical Facilities 80
4.5 Non Medical Facilities 83
4.6 Remarks for Data Improvement 86
CHAPTER 5 SUMMARY AND CONCLUSIONS 88
LIST OF TABLES
Table Title Page
1.1 Number of Reporting Towns, 1962-1978 9
1.2 Number of Towns in Census Years by Size of
Population, 1901-1973 11
1.3 Life Expectancy at Birth for Urban Burma,
1921-1978 13
2.1 Crude Death Rates for Urban Burma for Both Sexes,
1950-1978 20
2.2 Crude Death Rates by Divisions and States of
Urban Burma, 1972-1974 25
2.3(a) Crude Death Rates of State and Division Capitals
of Urban Burma, 1972-1974 28
2.3(b) Observed and Standardised Crude Death Rates of
Urban Burma by Divisions and States for Both
Sexes, 1972-1974 28(a)
2.4 Age Specific Death Rates of Urban Burma by
Divisions and States, 1972-1974 31
2.5(a) Infant Deaths and Infant Mortality Rates for
Both Sexes, Urban Burma 1940-1978 38
2.5(b) Proportion of Infant Deaths by Specific Age to
Death Under 1 Year for Urban Burma, 1966 and 1978 41
2.5(c) Infant Mortality Rates by Divisions and States,
Urban Burma 1972-1974 42
2.6 Maternal Mortality Rates of Urban Burma, 1954-1978 47
3.1 Proportion of Persons Certifying Cause of Death
for Urban Burma, 1966-1978 53
3.2 Mortality From Eight Leading Causes for Urban
Burma, 1965-1978 55
3.3 Cause of Maternal Death by Age Group for Urban
Burma, 1978 59
3.4 Expectation of Life at Birth for Urban Burma by
Sex and Source, 1921-1978 60
3.5 Expectation of Life of Urban Burma by Divisions
viii
T a b l e T i t l e P a g e
4.1 O b s e r v e d a n d A d j u s t e d D e a t h R a t e s f o r U r b a n
B u r m a , 1 9 7 2 - 1 9 7 4 7 0
4 . 2 A g e S p e c i f i c D e a t h R a t e s B e f o r e a n d A f t e r
C o r r e c t i o n , U r b a n B u r m a , 1 9 7 2 - 1 9 7 4 72 4 . 3 E x p e c t a t i o n o f L i f e at V a r i o u s A g e s f o r U r b a n
LIST OF FIGURES
Figure Title Page
1.1 Map of Union of Burma 4
2.1 Crude Death Rates of Urban Burma, 1955-1978 23
2.2 Map of Crude Death Rates of Urban Burma for
Both Sexes by Divisions and States, 1972-1974 26
2.3 Age Specific Death Rates of Urban Burma Males
and Females for 1972-1974 34
2.4(a) Age Specific Death Rates of Urban Burma (Both
Sexes) by Divisions for 1972-1974 35
2.4(b) Age Specific Death Rates of Urban Burma (Both
Sexes) by States for 1972-1974 36
2.5 Infant Mortality Rates 0 f Urban Burma (Both
Sexes) for 1940-1978 40
2.6 Maternal Mortality Rates of Urban Burma for
1955-1978 48
4.1(a) Deviation of Urban Burma Males Age Specific
Death Rates from Various Patterns of the Life
Table Families, 1972-1974 74
4.1(b) Deviation of Urban Burma Females Age Specific
Death Rates from Various Patterns of the Life
Table Families, 1972-1974 75
4.2(a) Probability of Dying of Urban Burma Males Between
Observed and Smoothed Data, 1972-1974 77
4.2(b) Probability of Dying of Urban Burma Females
X
LIST OF APPENDICES
Appendix T a b l e T i t l e Page
1 . 1 Crude Death R a t e s o f Urban Burma by Towns
i n D i v i s i o n s and S t a t e s , 1972-1974 95-108
2 . 1 Number o f D e a t h s by Sex and R a t i o f o r Urban
Burma, 1965-1979 109
2 . 2 Number o f D e at hs by Sex by Month f o r Urban
Burma, 1975-1979 110
2 . 2 ( a ) S e a s o n a l I ndex o f Male D eat hs f o r Urban
Burma, 1975-1979 111
2 . 2 ( b ) S e a s o n a l I nd ex o f Female Deaths f o r Urban
Burma, 1975-1979 112
2 . 3 ( a ) P r o p o r t i o n o f D e a t h s o f C h i l d r e n Aged 0- 4 Y e a r s t o T o t a l De at hs and P e r c e n t a g e S h a r e
o f Deaths Under 1 Y ea r, 1966-1978 113
2 . 3 ( b ) P e r c e n t a g e P r o p o r t i o n o f C h i l d De at hs by
S p e c i f i c Age t o 0-4 Year D e a t h s , 1966-1978 114
2 . 4 ( a ) Age S p e c i f i c De at h R a t e s by D i v i s i o n f o r
Males and F e m a l e s , Urban Burma, 1972-1974 115
2 . 4 ( b ) Age S p e c i f i c De at h R a t e s by S t a t e f o r Males
and F e m a l e s , Urban Burma, 1972-1974 116
2 . 4 ( c ) Age S p e c i f i c Deat h R a t e s f o r Both S e x e s ,
Urban Burma, 19 72/7 4- 1 97 8 117
3 . 1 Cause o f Death C l a s s i f i e d Under 17 Major
H e a d i n g s , Urban Burma, 1965-1978 118
3 . 2 I n f a n t De at hs by 14 Lea di ng C au s es , Urban
Burma, 1965-1978 119
3 . 3 ( a ) A b r i dg ed L i f e T a b l e s f o r Urban Burma Males
f o r 1972-1974 120
3 . 3 ( b ) A b r id ge d L i f e T a b l e s f o r Urban Burma Females
f o r 1972-1974 121
4 . 1 ( a ) E s t i m a t i o n o f M o r t a l i t y by S t a b l e P o p u l a t i o n
A n a l y s i s f o r M a l e s , Urban Burma, 1972-1974 122
4 . 1 ( b ) E s t i m a t i o n o f M o r t a l i t y by S t a b l e P o p u l a t i o n
A n a l y s i s f o r F e m a l e s , Urban Burma, 1972-1974 123
4 . 1 ( c ) E s t i m a t i o n o f M o r t a l i t y by S t a b l e P o p u l a t i o n
Appendix Table Title Page 4.1(d) Estimation of Mortality by Stable Population
Analysis for Females, Union of Burma, 1972-1974 125 4.2(a) Estimation of Mortality by Brass Growth Balance
Equation for Urban Burma Males, 1972-1974 126 4.2(b) Estimation of Mortality by Brass Growth Balance
Equation for Urban Burma Females,1972-1974 127 4.2(c) Estimation of Mortality by Preston-Coale Method
for Urban Burma Males, 1972-1974 128
4.2(d) Estimation of Mortality by Preston-Coale Method
for Urban Burma Females, 1972-1974 129 4.2(e) Estimation of Mortality by Preston and Hill
Method for Urban Burma Males, 1972-1974 130 4.2(f) Estimation of Mortality by Preston and Hill
Method for Urban Burma Females, 1972-1974 131 4.2(g) Estimation of Mortality by Courbage and
Fargues Method for Urban Burma Males, 1972-1974 132 4.2(h) Estimation of Mortality by Courbage and
Fargues Method for Urban Burma Females, 1972-1974 132 4.2(i) Estimation of Mortality by Carrier Method for
Urban Burma Males, 1972-1974 133
4.2(j) Estimation of Mortality by Carrier Method for
Urban Burma Females, 1972-1974 134
4.3(a) Estimation of Mortality by Brass Growth Balance Equation Method for Union of Burma Males for
1972-1974 135
4.3(b) Estimation of Mortality by Brass Growth Balance Equation Method for Union of Burma Females for
1972-1974 136
4.3(c) Estimation of Mortality by Preston-Coale Method for for Union of Burma Males for 1972-1974 137 4.3(d) Estimation of Mortality by Preston-Coale Method
for Union of Burma Females for 1972-1974 138 4.4 Probability of Dying (n^x) for Urban Burma Males
and Females for 1972-1974 139
4.5(a) Abridged Life Tables for Urban Burma Males
(Adjusted by Preston-Coale Method), 1972-1974 140 4.5(b) Abridged Life Tables for Urban Burma Females
xii
Appendix Table 4.5(c)
4.5(d)
Title
Abridged Life Tables for Urban Burma Males (Adjusted by the Model Life Tables for Developing Countries), 1972-1974
Abridged Life Tables for Urban Burma Females (Adjusted by the Model Life Tables for
Developing Countries), 1972-1974
Page
142
The objectives of the study is to examine vital registration data.
The particular aims are (a) to review the vital registration system, (b) to
analyse the mortality statistics, (c) to appraise the mortality situation,
and (d) to predict the future perspectives.
1.1 The Study Area and People
Burma is situated in Southeast Asia between latitudes 10°N and
28°N and longitude 92°E and 101°E. It is bordered by Bangladesh and
India on the northwest, China to the northeast, Laos and Thailand to the
southeast, and the Bay of Bengal on the south and west. The total area
of the country is 261,228 square miles. The mountain ranges on the west,
north and east serve as natural barriers. There are three seasons
-monsoon, cold and dry. The annual rainfall ranges from 25 to 45 inches
in central Burma; about 100 inches in the hills of the east (Shan, Kayah,
etc.) and around 200 inches in the coastal regions of Arakan and Tennesserim,
and the mountain regions to the extreme north.
Burma is a planned socialist state. The Socialist Republic of
the Union of Burma as declared in the constitution adopted by the country
wide referendum in 1973, is a republic comprising seven states bearing
the names of the indigenous racial groups and seven divisions having
geographical names, thus making fourteen major administrative units in
all. The fourteen states and divisions are further divided into 314
townships, which are again subdivided into 283 towns and 13,670 village
tracts (Union of Burma, 1973, p.8). The administrative levels are
arranged with the highest being the union level, followed by state and
division level, township level and finally the village level.
2.
g r o u p s . T i b e t o - B u r m a n , Mon-Khmers, and T h a i - C h i n e s e . A c c o r d i n g t o t h e
1973 c e n s u s Burma had a p o p u l a t i o n o f 28. 9 m i l l i o n . Rangoon d i v i s i o n ,
b e i n g t h e most u r b a n , i s t h e most d e n s e l y p o p u l a t e d r e g i o n w i t h a d e n s i t y
o f 811 p e r s o n s p e r s q u a r e m i l e , f o l l o w e d by I r r a w a d d y d i v i s i o n and Mon
s t a t e w i t h 306 and 277 p e r s o n s p e r s q u a r e m i l e r e s p e c t i v e l y . Out o f
f o u r t e e n s t a t e and d i v i s i o n s , Kayah s t a t e i s t h e s m a l l e s t . Kachin s t a t e
i s t h e most s p a r s e l y p o p u l a t e d s t a t e w i t h a d e n s i t y o f o n l y 21 p e r s o n s
p e r s q u a r e m i l e . Male t o f e m a l e s e x r a t i o i s h i g h e s t i n Rangoon d i v i s i o n
and l o w e s t i n t h e Chin h i l l s .
The p o p u l a t i o n i s made up o f 68 p e r c e n t Burmese, 9 p e r c e n t Shans,
7 p e r c e n t K a re ns , 4 p e r c e n t Ar ak ans w i t h t h e r e m a i n i n g p e r c e n t a g e
d i s t r i b u t e d among o t h e r e t h n i c g r o u ps and f o r e i g n e r s . Burmese i s t h e
n a t i o n a l l a n g u a g e . Almost 89 p e r c e n t o f t h e p o p u l a t i o n a r e B u d d h i s t s ,
Among o t h e r r e l i g i o u s gr ou ps C h r i s t i a n s form n e a r l y 5 p e r c e n t and Muslims
form a mere 4 p e r c e n t o f t h e p o p u l a t i o n (Union o f Burma, 1973, p . 2 0 ) .
A c c o r d i n g t o t h e 1973 c e n s u s t h e f em a l e l i t e r a c y r a t e was 29. 6 p e r c e n t
w h i l e t h e male l i t e r a c y r a t e r e c o r d e d was 3 6 . 0 p e r c e n t . P e r c a p i t a
income was c a l c u l a t e d as 488 k y a t s ( c o n s t a n t p r i c e s ) (Union o f Burma,
1982, p . 2 8 ) . Average f a m i l y s i z e was e s t i m a t e d a s 5 . 9 p e r s o n s ( C e n t r a l
S t a t i s t i c a l O r g a n i s a t i o n , 1975, p . 3 8 4 ) .
Burma i s an a g r i c u l t u r a l e x p o r t i n g c o u n t r y w i t h p l e n t i f u l a r a b l e
l a n d and a c l i m a t e s u i t a b l e f o r p e r e n n i a l a g r i c u l t u r e ( Andr us , 1947, p , 4 4 ) .
P r i n c i p a l a g r i c u l t u r a l e x p o r t s i n c l u d e r i c e an d r i c e p r o d u c t s , p u l s e s ,
j u t e , r u b b e r , c o t t o n and m a i z e . The e x p o r t o f a g r i c u l t u r a l p r o d u c t s
c o n t r i b u t e s n e a r l y 57 p e r c e n t o f t h e t o t a l e x p o r t r e v e n u e . R e c e n t l y t h e
e x p o r t o f f o r e s t p r o d u c t s i s o f growi ng i m p o r t a n c e , m a i n l y t e a k and
hardwood ( C e n t r a l S t a t i s t i c a l O r g a n i s a t i o n , 1975, p . 1 7 5 ) . Burma h a s n o t
s u f f e r e d s e r i o u s n a t u r a l c a t a s t r o p h i e s n o r m a j o r s h o r t a g e s o f f o o d s t u f f
Between t h e s t a t e s and d i v i s i o n s a wide d i s p e r s i o n o f n a t u r a l
r e s o u r c e s and s o c i o - e c o n o m i c s e r v i c e s e x i s t . T h i s i s t h e i n t e n t i o n o f t h e
Union o f Burma Government t o r e d u c e t h e s e m a l - d i s t r i b u t i o n s by p r e f e r e n t i a l
e x p e n d i t u r e p r o g r a m s . Lar ge d i s c r e p a n c i e s i n w e a l t h , income, h e a l t h and
w e l f a r e p e r s i s t b e t w e e n r e g i o n s . As a r e s u l t o f t h e s e p e r s i s t i n g
d i f f e r e n c e s , we mi ght e x p e c t s i m i l a r d i f f e r e n t i a l s i n m o r t a l i t y b et we e n
r e g i o n s .
1 . 2 S t a t u s o f V i t a l R e g i s t r a t i o n i n Burma
V i t a l r e g i s t r a t i o n i n t h e p r e - w a r p e r i o d was f i r s t i n t r o d u c e d t o
l ow e r Burma u n d e r B r i t i s h r u l e and g r a d u a l l y e x t e n d e d t o o t h e r p a r t s o f
t h e c o u n t r y . I t was i n t r o d u c e d i n t o t h e towns o f Lower Burma i n 1906 and
s p r e a d i n t o t h e v i l l a g e s o f Upper Burma i n 1907. B i r t h s and d e a t h s
s t a t i s t i c s were c o l l e c t e d u n d e r t h e a u t h o r i t y o f t h e D e p ar t m e nt o f P u b l i c
H e a l t h . I n u r b a n a r e a s m u n i c i p a l h e a l t h o f f i c e r s and ward headmen r e c o r d e d
t h e v i t a l e v e n t s . I n r u r a l a r e a s , r e c o r d i n g was done by t h e v i l l a g e
headman. V i l l a g e headman l a t e r r e p o r t e d t h e v i t a l e v e n t s t o t h e Depar tment
o f P u b l i c H e a l t h t h r o u g h t o w n s h i p o r d i s t r i c t h e a d q u a r t e r s . The t o p i c s on
w hi ch d a t a were c o l l e c t e d i n b i r t h r e g i s t r a t i o n form i n c l u d e d d a t e o f
b i r t h , s e x o f c h i l d , names o f p a r e n t s and o c c u p a t i o n o f t h e f a t h e r . Death
r e g i s t r a t i o n forms i n c l u d e d name, age and s e x o f t h e d e c e a s e d , p l a c e o f
d e a t h and t h e c a u s e o f d e a t h c l a s s i f i e d i n t o a s m a l l gr oup o f d i s e a s e s .
The r e g i s t r a t i o n o f b i r t h s and d e a t h s i s c o m p u l s o r y by law t h r o u g h o u t t h e
c o u n t r y . V i t a l e v e n t s were r e c o r d e d u n d e r t h e p r o v i s i o n s o f bylaws made
u n d e r (1) t h e M u n i c i p a l Act 1898, (2) t h e Burma Towns Act 1907, (3) t h e
Burma V i l l a g e Act 1907, and (4) t h e C i t y o f Rangoon M u n i c i p a l Act 1922.
The v i t a l r e g i s t r a t i o n s y s t e m b r o k e down c o m p l e t e l y d u r i n g t h e
w a r . I t was r e v i v e d so on a f t e r t h e war and c o v e r e d 78 m u n i c i p a l i t i e s .
Immediate p o s t - w a r r e g i s t r a t i o n more o r l e s s f o l l o w e d t h e same o r g a n i s a t i o n a l
FIGURE 1.1 MAP OF UNION OF BURMA
UNION
BURMA
j K.ACHIN STATE
(A U N G H KAM Tt
f f A L A M '
I < CHIN I
R . ! M O N Y W A «
iSTATE \
*?xu:Mr*a<tauru\^^I' —
S H A N S T A T E
• T n n r\ < A tu /r^O
q A K Y A S M l N B U t
M Y A U N G M Y A
•TA V<
C a p ita l o f C o u n try H e a d - q u a r te r! o f O 'v t n c t
f'r.'ncipaJ H i|K « *a y j
»ma o*m in f.01
fif5 64f 6 7
[image:16.557.65.525.39.741.2]I n 1953 an I n t e r - D e p a r t m e n t a l Committee on V i t a l and H e a l t h
S t a t i s t i c s was s e t up f o r t h e improvement o f r e g i s t r a t i o n i n t h e c o u n t r y .
I n 1956 a V i t a l and H e a l t h S t a t i s t i c s Branch was s e t up a t t h e D i r e c t o r a t e
o f H e a l t h S e r v i c e s as a World H e a l t h O r g a n i s a t i o n a s s i s t e d p r o j e c t . I n
1961 t h e V i t a l S t a t i s t i c s Branch and t h e H e a l t h S t a t i s t i c s Branch were
s e t up i n d e p e n d e n t l y u n d e r t h e D i r e c t o r a t e o f H e a l t h S e r v i c e s .
I n 1962 t h e new v i t a l r e g i s t r a t i o n s y s t e m was f i r s t i n t r o d u c e d
i n Rangoon and 16 o t h e r towns w i t h a s t a n d a r d i z e d law and p r o c e d u r e s .
V i t a l s t a t i s t i c s wer e c o l l e c t e d u n d e r t h e C e n t r a l S t a t i s t i c a l A u t h o r i t y
A c t o f 1952. V i t a l r e g i s t r a t i o n was j o i n t l y o p e r a t e d by t h e H e a l t h
D e p a r t m e n t and t h e C e n t r a l S t a t i s t i c s and Economics Depar tment (now C e n t r a l
S t a t i s t i c a l O r g a n i s a t i o n ) . B i r t h s and d e a t h s were r e g i s t e r e d by t h e
h e a l t h a u t h o r i t i e s . V i t a l e v e n t s wer e s y s t e m a t i c a l l y r e g i s t e r e d u n d e r
t h e s t r i c t s u p e r v i s i o n o f t h e m e d i c a l r e g i s t r a r . Ca us e s o f d e a t h had
t o be v e r i f i e d by t h e t o w n s h i p m e d i c a l o f f i c e r . Death had t o be i n i t i a l l y
c e r t i f i e d by a l e g a l m e d i c a l p r a c t i t i o n e r o r , i n t h e a b s e n c e o f s u c h a
p e r s o n , by t h e ward p e o p l e ' s c o u n c i l member.
I n 1964 t h e V i t a l S t a t i s t i c s Br anch u n d e r t h e D ep ar tment o f H e a l t h
was r e o r g a n i s e d and p u t i n t o t h e C e n t r a l S t a t i s t i c s and Economics Depar tmen t
( C . S . E . D ) . The r o l e o f t h e V i t a l S t a t i s t i c s Branch was t o r e c o r d ,
c o m p i l e and a n a l y s e v i t a l s t a t i s t i c a l e v e n t s . I t a l s o p u b l i s h e d a nn u al
v i t a l r e p o r t s j o i n t l y w i t h t h e H e a l t h D e p a r t m e n t .
The new v i t a l r e g i s t r a t i o n s y s t e m i s more o f a c e n t r a l i s e d s y st e m.
Towns c o v e r e d by t h e r e g i s t r a t i o n had t o s e nd r e p o r t s m on t h l y t o t h e C e n t r a l
O f f i c e (CoS. E . D ) . The r e g i s t r a t i o n o f d e a t h s e x i s t s i n u r b a n Burma o n l y .
Out o f 283 t o wn s , r e g i s t r a t i o n i s c a r r i e d o u t i n 243 t o wn s . In p o p u l a t i o n
terms i t i m p l i e s t h a t 80 p e r c e n t o f t h e t o t a l u r b a n p o p u l a t i o n i s c o v e r e d
by r e g i s t r a t i o n . I n 1973 t h e u r b a n p o p u l a t i o n o f Burma was 24 p e r c e n t o f
6.
A c t u a l c o p i e s o f r e g i s t r a t i o n s l i p s a r e c o l l e c t e d by t h e c e n t r a l
o f f i c e . The i n f o r m a t i o n c o l l e c t e d on t h e b i r t h r e g i s t r a t i o n form i n c l u d e s
p l a c e an d d a t e o f o c c u r e n c e , s e x , name o f p a r e n t s , c i t i z e n s h i p o f p a r e n t s ,
r e l i g i o n , o c c u p a t i o n , m o t h e r ' s age and t y p e o f b i r t h ( i . e . t w i n o r
t r i p l e t s ) . I n f o r m a t i o n c o l l e c t e d on t h e d e a t h r e g i s t r a t i o n form i n c l u d e s
p l a c e and d a t e o f d e a t h , name, s e x , o c c u p a t i o n , a g e , c i t i z e n s h i p , name
o f p a r e n t s , m a r i t a l s t a t u s and t h e c a u s e o f d e a t h . S t i l l b i r t h i s r e c o r d e d
s e p a r a t e l y i n t h e new r e g i s t r a t i o n s y st e m , wher eas t h e p r e - w a r r e g i s t r a t i o n
s y s t e m d i d n o t r e c o r d s t i l l b i r t h s e p a r a t e l y . Over 80 p e r c e n t o f t h e
t o t a l Burmese p o p u l a t i o n had b e e n c o v e r e d by t h e p r e - w a r v i t a l r e g i s t r a t i o n
(Sundrum, 1957, p . 7 ) , hence p o s t - w a r r e g i s t r a t i o n c o v e r a g e i s w e l l b e h i n d
t h e p r e - w a r s i t u a t i o n .
P r e - w a r r e g i s t r a t i o n o m i t t e d t h e q u e s t i o n on age o f t h e m o t h e r i n
t h e c a s e o f b i r t h r e g i s t r a t i o n . T h i s made i t i m p o s s i b l e t o c a l c u l a t e age
s p e c i f i c f e r t i l i t y r a t e s . Deaths were c l a s s i f i e d i n s e l e c t e d g r o u ps o f
d i s e a s e s which l i m i t s t h e s c o p e o f t h e a n a l y s i s o f t h e c a u s e o f d e a t h
s t a t i s t i c s . The new s y s t e m c l a s s i f i e s c a u s e s o f d e a t h i n a c c o r d a n c e w i t h
t h e I n t e r n a t i o n a l C l a s s i f i c a t i o n o f D i s e a s e s i s s u e d by t h e World H e a l t h
O r g a n i z a t i o n .
1 . 3 T o p i c s Cover ed i n V i t a l S t a t i s t i c s R e po r t
M o r t a l i t y s t a t i s t i c s a r e c o v e r e d u n d e r f i v e b r o a d h e a d i n g s i n
t h e v i t a l s t a t i s t i c s r e p o r t . T h e s e a r e g e n e r a l , p e r i n a t a l , f o e t a l , i n f a n t ,
n e o n a t a l , and m a t e r n a l m o r t a l i t y . The f o l l o w i n g a r e t h e t a b l e s p r o v i d e d
G e n e r a l M o r t a l i t y
1. D eat hs by a g e g r o u p , sex and t o wn s .
2. D e a t h s and p e r c e n t a g e s by age gr ou p and m a r i t a l s t a t u s
o f d e c e a s e d .
3. Age s p e c i f i c d e a t h r a t e f o r t o w n s .
4. P e r s o n s c e r t i f y i n g c a u s e s o f d e a t h s and t h e i r p e r c e n t a g e s .
5. Deaths and p r o p o r t i o n a l m o r t a l i t y r a t e by p l a c e o f
o c c u r r e n c e and s e x f o r t h e C i t y o f Rangoon.
6. Deat hs and p r o p o r t i o n a l m o r t a l i t y r a t e by r e s i d e n c e and
sex f o r t h e C i t y o f Rangoon.
7. Causes o f d e a t h ( B - l i s t ) by a g e gr oup and sex by towns .
8. Causes o f d e a t h ( B - i i s t ) by age gr oup and s e x i n t h e
C i t y o f Rangoon.
9. Deaths and d e a t h r a t e from l e a d i n g c a u s e s by towns .
P e r i n a t a l M o r t a l i t y
1. P e r i n a t a l m o r t a l i t y and r a t i o by towns ,
2. P e r i n a t a l d e a t h s and p e r i n a t a l r a t i o s .
F o e t a l M o r t a l i t y
1. L a t e f o e t a l d e a t h s and l a t e f o e t a l d e a t h r a t i o by s e x
and age gr o up o f mo t h e r i n t h e C i t y o f Rangoon and o t h e r
t o w n s .
2. L a t e f o e t a l d e a t h s by s ex and b i r t h o r d e r i n t owns.
I n f a n t M o r t a l i t y
1. I n f a n t d e a t h s a nd i n f a n t m o r t a l i t y r a t e by age gr oup
and sex i n town s.
2. I n f a n t d e a t h s and i n f a n t m o r t a l i t y r a t e by p l a c e o f
o c c u r r e n c e and s e x i n t h e C i t y o f Rangoon,
8.
N e o n a t a l M o r t a l i t y
1. N e o n a t a l d e a t h s and n e o n a t a l m o r t a l i t y r a t e s .
M a t e r n a l M o r t a l i t y
1 . M a t e r n a l d e a t h s and m a t e r n a l m o r t a l i t y r a t e .
2 . M a t e r n a l d e a t h s b y c a u s e and a ge g r o u p i n towns .
3. M a t e r n a l d e a t h s by c a u s e an d age g r o u p i n t h e C i t y o f
Rangoon.
1 . 4 I r r e g u l a r R e p o r t i n g o f R e g i s t r a t i o n Towns
Under t h e Burmese v i t a l r e g i s t r a t i o n s y s t e m , r e p o r t i n g i s i r r e g u l a r .
D i v i s i o n towns w i t h e s t a b l i s h e d a d m i n i s t r a t i v e f a c i l i t i e s and e a s i e r
t r a n s p o r t a c c e s s have b e t t e r r e p o r t i n g t h a n S t a t e t o wn s . S t a t e towns a r e
m o s t l y s i t u a t e d i n h i l l and m o u n t a i n o u s r e g i o n s o r c o a s t a l a r e a s . A i r
and s e a s e r v e a s t h e m a j o r means o f t r a n s p o r t a t i o n which a r e v e r y
u n r e l i a b l e . The pr ob lem o f i r r e g u l a r r e p o r t i n g may be r e g a r d e d as an
o r g a n i s a t i o n a l w e a k n e s s . A p a r t from b i g c i t i e s ( e . g . Rangoon, Mandalay)
most h o p s i t a l s a r e g e n e r a l l y u n d e r s t a f f e d . I t i s l i k e l y t h a t d e a t h
r e p o r t i n g i s n e g l e c t e d b e c a u s e o f o t h e r p r i o r i t y wor k. E s p e c i a l l y i n s mal l
t o w n s , t o w n s h i p m e d i c a l o f f i c e r s a r e o v e r - b u r d e n e d w i t h many r e s p o n s i b i l i t i e s .
No s e r i o u s a c t i o n i s t a k e n a g a i n s t i r r e g u l a r r e p o r t i n g o r n o n
r e p o r t i n g o f d e a t h s i n t h e r e g i s t r a t i o n t o w n s . The C e n t r a l S t a t i s t i c a l
O f f i c e u s u a l l y s e n d s r e m i n d e r s b u t t h e r e s p o n s e i s p o o r . T h e r e f o r e , t h e
d e a t h r e g i s t r a t i o n o f Burma f a c e s t h e p r o b l e m o f i r r e g u l a r and p oo r
r e p o r t i n g from d e s i g n a t e d t ow ns . R e g u l a r v i s i t s o f i n s p e c t i o n teams t o
p o o r r e p o r t i n g towns d i d r e s u l t i n some improvement i n t h e number o f
r e p o r t i n g t o w n s . However, f i n a n c i a l c o n s t r a i n t s as w e l l a s l i m i t e d v i t a l
s t a t i s t i c s s t a f f p o s e a p r o b l e m f o r w i d e r i n s p e c t i o n o f r e g i s t r a t i o n
t o w n s . The u n r e l i a b l e and i n e f f i c i e n t p o s t a l s e r v i c e a l s o ad ds t o t h e
p r o b l e m . Though t h e r e e x i s t no r e c o r d s f o r s u c h o m i s s i o n s , a n o t h e r f a c t o r
a l s o n ee ds t o b e t a k e n i n t o a c c o u n t r e g a r d i n g p o o r r e p o r t i n g . P ap er i s
r a t h e r e x p e n s i v e i n Burma. Used o f f i c e p a p e r s as w e l l as o l d n e w s p r i n t
f o r r e p a c k i n g p u r p o s e s c an f e t c h a r e a s o n a b l e p r i c e . L os ses o f v i t a l
1 . 5 Cov e r a g e o f R e g i s t r a t i o n Towns
The 1978 V i t a l S t a t i s t i c s R e p o r t shows t h a t o u t o f 283 towns i n Burma
243 towns have b ee n c o v e r e d by t h e v i t a l r e g i s t r a t i o n s y s t e m . With t h e
i n t r o d u c t i o n o f t h e new v i t a l r e g i s t r a t i o n s y st e m i n 1962 t h e number o f
r e g i s t r a t i o n towns had grown t h r o u g h t h e y e a r s . The peak e x p a n s i o n
p e r i o d was r e a c h e d i n 1974 c o v e r i n g 275 to wns .
T a b l e 1 . 1
Number o f R e p o r t i n g Towns, 1962-1978
Year 1962 1965 1970 1974 1978
R e g i s t r a t i o n Towns 15 126 240 275 243
R e p o r t i n g Towns 15 119 139 178 159
P e r Cent R e p o r t i n g 10 0. 0 9 4 . 4 5 7. 9 6 4 . 7 6 5. 4
S o u r c e : 1962-1978 V i t a l S t a t i s t i c s R e p o r t s , C e n t r a l S t a t i s t i c a l O r g a n i s a t i o n , and t h e D i r e c t o r a t e o f H e a l t h , Rangoon, Burma.
T a b l e 1 . 1 shows t h e number o f r e p o r t i n g towns from 196 2- 1978.
Over 90 p e r c e n t o f towns r e p o r t e d when t h e t o t a l number o f r e g i s t r a t i o n
towns was l e s s t h a n 200. R e p o r t i n g d r o p p ed c o n s i d e r a b l y w i t h t h e i n c r e a s e
i n t h e number o f t o w n s . The r e p o r t i n g a l s o v a r i e d from y e a r t o y e a r .
Some o f t h e e s t a b l i s h e d r e g i s t r a t i o n towns were l o s t i n 1978 r e c o r d i n g
32 f ew er towns t h a n t h e l a s t f o u r - y e a r t o t a l . I n s h o r t , we may n o t e t h a t
Burmese d e a t h r e g i s t r a t i o n i s n o t m a i n t a i n i n g t h e e s t a b l i s h e d norms b u t
r a t h e r i s l o o s i n g gr ou nd t h r o u g h t i m e . A n o t h e r c o n s i d e r a t i o n i s t h a t t h e
p r e s e n t s t a t i s t i c a l f a c i l i t y i s n o t s u f f i c i e n t t o f a c i l i t a t e e x p a n s i o n
[image:21.557.36.498.114.476.2]10.
1.6 Definition of Town in Burma
In Burma deaths are recorded compulsorily by law by the death registration system in towns designated as urban areas. Though towns are designated as urban, many of the towns either lack the basic characteristics of a town or else cannot be literally termed as urban. In this study
some explanation might be necessary for a clear understanding of the word ’town’ in the Burmese context. Emphasis is given to administrative
criteria in classifying towns in Burma, Classification as a town does not require any essential characteristic and does not adhere to any
international standard definitions.
Table 1.2 presents the number of towns in census years by size of population. The 1901 Burma census showed a total of 53 towns. The
following is the 1901 census definition of towns. (1) Areas under the municipalities regardless of size of population, (2) civil lines (other than municipalities), (3) army contonment areas, (4) areas of not less than 5,000 population with permanent buildings and areas specified as important for inclusion in the census by the head of the region (U Win,
1979, p.171). The number of towns rose to 75 in the 1911 census. The increase in the number of towns was due mainly to the consideration that the inclusion of areas according to the 1901 census definition was found to be insufficient for covering enough areas for the 1911 census. The number of towns did not vary significantly during the 1921 and 1931 censuses (U Win, 1979, p.171). Information about towns in the 1941 census was lost in the Second World War.
After Independence the first stage census was taken in 1953 and the number of town rose to 252. This was due to the fact that after
Independence, most of the areas in the country were reorganised and divided into various administrative regions. All administrative areas were
classified as towns in the 1953 census. Towns in the 1953 census
included (1) municipal towns, (2) areas classified as towns, (3) railway station towns, and (4) areas which local people called towns. Therefore, in the 1953 census there were 145 towns with less than 5,000 population
report showed a total of 288 towns (Central Statistical Organisation
and the Directorate of Health, 1978, p.2). Although there is some
discrepancy in the number of towns in the country the 1973 census report
should be taken as most accurate. In the 1973 census the classification
of towns emphasized the inclusion of administrative regions as towns
rather than areas with town characteristics (U Win, 1979, p.172). In
general, it can be remarked that the Burmese definition of towns is
primarily administrative in nature. This fact is rather noteworthy for our
analysis. Towns covered by death registration varied in size of
population as well as basic socio-economic characteristics. The aim of
this study is to spell out the situation of mortality statistics based
on such differences.
Table 1.2
Number of Towns in Census Years by Size of Population
1901-1973
Population Group 1901 1911 1921 1931 1953 1973*
100,000 and Above 2 2 2 2 3 5
50,000 - 100,000 1 1 1 1 2 16
20,000 - 50,000 5 6 5 5 23 48
10,000 - 20,000 17 17 17 17 26 60
5,000 - 10,000 18 37 39 51 53 74
Below - 5,000 10 12 21 15 145 80
Total 53 75 85 91 252 283
Source: U Win, Definition of
Rangoon University,
Towns in Rangoon,
Burma, Burma,
Takatho 1979, p.
Pade'tha 169.
Sasaung,
1 2.
1. 7 M o r t a l i t y S i t u a t i o n
M o r t a l i t y i n Burma may be s a i d t o have i mproved d u r i n g t h e l a s t
h a l f c e n t u r y . The c r u d e d e a t h r a t e s from v i t a l r e g i s t r a t i o n i n d i c a t e
s i g n s o f d e c l i n i n g m o r t a l i t y . I n f o r m a t i o n on t h e c a u s e s o f m o r b i d i t y
and m o r t a l i t y i s d e f i c i e n t i n Burma. Crude d e a t h r a t e s may s e r v e as
good m e a s u r e s o f t h e m o r t a l i t y s i t u a t i o n o f t h e c o u n t r y i n t h e a b s e n c e o f
o t h e r s o p h i s t i c a t e d m e a s u r e s , i n s p i t e o f t h e i r l i m i t a t i o n s . The q u a l i t y
o f r e g i s t r a t i o n d a t a and t h e e x t e n t o f u n d e r - r e g i s t r a t i o n were n e i t h e r
known n o r c he cked by any de mo gr ap hi c m e a s u r e s . T h e r e f o r e , t h e c r ud e
d e a t h r a t e s may n o t be t a k e n a t f a c e v a l u e . However, t h e c r u d e r a t e s
b r o a d l y r e v e a l e d a f a l l i n g m o r t a l i t y p a t t e r n i n t h e c o u n t r y .
The c r u d e d e a t h r a t e i n 1950 was r e c o r d e d a t 4 6 . 8 b u t f e l l by
more t h a n h a l f in 1960 w i t h 20 d e a t h s p e r t h o u s a n d . I t was a g a i n r e d u c e d
t o h a l f i n 1970 and f e l l f u r t h e r t o 8 . 6 i n 1978 ( C e n t r a l S t a t i s t i c a l
O r g a n i s a t i o n and t h e D i r e c t o r a t e o f H e a l t h , 1978, p , 4 ) . The r a t e s
p u b l i s h e d by t h e M i n i s t r y o f P l a n n i n g g i v e s much h i g h e r e s t i m a t e s t h a n
t h o s e b a s e d on v i t a l r e g i s t r a t i o n . Crude d e a t h r a t e f o r 1978 was g i v e n
a s 10.1 (Union o f Burma, 1 9 79 / 80 , p . 2 1 0 ) . The U n i t e d N a t i o n s ' e s t i m a t e d
r a t e f o r 1978 was 14 . 3 ( U n i t e d N a t i o n s , 1980, p . 4 6 5 ) . T h e r e f o r e , i t may
b e r e a s o n e d t h a t t h e l e v e l o f m o r t a l i t y c o u l d be h i g h e r t h a n t h e a n t i c i p a t e d
r a t e s . However, t h e U n i t e d N a t i o n s ' e s t i m a t e s a r e f o r t o t a l Burma w h i l e
t h o s e o f v i t a l r e g i s t r a t i o n r a t e s a r e f o r u r b a n a r e a s o n l y .
The i n f a n t m o r t a l i t y r a t e f e l l from o v e r 300 i n 1950 t o a l mo s t
h a l f i n 1960 and r e a c h e d i t s l o w e s t l e v e l i n 1978 w i t h 46 i n f a n t d e a t h s
p e r l i v e b i r t h s . I n a s i m i l a r manner t h e m a t e r n a l m o r t a l i t y r a t e a l s o
f e l l from 5 . 3 i n 1954 t o 3 . 5 i n 1964, and f u r t h e r t o 1 . 5 ( p e r t h o u s a n d
l i v e b i r t h s ) i n 1978. I t was o b s e r v e d t h a t t h e f a l l i n m a t e r n a l m o r t a l i t y
was n o t d r a s t i c i n t h e l a t e r y e a r s a f t e r 1967, b u t s t a b i l i z e d i n t h e
T a b l e 1. 3 shows l i f e e x p e c t a n c y a t b i r t h f o r u r b a n ma l es and
f e m a l e s from 19 21 -19 78. Over t h e l a s t f i v e d e c a d e s t h e e x p e c t a t i o n o f
l i f e h a s i n c r e a s e d by 70 and 74 p e r c e n t . The a v e r a g e e x p e c t a n c y o f
l i f e f o r b o t h s e x e s was e s t i m a t e d a t more t h a n 60 y e a r s i n 1978.
T a b l e 1 . 3
L i f e E x p e c t a n c y a t B i r t h f o r Urban Burma, 1921-1978
P e r i o d L i f e E x p e c t a n c y a t B i r t h P e r c e n t a g e I n c r e a s e i n e° S in ce 1921 o
Male Female Male Female
1921-31 3 4. 9 3 6 . 8 -
-1954 4 0 . 8 4 3 . 8 1 6 . 9 19. 0
1964 4 5 . 0 4 7 . 8 28. 9 29. 9
1965* 4 7 . 1 5 0 . 0 3 4 . 9 3 5 . 9
1971 55 .9 59. 1 6 0 . 2 60 . 6
1974 5 6 . 3 5 0 . 2 6 1 . 3 6 3 . 6
1978 5 9 . 3 6 4 . 0 6 9 . 9 7 3. 9
S o u r c e : R e p o r t t o P y i t h u H l u t t a w on t h e f i n a n c i a l , economic and s o c i a l c o n d i t i o n s o f t h e S o c i a l i s t R e p u b l i c o f t h e Union o f Burma, 1 9 6 9 / 7 0 , p , 139; 1 9 7 4 / 7 5 , p ?222; 1 9 8 3 / 8 4 , p . 2 2 9 , M i n i s t r y o f
P l a n n i n g and F i n a n c e , Rangoon, Burma.
* S t a t i s t i c a l Year Book, 1975, p . 5 5 , C e n t r a l S t a t i s t i c a l O r g a n i s a t i o n , Rangoon, Burma.
Gains i n l i f e e x p e c t a n c y b e t w e e n 1965-1971 a n d 1974-1978 a r e v e r y s i g n i f c a n t .
Such a s p e c t a c u l a r improvement i n m o r t a l i t y w i t h i n a s h o r t p e r i o d may be
due l a r g e l y t o t h e i mpr ovement s i n economic and h e a l t h c o n d i t i o n s , p a r t i c u l a r l y
i n m a t e r n a l and c h i l d h e a l t h . Females seem t o have b e n e f i t e d more from
im pr o vi ng h e a l t h c o n d i t i o n s t h a n m a l e s , e n j o y i n g l o n g e r l i f e e x p e c t a n c y
and t h u s f u r t h e r w i d e n i n g t h e m o r t a l i t y gap b e t w e e n t h e s e x e s . Many o f t h e
q u e s t i o n s on t h e s i g n i f i c a n t p r o g r e s s i n m o r t a l i t y i n t h e above s h o r t p e r i o d
[image:25.557.41.511.67.540.2]1 4.
b e c a u s e e x i s t i n g v i t a l r e g i s t r a t i o n d a t a a r e d e f i c i e n t , f i n d i n g p l a u s i b l e
e x p l a n a t i o n s f o r t h e above phenomenon mi ght n o t be p o s s i b l e . The most
one can s p e c u l a t e i s t h a t t h e i m p r o v i n g m o r t a l i t y i n t h e u r b a n towns was
b r o u g h t a b o u t by t h e m o d e r n i s a t i o n p r o c e s s and h e a l t h i n t e r v e n t i o n .
1 . 8 S o u r c e s and L i m i t a t i o n s o f Data
The s t u d y w i l l be b a s e d m a i n l y on t h e 13 y e a r s v i t a l r e g i s t r a t i o n d a t a
c o v e r i n g t h e p e r i o d b e t we e n 19 6 5- 1 97 8 . S i n c e 1962, r e g i s t r a t i o n r e p o r t s
h av e b e e n p u b l i s h e d a n n u a l l y , b u t t h e 1962-1964 r e p o r t s a r e n o t a v a i l a b l e
t o t h e a u t h o r . A l s o , t h e 1969 r e p o r t c o v e r e d T h e i n c h a u n g R u r a l E x p e r i m e n t a l
S t a t i o n o n l y . T h e i nc ha un g r u r a l a r e a was c h os e n as a t e s t s i t e i n 1969 f o r
t h e i n t r o d u c t i o n o f v i t a l r e g i s t r a t i o n i n r u r a l a r e a s . T h e r e f o r e , t h i s
r e p o r t n e e d s t o be e x c l u d e d from t h e s t u d y .
1973 u r b a n c e ns u s d a t a a r e u s e d f o r t h e c a l c u l a t i o n o f t h r e e y e a r s
( 1972- 1974) a v e r a g e v i t a l r a t e s as i t i s t h e l a t e s t a v a i l a b l e c e n s u s d a t a .
The 1983 c e n s u s d a t a a r e s t i l l b e i n g p r o c e s s e d and a r e n o t y e t p u b l i s h e d
f o r u s e i n t h e p r e s e n t s t u d y . The 1973 n a t i o n a l p o p u l a t i o n c e n s u s d a t a
h av e b e e n t e s t e d and j u d g e d t o be o f h i g h q u a l i t y ( T i n T i n Nyunt, 1978, p . 3 6 ) .
In c o n t r a s t , t h e 1973 u r b a n p o p u l a t i o n d a t a ha ve n o t b e e n p u t t o t h e t e s t .
I t i s assumed h e r e t o be as r e l i a b l e as t h e n a t i o n a l p o p u l a t i o n ce ns u s
d a t a .
H o s p i t a l s t a t i s t i c s , m o r b i d i t y and m o r t a l i t y r e p o r t s w i l l be
s u p p l e m e n t e d i n a n a l y s i n g t h e c a u s e o f d e a t h d a t a . Thes e s t a t i s t i c s a r e
c o m p i l e d from h o s p i t a l r e c o r d s o f u r b a n t o w n s . They a r e t a k e n t o be
more r e l i a b l e i n d e f i n i n g m o r b i d i t y and c a u s e o f d e a t h .
Ad hoc economic and s o c i a l s u r v e y s a r e c o n d u c t e d on a r o t a t i o n a l
in the country. Some of this survey data will be used to explain the
socioeconomic background of the study area with respect to the prevailing
mortality situations. Linking survey information to registration data will
pose some difficulty.
The Limitations: Vital registration data is deficient in a number
of ways. First, the coverage. The registration system exists in urban
areas only. 21 per cent of the total population is covered. But for the
towns (designated as urban areas) the coverage is 80 per cent (Central
Statistical Organisation and the Directorate of Health, 1973, p,3).
Second, the under-registration of the deaths an^ irregular reporting of
registration towns. Under-registration may be due to two sources. The
failure of concerned respondents to report deaths in their family
households and the failure of registration towns staff to send registration
slips to the central office in Rangoon. It is stated that such failures
also occurred in the pre-war registration system (Sundrum, 1957, p.8).
Death reporting is much more likely to be accurate than birth reporting
(Sundrum, 1957, p.9). The event of death cannot escape unnoticed in the
Burmese community and is regarded as part of community affairs. Neighbours,
friends and relatives usually gather together to assist with the burial,
In the event of death in a certain family, it is the usual custom
for all the family members to gather at the place of the deceased. The
dead body is normally kept for an odd number of 1, 3 or 5 days in order
to allow time for the family members at faraway places to arrive in time
for the funeral day. It is not usual for the dead body to be buried
within 24 hours or a day, unless a person dies of some contagious disease
and immediate burial is instructed by the medical doctor. Most of the
1 6.
c h i l d r e n a r e k e p t f o r a s h o r t e r p e r i o d o f 3 d a y s . I n f a n t d ea d a r e
u s u a l l y b u r i e d w i t h i n a day. The c u s t o m a r y b u r i a l p r o c e d u r e s f o l l o w e d
a r e t h e same as f o r a d u l t d ea d . The immedi ate b u r i a l o f dead i n f a n t s
may be r e s p o n s i b l e f o r t h e l a r g e p r o p o r t i o n o f u n d e r - r e p o r t i n g a t
young a g e s . Dead i n f a n t g i r l s a r e r e p o r t e d l e s s t h a n i n f a n t b oys a s
b e i n g n o t s i g n i f i c a n t l y i m p o r t a n t (Sundrum, 1957, p . 8 ) .
I n e f f i c i e n c y and u n r e l i a b i l i t y o f p o s t a l s e r v i c e s l e a d t o t h e
f a i l u r e o f r e g i s t r a t i o n s l i p s t o r e a c h t h e C e n t r a l S t a t i s t i c s O f f i c e .
I t i s a l s o p r o b a b l e t h a t l a c k o f i n t e r e s t , i g n o r a n c e o f t h e v a l u e o f v i t a l
s t a t i s t i c s and l e s s a t t e n t i o n t o r e g i s t r a t i o n due t o heavy work l o a d s
a r e r e a s o n s f o r u n d e r - r e g i s t r a t i o n as w e l l .
E r r o r s i n age r e p o r t i n g a nd d e f e c t s i n c l a s s i f i c a t i o n o f d e a t h s
by c a u s e compound t h e p r o b l e m . Cause o f d e a t h i s r e c o r d e d i n a c c o r d a n c e
w i t h t h e I n t e r n a t i o n a l C l a s s i f i c a t i o n o f D i s e a s e s , However, t h e d a t a i s
n o t o f h i g h q u a l i t y , a s c a n be s e e n from t h e p r o p o r t i o n s i n t h e unknown
c a u s e c a t e g o r y , w hi ch u s u a l l y s e r v e s a s t h e q u a l i t y m e a s u r e , i s w e l l o v e r
40 p e r c e n t .
I t h a s a l r e a d y b e e n n o t e d i n t h e e a r l i e r s e c t i o n ( S e c t i o n 1. 8)
t h a t Burmese v i t a l r e g i s t r a t i o n d a t a i s d e f e c t i v e i n a number o f ways.
T h e r e i s much t o be c h a l l e n g e d i n b o t h q u a n t i t a t i v e and q u a l i t a t i v e
m e a s u r e s . However, d e s p i t e i t s l i m i t a t i o n s and s h o r t - c o m i n g s , d a t a from
v i t a l r e g i s t r a t i o n p r o v i d e s t h e o n l y b a s i s f o r m e a s u r i n g t h e m o r t a l i t y
s i t u a t i o n i n Burma. T h e r e f o r e , b e a r i n g t h i s i n mind, t h e a n a l y s i s and
i n t e r p r e t a t i o n s made t h r o u g h o u t t h i s t h e s i s a r e c o n s t r a i n e d p r i m a r l y by
Data on f o e t a l d e a t h s w i l l n o t b e a n a l y s e d i n t h i s p r e s e n t s t u d y
b e c a u s e t r y i n g t o a r r i v e a t c o n s l u s i v e r e s u l t s i s n o t p o s s i b l e f o r
i n c o m p l e t e n e s s o f t h e i r r e g i s t r a t i o n , t h e p r o b l e m s o f a c c u r a c y o f d i a g n o s i s
and o f r e p o r t i n g t h e s ex o f t h e f o e t u s .
1. 9 O r g a n i z a t i o n o f Study
The r e s t o f t h e c h a p t e r s i n t h i s t h e s i s a r e o r g a n i z e d as f o l l o w s :
C h a p t e r I I M o r t a l i t y S t a t i s t i c s
C h a p t e r I I I Causes o f D e a t h and L i f e T a b l e s
C h a p t e r IV F u t u r e P e r s p e c t i v e s
1 8.
CHAPTER 2
ANALYSIS OF MORTALITY STATISTICS
2.1 The Number o f Deaths
The number o f d e a t h s depends on t h e s i z e and v a r i o u s d e m o g r a p h i c ,
s o c i o - e c o n o m i c c h a r a c t e r i s t i c s o f t h e p o p u l a t i o n and p h y s i c a l e n v i r o n m e n t ,
e . g . economic w e l l - b e i n g , t h e q u a l i t y o f h e a l t h f a c i l i t i e s , a v a i l a b i l i t y
and q u a l i t y o f f o o d . Age i s t h e most i m p o r t a n t f a c t o r i n c o n s i d e r i n g
d e a t h b e c a u s e t h e r i s k o f d e a t h s h a r p l y r i s e s w i t h a g e . A l s o , t h e s o c i o
economic c h a r a c t e r i s t i c s o f a p o p u l a t i o n v a r y w i t h a g e . T h e r e f o r e t h e
age s t r u c t u r e o f t h e p o p u l a t i o n p l a y s an i m p o r t a n t r o l e i n m o r t a l i t y
a n a l y s i s . The 1973 P o p u l a t i o n Census o f Burma shows t h a t more t h a n
t w o - f i f t h s ( 4 1 . 5 p e r c e n t ) o f t h e p o p u l a t i o n i s b el ow 15 y e a r s o f age
(Union o f Burma, 1973, p . 4 8 ) . Hence, Burma h a s a young p o p u l a t i o n w i t h
o n l y a s m a l l p r o p o r t i o n a t o l d e r ag es where r i s k o f d e a t h i s h i g h e r .
I t can be s e e n t h a t t h e number o f d e a t h s i n Urban Burma r a n g e s
from n e a r l y f i f t y t h o u s a n d d e a t h s t o a l i t t l e o v e r s i x t y t h o u s a n d d e a t h s
a n n u a l l y (Appendix 2 . 1 ) . More t h a n 80 p e r c e n t o f t h e d e a t h s o c c u r i n
u r b a n d i v i s i o n t o w n s , w i t h a l m o s t 50 p e r c e n t o f t h e t o t a l d e a t h s i n
Rangoon D i v i s i o n , f o l l o w e d by 14 p e r c e n t i n Mandalay D i v i s i o n and
o v e r 11 p e r c e n t i n I r r a w a d d y D i v i s i o n ( C e n t r a l S t a t i s t i c a l O r g a n i s a t i o n ,
1982, p . 5 ) .
There a r e some v a r i a t i o n s i n t h e t o t a l number o f d e a t h s from
y e a r t o y e a r c a u s e d m a i n l y by i r r e g u l a r r e p o r t i n g o f r e g i s t r a t i o n towns .
Hence, n o t h i n g c o n c l u s i v e can be d e r i v e d from t h e r e p o r t e d number o f
t o t a l d e a t h s i n t h e s e t ow ns , e x c e p t t h a t t h e number o f male d e a t h s e x c e e d s
The number o f m on t h l y d e a t h s by s e x f o r Urban Burma f o r 1975-1979
(Appendix 2 . 2 ) a r e c o m p i l e d from raw d a t a o f d e a t h r e t u r n s a s s e n t t o
t h e V i t a l S t a t i s t i c a l S e c t i o n . These f i v e - y e a r d a t a on m on t h l y d e a t h
r e t u r n s i n d i c a t e some form o f s e a s o n a l i t y o f d e a t h i n Burma.
The h i g h e r number o f r e p o r t e d d e a t h s i n December may be due t o
t h e l a t e a r r i v a l o f r e t u r n s from t h e r e p o r t i n g t o w n s , t h u s lumping a
l a r g e r number o f d e a t h s i n t o December. S e a s o n a l i n d e x e s c a l c u l a t e d
on f i v e y e a r s d a t a (19 75- 19 79) f o r m a l e s and f e m a l e s o f Urban Burma
a r e shown i n Appendix 2 . 2 ( a ) and 2 . 2 ( b ) . The r e s u l t s f u r t h e r s t r e n g t h e n
t h e f i n d i n g s o f e x i s t e n c e o f s e a s o n a l p a t t e r n o f d e a t h s i n Burma.
2 . 2 The Crude Death R a t e s
The c r u d e d e a t h r a t e i s d e f i n e d a s t h e number od d e a t h s p e r y e a r
p e r 1000 p o p u l a t i o n a t t h e m i d - y e a r . I t i s one o f t h e most common
m e a s u r e s o f m o r t a l i t y . However, i t i s n o t a good me asur e as i t i s
h i g h l y s e n s i t i v e t o change i n p o p u l a t i o n s t r u c t u r e , e s p e c i a l l y i n age
s t r u c t u r e . Hence, i n t h e s t u d y o f m o r t a l i t y t r e n d s w i t h i n a p o p u l a t i o n
o v e r l o n g p e r i o d s o r m o r t a l i t y d i f f e r e n t i a l s b e t we e n p o p u l a t i o n s , t h e
u s e o f t h i s r a t e i s n o t v e r y a p p r o p r i a t e . However, i n t h e a b s e n c e o f
any o t h e r m o r t a l i t y s t u d i e s , c r u d e d e a t h r a t e may a c t as a good i n d i c a t o r
20.
In Burma crude death rates were calculated from the death
statistics and estimated populations of urban reporting towns. Therefore,
these rates are not for the whole country.
Table 2.1 presents the crude death rates for Urban Burma for
both sexes. It is apparent that the highest crude death rate was recorded
in 1950. The early years of the 1950s were post-war years of rehabilitation
Table 2.1
Crude Death Rates for Urban Burma for
Both Sexes, 1950-1978
1 2
Year Number of Reporting Towns Crude Death Rate Crude Death Rate
1950 N. A. 46.8 N . A.
1955 66 20.7 20.0
1960 61 20.0 20.0
1965 104 16.4 17.9
1970 139 10.4 10.8
1971 138 10.9 11.4
1972 126 10.9 11.3
1973 170 9.5 11.1
1974 178 10.5 11.3
1975 164 10.1 10.5
1976 145 9.8 10.6
1977 115 9.1 10,4
1978 159 8.6 10.1
Source: 1
Vital Statistics Organisation and
Report, 1978, p.4, Central the Directorate of Health,
Statistical Rangoon, Burma.
2
Union of Burma, of Planning and
1971/72, p.162; 1982/83, p
Finance, Rangoon, Burma.
[image:32.557.45.508.200.791.2]w i t h p o o r economic p e r f o r m a n c e and a l a c k o f g e n e r a l h e a l t h f a c i l i t i e s
(Knappen T i p p e t t s Abbet E n g i n e e r i n g R e p o r t , 1952, p . 2 0 ) . I n t e r n a l
s t r u g g l e s f o r power r a g i n g i n t h e c o u n t r y i n t h a t p e r i o d may a l s o e x p l a i n
s u c h a b n o r m a l l y h i g h d e a t h r a t e s .
A marked improvement i n c r u d e d e a t h r a t e s was s e e n o v e r t h e
f o l l o w i n g y e a r s , f a l l i n g from o v e r 20 d e a t h s p e r t h o u s a n d i n 1960s t o
below 9 i n 1978. Such a p r on ou nc ed f a l l i n d e a t h r a t e s was b r o u g h t
a b o u t b y i m pr ovement s i n s o c i o - e c o n o m i c c o n d i t i o n s , h e a l t h f a c i l i t i e s
and t h e i n t r o d u c t i o n o f modern ( Wes te rn ) m e d i c i n e . S t e a d y economic
gr owt h was a c h i e v e d b e t w e e n 1960- 1978 , w i t h G r o ss Domesti c P r o d u c t
i n c r e a s i n g a t an a n n u a l a v e r a g e o f 4 p e r c e n t (Union o f Burma, 197 2/73,
p . l ; 1 9 7 7 / 7 8 , p . 3 ) . Economic d ev el o pme nt h a s e n a b l e d t h e Union o f
Burma Government t o i n c r e a s e h e a l t h e x p e n d i t u r e f o u r - f o l d , r e s u l t i n g
i n a s u b s t a n t i a l e x p a n s i o n o f p u b l i c h e a l t h f a c i l i t i e s (Union o f Burma,
1977, p . 1 6 5 ) .
A n o t h e r c o n s i d e r a t i o n i s t h a t c ru d e r a t e s may a l s o v a r y w i t h
t h e c h a n g i n g p o p u l a t i o n b a s e . P r o j e c t e d o r e s t i m a t e d p o p u l a t i o n s were
u s e d f o r t h e c a l c u l a t i o n o f c r u d e r a t e s i n t h e y e a r s b e f o r e 1973,
T h es e e s t i m a t e s we re p r o v i d e d by t h e Census D e p ar t m en t ( C e n t r a l
S t a t i s t i c a l O r g a n i s a t i o n , 1967, p . 2 ) . Dur in g t h e p o s t - w a r p e r i o d
Burma c o n d u c t e d t h r e e c e n s u s e s , i n 1953, 1973 and 1983, The c e n s u s
o f 1953 was n o t c o m p l e t e d due t o p o l i t i c a l u n r e s t an d i n s u r g e n c y
p r e v a l e n t i n t h e c o u n t r y a t t h a t t i m e . The 1973 and 1983 c e n s u s e s a r e
t h e o n l y two c o m p l e t e c e n s u s e s c o n d u c t e d i n t h e p o s t - w a r e r a , 1973
c e n s u s d a t a i s p u b l i s h e d b u t 1983 d a t a i s s t i l l b e i n g p r o c e s s e d a t
2 2.
B e s i d e s t h e v a r i o u s p o p u l a t i o n p r o j e c t i o n s b a s e d on v a r i o u s
a s s u m p t i o n s , t h e r e was ev en an i n s t a n c e where t h e a n n u a l r a t e p e r c a p i t a
c on s u m p t i o n o f r i c e was u s ed as a b a s i s f o r c a l c u l a t i n g p o p u l a t i o n
e s t i m a t e s (Census Dep ar tm en t mimeograph, n . d . , Appendix C ) . Given
s uch e v i d e n c e we may c o n c l u d e t h a t t h e d e a t h r a t e s d e r i v e d from t h e
v a r i o u s p o p u l a t i o n e s t i m a t e s may have added t o v a r i a t i o n s o f r a t e s
s e en i n our s t u d y .
T h e r e seems t o be a growing a w a r e n e s s among t h e Burmese
a u t h o r i t i e s c o n c e r n i n g t h e p r o b l e m o f u n d e r - r e g i s t r a t i o n . T h i s p o i n t
i s e v i d e n t from t h e c r u d e d e a t h r a t e s p u b l i s h e d b y t h e M i n i s t r y o f
P l a n n i n g and F i n a n c e which a r e h i g h e r t h a n t h e p u b l i s h e d v i t a l
r e g i s t r a t i o n r a t e s . I t i s v e r y l i k e l y t h a t t h e M i n i s t r y o f P l a n n i n g
and F i n a n c e , b e i n g awar e o f t h i s p r o b l e m , i n f l a t e d t h e i r r a t e s ( F i g u r e
2.1) .
I n o r d e r t o add r e l i a b i l i t y t o t h e m e as ur e o f m o r t a l i t y ,
a 3 - y e a r a v e r a g e c r u d e d e a t h r a t e c o v e r i n g t h e p e r i o d 1972-1974 was
c a l c u l a t e d . The 1972-1974 p e r i o d was c h o s e n b e c a u s e 1973 was t h e
c e n s u s y e a r , t h e r e f o r e t h e 1973 c e n s u s p o p u l a t i o n i s employed i n t h e
c a l c u l a t i o n o f c r u d e r a t e s i n t h i s s t u d y . The 1973 p o p u l a t i o n ce ns u s
was fo un d t o be o f good q u a l i t y by Daw T i n T i n Nyunt (Daw T i n Ti n Nyunt,
1978, p . 3 6 ) .
The n u mb e rs o f d e a t h s f o r t h e y e a r s 1972-1974 were a v e r a g e d
and d i v i d e d by t h e 1973 c e n s u s p o p u l a t i o n t o a r r i v e a t c r u d e d e a t h
r a t e s . The r a t e s wer e c a l c u l a t e d f o r e ac h r e g i s t r a t i o n r e p o r t i n g
town o f t h e s even D i v i s i o n s and s e v e n S t a t e s . The c r u d e d e a t h r a t e
o f e a c h town i s shown i n Appendix 1 . 1 . The r a t e s f o r u r b a n Burma by d i v i s i o n
--- Central Statistics Data
_____ Planning Data
10
>
0 J \ --- '---— .---•--- *--- *--- *
--1955 61-63 64-66 67-69 70-72 73-75 76-78
YEAR
Figure 2.1
[image:35.557.36.517.51.740.2]Table 2.2 shows the three-year (1972-1974) crude death rates of
Urban Burma by division and state. It can be observed that male crude
death rates are higher than female rates in all divisions and states. The rates for Urban Burma are 10.4 for males and 8.8 for females, a slightly higher rate than the 1973 annual rate in the Vital Registration Report. Since over 70 per cent of the total urban population of Burma lives in divisions, the division crude death rate is almost the same as the national rate. Of the seven divisions the death rate is highest in both Irrawaddy and Mandalay Divisions, with Rangoon and Tennesserim
slightly lower from both males and females. Among the seven states,
Kachin has the highest rate followed by Mon and Shan.
The high mortality in Kachin State may be due to persistent insurgency, intermittent food shortages, poor health facilites and
slower economic development. Development and public works programs
in the area are greatly hampered by the constant insurgency.
In the course of this study it was also found that death rates of some towns are as low as one to three deaths per thousand, The
existence of such low rates in towns in Burma is quite abnormal. The
most likely explanation for such low rates is poor reporting rather
than any other reasons. The health and socio-economic conditions of
towns cannot possibly be better than big cities like Rangoon and
Mandalay which have much higher death rates (Union of Burma, 1972-1975,
