is a more reliable method. An actual increase in
the low birthweight prevalence from 7.1% in
2006 to 12.4% in 2009 is unlikely, because there
were no major adverse events to cause such a
rapid change during this short, three-year period.
The Asian economic crisis in 1997- 199821 was
too remote to have had such an impact in those
years. However, the prevalence of low birthweight
in 2009 based on the birth registration
records of 9.6% (range across the 76 provinces
across the country of 8%- 13.2%) compared to
12.4% in the 2009 Reproductive Health Survey
is a major discrepancy, which warrants further
in-depth investigations.
Second, exclusive breastfeeding referred to
infants who received only breastmilk and vitamins,
mineral supplements and medicines during
the last 24 hours. The 2006 survey did not apply a
standard questionnaire as the 2009 survey did.
As a result, the prevalence of 25.1% in 2006
is unreliably high. The figure of 15.5% in the
2009 survey should be more reliable. However,
the 2006 MICS, based on a similar definition to
the one applied in the 2009 Reproductive Health
Survey, reported 5.4% exclusive breastfeeding
among children below 6 months old. There was
therefore progress in the prevalence of exclusive
breastfeeding between 2006 and 2009.
Third, the face-to-face interview used in the
Reproductive Health Survey may limit the accurate
measurement of unmet need for FP services;
it is embarrassing and socially stigmatising to
ask unmarried adolescents about their use of
contraception. A self-administered questionnaire
survey would be a better approach.
Fourth, we used point estimates without statistically
bound uncertainty for calculating the
prevalence and coverage in this study. Finally,
the Reproductive Health Survey only captures
the native Thai population (64 million). The
non-Thai highlanders in the Northern mountainous
areas (approximately 0.5 million) and
migrant workers (approximately 1 million women
migrants) were not enumerated by the survey.
Their reproductive health needs and coverage
are not well captured by this survey.
The use of the household asset index in 2009
as the equity stratifier was a major strength of
this study. The asset index quintiles have been
commonly applied in the equity analysis with
respect to an economic gradient, for example in
an assessment of unwanted births and contraceptive use between rich and poor women in
41 countries.22