Access to community-based reproductive health services and incidence of low birthweight delivery among refugee and displaced mothers: a retrospective study in the Thailand-Myanmar border region

Abstract

ObjectivesOver 2.4 million people have been displaced within the Thailand-Myanmar border region since 1988. The efficacy of community-driven health models within displaced populations is largely unstudied. Here, we examined the relationship between maternal healthcare access and delivery outcomes to evaluate the impact of community-provided health services for marginalised populations.SettingStudy setting was the Thailand-Myanmar border region’s single largest provider of reproductive health services to displaced mothers.ParticipantsAll women who had a delivery (n=34 240) between 2008 and 2019 at the study clinic were included in the performed retrospective analyses.Primary and secondary outcome measuresLow birth weight was measured as the study outcome to understand the relationship between antenatal care access, family planning service utilisation, demographics and healthy deliveries.ResultsFirst trimester (OR=0.86; 95% CI=0.81 to 0.91) and second trimester (OR=0.86; 95% CI=0.83 to 0.90) antenatal care visits emerged as independent protective factors against low birthweight delivery, as did prior utilisation of family planning services (OR=0.82; 95% CI=0.73 to 0.92). Additionally, advanced maternal age (OR=1.36; 95% CI=1.21 to 1.52) and teenage pregnancy (OR=1.27, 95% CI=1.13 to 1.42) were notable risk factors, while maternal gravidity (OR=0.914; 95% CI=0.89 to 0.94) displayed a protective effect against low birth weight.ConclusionAccess to community-delivered maternal health services is strongly associated with positive delivery outcomes among displaced mothers. This study calls for further inquiry into how to best engage migrant and refugee populations in their own reproductive healthcare, in order to develop resilient models of care for a growing displaced population globally.

Maternal socio-demographic, medical and nutritional predictors of low birth weight neonates delivered in a civil unrest setting: A case study of Bosaso general hospital, North Eastern Somalia

“…Teenage mothers, 13 to 19 years old were at higher risk of giving birth to LBW neonates compared to mothers who were 20 years and above. These ndings are similar to previous studies conducted in either con ict-affected settings or non-con ict-affected settings [31][32][33]. The reason why teenage mothers may give birth to LBW babies could be attributed to the increased nutritional demands of teenagers which have to be shared between the growing teenager and her fetus [34].…”

“…In this multi-country study, the prevalence of LBW in Burkina Faso, Ghana, Malawi, Senegal, and Uganda was at 13.4%, 10.2%, 12.1%, 15.7%, and 10%, respectively [29]. However, the 18% prevalence of LBW observed in this present study is near to the 15.8% prevalence of LBW observed in a con ict-affected community with refugee camps and IDP camps at the Thailand-Myanmar border region [30]. The high prevalence of LBW observed in con ict-affected settings could be attributed to inadequate antenatal care and inadequate ANC visits by healthcare workers and pregnant women, respectively.…”

“…The high prevalence of LBW observed in con ict-affected settings could be attributed to inadequate antenatal care and inadequate ANC visits by healthcare workers and pregnant women, respectively. This is because of the insecurity that either makes the former fear traveling to the health care centers to receive the pregnant mothers for ANC services or the latter are afraid of their security while traveling to the health centers to seek ANC services [16,18,30].…”

“…favor changes in placental angiogenesis, limiting the availability of oxygen to the fetus and, consequently causing intrauterine fetal growth retardation and LBW [39]. Besides, Pregnant mothers who reside in IDP camps are likely to have post-traumatic stress disorders [40], and are worried about their security to travel back and forth to health facilities to seek and access LBW preventive ANC services such as IFAS, deworming, and malaria prevention during pregnancy [30].…”

“…Furthermore, the unemployed may also lack the income to support their transportation costs to the health care center to attend and utilize ANC services or are unable to meet ANC costs [30].…”