Access To Essential Maternal Health Interventions and Human Rights Violations among Vulnerable Communities in Eastern Burma

Abstract

BackgroundHealth indicators are poor and human rights violations are widespread in eastern Burma. Reproductive and maternal health indicators have not been measured in this setting but are necessary as part of an evaluation of a multi-ethnic pilot project exploring strategies to increase access to essential maternal health interventions. The goal of this study is to estimate coverage of maternal health services prior to this project and associations between exposure to human rights violations and access to such services.Methods and FindingsSelected communities in the Shan, Mon, Karen, and Karenni regions of eastern Burma that were accessible to community-based organizations operating from Thailand were surveyed to estimate coverage of reproductive, maternal, and family planning services, and to assess exposure to household-level human rights violations within the pilot-project target population. Two-stage cluster sampling surveys among ever-married women of reproductive age (15–45 y) documented access to essential antenatal care interventions, skilled attendance at birth, postnatal care, and family planning services. Mid-upper arm circumference, hemoglobin by color scale, and Plasmodium falciparum parasitemia by rapid diagnostic dipstick were measured. Exposure to human rights violations in the prior 12 mo was recorded. Between September 2006 and January 2007, 2,914 surveys were conducted. Eighty-eight percent of women reported a home delivery for their last pregnancy (within previous 5 y). Skilled attendance at birth (5.1%), any (39.3%) or ≥ 4 (16.7%) antenatal visits, use of an insecticide-treated bed net (21.6%), and receipt of iron supplements (11.8%) were low. At the time of the survey, more than 60% of women had hemoglobin level estimates ≤ 11.0 g/dl and 7.2% were Pf positive. Unmet need for contraceptives exceeded 60%. Violations of rights were widely reported: 32.1% of Karenni households reported forced labor and 10% of Karen households had been forced to move. Among Karen households, odds of anemia were 1.51 (95% confidence interval [CI] 0.95–2.40) times higher among women reporting forced displacement, and 7.47 (95% CI 2.21–25.3) higher among those exposed to food security violations. The odds of receiving no antenatal care services were 5.94 (95% CI 2.23–15.8) times higher among those forcibly displaced.ConclusionsCoverage of basic maternal health interventions is woefully inadequate in these selected populations and substantially lower than even the national estimates for Burma, among the lowest in the region. Considerable political, financial, and human resources are necessary to improve access to maternal health care in these communities.

Prevalence of Anemia and Its Risk Factors Among Lactating Mothers in Myanmar

“…Anemia is still widespread in Myanmar, and there is also a high risk of maternal mortality. 4 This current survey has supported and extended previous findings by showing that anemia is an important public health problem in lactating women from Myanmar.…”

“…The overall prevalence was 60.3%, which is similar with the reported rate (61.1%) among women of reproductive age (15-45 years old); however, this number is much higher than the 42% prevalence in women living elsewhere in southeast Asia. 4 It is worth noting that the postpartum period is generally the time with the lowest anemia rate 9 ; however, anemia rates in some vulnerable villages were unacceptably high (exceeding 90% in K1). The consequences of anemia in post-partum women include impaired physical work capacity, low work efficiency, fatigue, depressive symptoms, reduced immune function, and other disease.…”

“…3 Although the government and humanitarian organizations made great efforts to promote maternal and children health, the anemia prevalence in Myanmar is still unacceptably high (around 70% in children and 60% in women). [4][5][6] Multiple factors contribute to anemia, including inherited conditions, infectious diseases, micronutrient deficiencies (such as iron, folate, and vitamin B12), and compromised environment factors. 7,8 The post-partum period is conventionally thought to be the time of lowest anemia risk, because iron status is expected to dramatically improve after delivery because of the lower iron requirement with the birth of the infant and reduced blood losses by amenorrhea.…”

‘Because the baby asks for it’: a mixed-methods study on local perceptions toward nutrition during pregnancy among marginalised migrant women along the Myanmar–Thailand border

“…Pregnant women and midwives posited that women would make improved dietary choices, within their social constraints, if they were provided with appropriate information regarding nutrition. However, the reach of clinic-based care during pregnancy is far from comprehensive in this border region, with limitations in clinic-based programming for maternal nutrition [24,54,55]. Awareness-raising at a community level should be considered to reach younger women whose diets may be tied to the choices of older members of the household.…”

Snakes, Ladders, and Information about Sexually Transmitted Infections: Evaluation of a Peer Educator Training on the Thailand-Burma Border

“…Lack of access to comprehensive, medically accurate, and affordable healthcare including family planning services, abortion care, skilled birth attendants, and sexually transmitted infection (STI) prevention and treatment contributes significantly to heightened maternal mortality and morbidity in the Thailand-Burma border region (Back Pack Health Worker Team, 2006;Lee et al, 2006;Mullany et al, 2008). Among the millions who suffer from non-existent or inadequate health services are adolescents who either reside in conflict-affected Eastern Burma (referred to as 'cross border') or in Thailand as refugees or migrants, most of whom are undocumented (Hobstetter et al, 2015;Walsh et al, 2012).…”