Separated by Borders, United by Need: An assessment of reproductive health on the Thailand-Burma border

In conflict-affected eastern Burma CPI's local partners in many cases provide the only access to safe births and emergency obstetric care for moms and babies.

A new report, "Separated by Borders, United by Need," by Ibis Reproductive Health and Global Health Access Program (GHAP) — the health branch of Community Partners International — documents a widespread public health emergency in populations affected by the decades-long conflict in eastern Burma / Myanmar. The consequences include maternal mortality rates that dwarf the rates in Thailand and Burma as a whole, leaving women in eastern Burma with the worst pregnancy outcomes anywhere in Asia.

Ongoing civil war in eastern Burma has decimated reproductive health care on both sides of the Thai-Burma border.  Conflict-related human rights abuses and the absence of health care infrastructure inside eastern Burma — as well as for those Burmese living illegally as migrants in Thailand — has produced a kind of reproductive health “perfect storm.”

The report’s findings demonstrate little access to family planning resources, including sexual and reproductive health information; a pervasive need for increased access to skilled birth attendants; and high rates of unplanned pregnancy, maternal mortality, and harm from unsafe abortion. Unsafe abortion is a leading cause of maternal mortality for Burmese populations on both sides the Thailand-Burma border.

While addressing gaps in reproductive health will require overcoming seemingly impossible regional challenges, the report illustrates how local organizations have made demonstrated headway in improving health outcomes, even while working in the constraints of this setting. One such example is the Mobile Obstetric Maternal Health Workers (MOM) Project, a community-based joint project between GHAP, Johns Hopkins Center for Public Health and Human Rights, The Mae Tao Clinic, the Burma Medical Association and four local ethnic health departments. The MOM Project, which has been replicated in other regions of Burma, uses a three-tiered approach to increase access to essential RH services, and demonstrated a ten-fold increase in access in eastern Burma to key services including trained birth attendents and emergency obstetric care.

“Separated by Borders, United in Need” is based on a multi-methods assessment involving Ibis and GHAP researchers and numerous local community-based organizations serving cross-border and migrant populations, as well as seven of the nine refugee camps along the Thai-Burma border. CPI partners involved in the report include the Mae Tao Clinic, Back Pack Health Worker Team, Karen Women's Association, the Karen Department of Health and Welfare, and the Burma Medical Association.

The work of Ibis Reproductive Health and GHAP on the Thai-Burma aims to reduce harm from unsafe abortion, and to expand knowledge of and access to emergency contraception and long-acting reversible contraceptives, especially among vulnerable populations that include adolescents and post-abortion care patients.

Community Partners International partners with local organizations to lead evidence-based trainings for health care providers and to conduct relevant research that includes interventions to improve health outcomes.