Daughters of the Delta: Linking Women to Health Care, Livelihoods and Leadership

The health of low-income families and communities depends on more than access to health care. We revisit a pioneering project supported by Community Partners International in Myanmar’s Ayeyarwady Delta that seeks to address health needs and empower women to strengthen the underlying social and economic factors that create healthy communities.

“Previously, people had to travel far for treatment and faced high medical and transport costs.”

Ayeyarwady Region in southern Myanmar is a low-lying and predominantly rural region where many livelihoods depend on agriculture and aquaculture. It is the delta for Myanmar’s largest river, the Ayeyarwady, whose vast waters drain through a complex network of waterways that crisscross the region and discharge into the Indian Ocean.

Many communities in the Ayeyarwady Delta are isolated by their geography, often reachable only by boat. Services are usually minimal, and livelihoods precarious. The World Bank’s Myanmar Living Conditions Survey 2017 identified the Ayeyarwady Region as having the highest number of people living below the national poverty line among all of Myanmar’s states and regions.

For more than a decade, Community Partners International (CPI) and the community organization Baythitsadarna have worked together to help remote, low-income communities in the villages in the Ayeyarwady Region’s Mawlamyinegyun Township.

In the first few years, the focus remained on health care: supporting two primary health care clinics and an auxiliary midwife network providing maternal and child health care services to around 12,000 people in 25 villages.

Hti To Lo village is a two-hour boat ride from Mawlamyinegyun. The village sits beside a tributary of the Ayeyarwady River, flanked by miles of agricultural land. The village monastery houses one of the clinics supported by Baythitsadarna and CPI.

“We opened the clinic in 2015,” reveals Sayadaw Ashin Sandima, the clinic founder and head monk of Hti To Lo Monastery. “We open once a week and serve about ten villages in the area,” he continues. “and receive about 50 patients in a day.”

Sayadaw Ashin Sandima was working at a charity eye clinic at Mawlamyinegyun Monastery when he saw the need to help. “There were no professional health services here, so I wanted to provide good health care and improve people’s health knowledge. Previously, people had to travel far for treatment and faced high medical and transport costs.”

“It’s difficult when we work so hard just to survive.”

Khin Mar Kyi, 50, lives with her husband in Hti To Lo village. “My husband is blind and can’t work anymore,” she explains. “There is no regular employment in the village. Sometimes, I work planting or carrying rice. My two daughters are maids in Yangon and Mawlamyinegyun and send 10,000 or 20,000 kyats each month [about $3-6 at the time of writing].”

“I came to the clinic because I carried straw bales all day yesterday and had stomach pain the whole night,” continues Khin Mar Kyi. “I also have hypertension, so I come for treatment when I feel symptoms. The doctor tells me to take care of my hypertension and avoid unhealthy food. But, it’s difficult when we work so hard just to survive.”

“The clinic is just 10 minutes’ walk from my house,” explains Khin Mar Kyi. “It helps our family and others get affordable care. If the clinic closes, I won’t be able to treat my hypertension. Before the clinic opened, we had to go to another village, and it cost 7,000 kyat each time [about $2 at the time of writing]. Or we had to go to Malwamyinegyun hospital. But we couldn’t afford it. That’s why my husband went blind.”

Baythitsadarna supports an auxiliary midwife (AMW) in the 25 villages they serve across Mawlamyinegyun Township. AMWs are community health workers who support the work of midwives who cover several villages.

Tin San Hlaing is the AMW in Hti To Lo Village. She provides essential maternal and child health services to pregnant women, new mothers, and newborns in the village. “I started working as the auxiliary midwife in 2015,” Tin San Hlaing explains. “At first, I wasn’t that confident, but the support from Baythitsardana and CPI helped me develop my skills.”

“I make routine visits to mothers and babies,” Tin San Hlaing continues. “I support pregnant women in receiving vaccinations and health education and encourage them to go for regular check-ups with the midwife. I also identify and refer high-risk pregnancies to the hospital. For normal deliveries, I call the midwife and assist her. For referral cases, I accompany pregnant women to the hospital and help them along the way.”

“I don’t want my children to struggle like I did.”

In 2018, CPI and Baythitsadarna launched a new project, “Better Homes, Better Lives”, to address social factors and poor living conditions that negatively impact the health status of these communities. Through extensive consultation, communities identified a range of priorities that encompassed good health practices, nutrition access and quality, clean water and improved sanitation and hygiene, economic stability, education access and quality, and the physical environment.
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At the community level, the project is shaped and led by women’s unions established in 25 participating villages. These women’s unions comprise more than 1,000 members and advise on community needs, act as peer educators, and lead the implementation of project activities in partnership with CPI and Baythitsadarna. This approach supports women’s leadership in these communities and contributes to project continuity, sustainability, and impact.

Than Win, 56, leads a women’s union in Shwe Bo Su village. “Baythitsadarna came to organize a women’s union in 2018,” she explains. “I liked the idea of developing our village and livelihoods, so I agreed to participate and became the union leader. We are poor and uneducated and grew up in an underdeveloped village. I worked in fishing when I was young. I did various jobs and worked in the mud to support my family. I don’t want my children to struggle like I did.”

“The microloan program takes away the stress of high-interest loans.”

“There are 30 households in our village,” continues Than Win. “We started the union with five members and now have 21. Baythitsadarna provided a 2.2 million kyats seed fund [about $640 at the time of writing] to start the microloan program. We gave microloans to 18 women with low interest rates in the first year. After two years, we repaid the loan and built a bridge across the village creek with the interest. We continue to run the microloan program to improve our lives and the village.”

“All the women’s union members are very active and interested in the microloan process,” confirms Than Win. “It’s very effective. Without it, we’d need to borrow money with high interest and struggle to repay it. The microloan program takes away the stress of high-interest loans. Women can support their families and their children’s education.”

“Baythitsadarna also trained us in organic farming,” continues Than Win. “We used to grow fruits and vegetables using chemical fertilizers. Organic farming gives us food security and health. I am growing chili, beans, radish, bitter gourd, spinach, and bottle gourd on my small farm and can earn income.”

“The people from the next village admire us for our effort and enthusiasm and for building a bridge,”

Shwe Bo Su women’s union member Hla Wine, is a microloan recipient. “I am the only earner in my family,” she explains. “My husband is over 70 and not in good health, so he can’t work anymore. I have a small organic farm and sell the produce.”

“I have taken microloans from the women’s union since the program started,” Hla Wine confirms. “It’s the main investment for my farm’s income. Last year, I used the loan to grow organic bitter gourds, bottle gourds, and eggplants. I earned income for my family and repaid the loan and interest. This year, I borrowed 200,000 kyats [about $58 at the time of writing] to buy foods like dried beans, desserts, and other products to resell. Before the microloan program started, we had to borrow money with high interest rates, so the program is useful and effective.”

“Learning about organic farming has also been very helpful,” continues Hla Wine. “ Now I know how to make organic fertilizer, compost, and grow organically. It is a healthy and cost-effective way to grow vegetables, and they taste better.”

“The people from the next village admire us for our effort and enthusiasm and for building a bridge,” reveals Hla Wine. “They say, ‘The women from Shwe Bo Su are very active and clever!’ We are happy to hear that and grateful to Baythitsadarna for their support.”

Baythitsadarna founder and program manager Nwet Yin Win oversees the organization’s work. She is aware of the importance of their impact, particularly as Myanmar experiences intensifying conflict and a deteriorating economy. “The clinics are a big success,” she confirms. “We provide affordable services for everyone. Many people are struggling with financial hardship now due to the country’s political and economic situation. So, affordable health care and livelihood support are essential.”