Safe Births in Unsafe Places: Supporting Pregnant Women and Newborns in Myanmar’s Conflict Zones

Despite conflict forcing half of their clinics to relocate and restricting their ability to travel, the Thaundaunggyi Women’s Group is adapting to provide women in eastern Myanmar with essential sexual and reproductive health services. But conflict and deep poverty are taking a profound toll on the families they serve.

“The main challenge is reaching communities.”

With support from Community Partners International (CPI), the Thandaunggyi Women’s Group (TWG) operates four sexual and reproductive health (SRH) clinics in Karen State and Bago Region, eastern Myanmar. The clinics and their outreach teams offer vital services, including pre and postnatal care, home delivery, emergency obstetric care, family planning, and reproductive health education to more than 100,000 people in nearly 100 villages scattered across rural hill tracts and plains.

Serving these remote, rural communities is challenging due to the rugged terrain and poor road infrastructure. However, the escalation of armed conflict in TWG’s project areas is compounding the challenges they face: displacing the communities they serve, forcing their clinics to relocate, and making it difficult for community health workers to reach people in need.

“We stopped services at our Htoe Lwee Wah and 13 Mile Village clinics since August 2023,” confirms Rallis, an SRH Project Officer working with TWG in Taungoo Township, Bago Region. “We relocated both clinics but can only offer services part-time due to safety and security.”

“The main challenge is reaching communities,” Rallis continues. “There are many checkpoints. We always ask the community about the situation before we visit, and based on that information, we make decisions. If our staff can’t reach the village safely, we plan a meeting in a safe and convenient place for the staff and villagers.”

“We supported two home births in one evening amid the fighting.”

​April works as a Health Promoter at TWG’s SRH clinic in 13 Mile Village, Thandaunggyi Township, Karen State. “The hospital here has been closed since the coup in 2021,” she reveals, “so people depend on us for health care. However, our clinic had to relocate due to the fighting in 13 Mile Village. Many displaced people need care in our new location, but we can only open two days a week. We also conduct appointments by phone. In the first few weeks after we relocated, it was tough to contact patients because the mobile phone network was unstable, and some people were displaced. But now they know how to reach us.”

April and her colleagues help women give birth safely. “We have a delivery room at the clinic, but most women choose to give birth at home,” she explains. “If they go into labor, they inform us, and we try to reach them as soon as possible, but it’s challenging,” she asserts. “Some live very far away from the clinic. We can’t visit them until the following day if they deliver at night. Sometimes, they call us while fighting is going on, and we must try to reach them.”

April remembers one tricky situation. “A woman called us one afternoon to help her give birth at home,” she recalls. “Fighting had broken out in her area, but we managed to reach her in the evening and helped her give birth. Shortly after, we received a call from a woman in labor in another village. Despite the fighting, we reached her, too. So we supported two home births in one evening amid the fighting. The next morning, we conducted check-ups with pregnant women at the 13 Mile Village clinic. The fighting became so intense that we had to abandon the clinic and flee to a displacement area.”
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When circumstances allow, April and her colleagues provide a comprehensive package of services to pregnant women. “When a pregnant woman reaches our clinic,” she explains, “we provide prenatal care and supplements for the pregnancy period. We offer women at least one ultrasound before they give birth and, based on the results, advise them where to give birth. We encourage them to visit the hospital for clinical care during pregnancy and birth. We also provide clean delivery kits. For emergency referrals, we provide support for transport and medicines. After they give birth, we provide postnatal care, including nutrition support, family planning, and vaccinations.”

“I’m so grateful to the clinic staff for referring me to the hospital. They saved me and my daughter’s life.”

Many of the women and families TWG serves live in precarious poverty. Htay, 36, lives with her husband and three daughters on the east bank of the Sittaung River in Taungoo Township, Bago Region. “Our income is not stable,” she explains. “My husband can only occasionally find daily work as a vehicle assistant on a tipper truck. He used to be a trishaw rider, but nobody uses them nowadays, and we can’t afford a motorcycle. So, we rely on my 16-year-old daughter. She earns about 4,000 kyats ($1.2 at the time of writing) per day as a snack vendor in the market.”

Sixteen years after giving birth to her second child, Htay unexpectedly got pregnant. She came to TWG’s clinic in Taungoo, Bago Region. “I didn’t plan to have another child because of the financial burden,” she reveals. “I came to the clinic on the recommendation of the midwife in our neighborhood and attended all my appointments. Everything was free, and they gave me supplements during pregnancy. If not for this clinic, I would have had to pay a lot of money at a private clinic.”

One evening, when Htay was seven months pregnant, she began to feel pain in her abdomen. “I felt pain the whole night,” she reveals. “In the morning, my elder sister visited and informed the clinic staff about my condition. They came to my house, examined me, and told me that I needed to go to the hospital urgently. I was in such pain that I didn’t know what was going on, but I went to the hospital with the clinic staff.”

“When I arrived at the hospital, I immediately went into surgery,” Htay continues. “They delivered my baby daughter and also had to remove my uterus. The hospital staff told me that if I’d arrived one hour later, my daughter and I might not have survived. I’m so grateful to the clinic staff for referring me to the hospital. They saved me and my daughter’s life.”

Now, both mother and daughter are doing well. However, despite the positive outcome, the hospital visit left Htay’s family saddled with debt they could not afford. “I stayed about sixteen days in the hospital,” she explains. “My baby daughter was premature, so we had to take extra care. I had to borrow money to cover the medical expenses. After I got home, TWG provided me with cash support that helped ease our burden.”

However, Myanmar’s deteriorating economic situation is increasing the pressure on Htay’s family and many others. “Prices are rising,” she confirms. “We struggle to eat and clothe ourselves on my daughter’s income. It’s not enough. Sometimes, I have to borrow rice from my sister so that we can eat. We eat frugally – cheap food. Life is more difficult than before.”