Maternal Health Problems in Burma Widespread

The maternal health care issues facing women in eastern Burma (also known as Myanmar) are widespread and underreported, according to surveys by researchers at the Johns Hopkins Bloomberg School of Public Health. The researchers report that more than 88 percent of women had a home delivery during their last pregnancy and displaced women were more than 5 time as likely to receive no antenatal care. Human rights violations, like displacement and forced labor, were are also widespread and found to affect access to maternal health care. The findings are published in the December 2008 issue of PLoS Medicine.

“Health indicators are poor and human rights violations are widespread in eastern Burma,” said Luke Mullany, PhD, MHS, lead author of the study and assistant professor with the Bloomberg School’s Department of International Health. “In conflict-affected regions of Burma, research indicates that infant and child mortality rates are higher than other areas due to widespread exposure to gross human rights violations.”

According to the study, among the women surveyed, 60 percent expressed an unmet need for modern contraceptives and nearly 95 percent gave birth without the assistance of a skilled attendant or someone with labor and delivery training. Many of these women displayed signs of poor nutrition and very few received vital iron supplements or utilized insecticide-treated bed nets. In addition, more than half of the women were diagnosed as anemic and more than 7 percent tested positive for the malaria parasite.

For the study, the researchers conducted two-stage cluster sampling surveys among reproductive-aged women (15 to 45). The surveys were conducted between September 2006 and January 2007 in the Shan, Mon, Karen, and Karenni communities in eastern Burma. Mullany, along with colleagues, documented access to antenatal care, skilled attendants at birth, postnatal care, family planning services and recent exposure to human rights violations such as displacement and forced labor. With the assistance of trained survey workers who spoke the local language and were known in the community, researchers explored strategies to increase access to maternal health interventions and examined the estimated coverage of maternal health services prior to the Mobile Obstetric Maternal Health Workers (MOM) Project, a program designed to assist in providing maternal health care in eastern Burma.

“The indicators and coverage estimates provided here are strikingly worse than the already low national estimates for Burma that have been provided by various institutional reports,” said Chris Beyrer, MD, MPH, senior author of the study and professor with the Bloomberg School’s Department of Epidemiology. “Increased access to antenatal, labor delivery and newborn care services in eastern Burma is essential to improve the overall health status of these vulnerable populations. In addition, considerable political, financial and human resources are necessary to improve access to care. There needs to be emphasis on maternal and more comprehensively, reproductive health services in health programs targeting these communities.”

“Access to Essential Maternal Health Interventions and Human Rights Violations among Vulnerable Communities in Eastern Burma” was written by Luke C. Mullany, Catherine I. Lee, Lin Yone, Palae Paw, Eh Kalu Swe Oo, Cynthia Maung, Thomas J. Lee and Chris Beyrer.

The researchers were funded by grants from the Bill and Melinda Gates Institute for Population and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health and the Foundation for the People of Burma.