Description:
Background:
Health 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 Findings:
Selected 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 insecticidetreated
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...
Conclusions:
Coverage 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.
Source/publisher:
PLoS Medicine, December 2008 | Volume 5 | Issue 12 | e242
Date of Publication:
2008-12-00
Date of entry:
2009-02-03
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- Individual Documents
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Language:
English
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