Access to essential maternal health interventions and human rights violations among vulnerable communities in eastern burma

Luke C Mullany, Christopher Beyrer, Thomas J. Lee, Catherine Irene En-Lin Lee, Lin Yone, Palae Paw, Eh Kalu Shwe Oo, Cynthia Maung

Research output: Contribution to journalArticle

Abstract

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 insecticide-treated 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.

Original languageEnglish (US)
Pages (from-to)1689-1698
Number of pages10
JournalPLoS Medicine
Volume5
Issue number12
DOIs
StatePublished - Dec 2008

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Myanmar
Prenatal Care
Family Planning Services
Confidence Intervals
Hemoglobins
Maternal Health Services
Insecticide-Treated Bednets
Parturition
Postnatal Care
Health Services Accessibility
Parasitemia
Food Supply
Health Services Needs and Demand
Reproductive Health
Thailand
Plasmodium falciparum
Contraceptive Agents
Anemia
Arm
Iron

ASJC Scopus subject areas

  • Medicine(all)

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Access to essential maternal health interventions and human rights violations among vulnerable communities in eastern burma. / Mullany, Luke C; Beyrer, Christopher; Lee, Thomas J.; Lee, Catherine Irene En-Lin; Yone, Lin; Paw, Palae; Oo, Eh Kalu Shwe; Maung, Cynthia.

In: PLoS Medicine, Vol. 5, No. 12, 12.2008, p. 1689-1698.

Research output: Contribution to journalArticle

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abstract = "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 insecticide-treated 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.",
author = "Mullany, {Luke C} and Christopher Beyrer and Lee, {Thomas J.} and Lee, {Catherine Irene En-Lin} and Lin Yone and Palae Paw and Oo, {Eh Kalu Shwe} and Cynthia Maung",
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AU - Paw, Palae

AU - Oo, Eh Kalu Shwe

AU - Maung, Cynthia

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AB - 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 insecticide-treated 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.

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