by Cari Siesttra, Ibis Reproductive Health

and Angel Foster, University of Ottawa & Ibis Reproductive Health

February 14, 2012 – 9:08am

Also see Anna Clark’s article about the lack of contraception access in Eastern Burma.

After decades of conflict and human rights abuses, reproductive health care in eastern Burma is among the worst in the world.  Millions of women still inside Burma as well as those who have fled to neighboring Thailand face a perfect storm of devastating health consequences from lack of access to family planning and safe, legal abortion.

In Burma, abortion is only legal to save the life of a pregnant woman.  And although abortion is legal in Thailand in some circumstances, women from Burma living in Thailand as refugees or migrants are generally unable to access safe abortion care.  As a result, unsafe abortion is a major contributor to maternal mortality and morbidity on both sides of the Thailand-Burma border.

Reproductive health efforts have been undertaken by non-governmental organizations and community-based organizations in this region for decades. However, these efforts are often fragmented and lack coordination.  In addition, few organizations address the issue of unsafe abortion beyond advocating for more family planning. In 2010-2011, a team of researchers from Ibis Reproductive Health and the Global Health Access Program conducted a comprehensive health assessment in order to understand abortion practices, harm to women, and ways to reduce the impact of unsafe abortion in this longstanding conflict setting.

Last week we formally released the report, Separated by borders, united in need. Our findings show a severe lack of access to family planning and considerable harm from unsafe abortion. Lack of health education and information contribute to high rates of unintended pregnancy, particularly among adolescents.  Women have difficulty accessing family planning services and organizations report lack of contraceptive supplies. There is widespread misinformation among health workers about the legal status of abortion and referrals for legal and safe services within Thailand are rare.  A lack of trained providers and restrictions on travel also prevent women from accessing safe, legal treatment.

As the world directs its attention to Burma and the possibilities for political change, it is important that we not forgot women and women’s health. The sixty-year civil conflict in Burma and has had a significant impact on reproductive health. As Burma embarks on its journey toward political reform, donor funds are likely to flood into the country.  We must remember to target some of those resources to women’s health so that women can fully participate in political and economic opportunities to come.

Burmese seek help from illegal clinics

Published: 18/07/2011
TAK : Mae Sot district is struggling to curb a rising problem of illegal and unsafe abortions among migrant workers.

Mo Mo Aung, a Burmese worker in the district, said a friend of hers, an illegal immigrant at a sewing factory, almost died as a consequence of an illegal abortion recently.

Her employer did not allow the woman to visit the doctor even when she suffered bleeding as a result of her abortion.

She had entered Thailand illegally and her employer feared he could be arrested if police heard about it, she said.

Her employer eventually took her to the Mae Tao humanitarian clinic at Mae Sot on the Thai-Burmese border, which is flooded daily with hundreds of Burmese refugees seeking medical attention.

They waited until a Sunday, when the streets of Mae Sot are busy, and authorities find it harder to detect illegal Burmese workers, she said.

Mo Mo Aung said she had known many Burmese women who crossed the border into Thailand because they wanted to end unwanted pregnancies. Some of the women had died as a result of the unsafe abortions.

Aye Aye Min, another Burmese worker in Mae Sot, said Burmese women usually sought advice about illegal abortion clinics from each other.

Ma Ma Aye, 28, a Burmese worker who has set up a group called “Yaung Chi Oo Worker Organisation” said many women end up going to an illegal abortionist because they were not ready to raise families.

Her group provides counselling to Burmese workers who are pregnant but do not want to keep their babies.

Burmese workers also turn to the Ruam Jai community, one of about 20 Burmese communities in Mae Sot, when they want help with unwanted pregnancies.

The community is a cluster of two-storey wooden row houses packed with Burmese tenants.

A number of non-profit organisations work there to help migrant workers.

One non-governmental organisation worker, who asked not to be named, said the cost of an illegal abortion in Mae Sot ranges from 1,000 baht to 4,000 baht, depending on how advanced the pregnancy was.

When complications occur, the women are sent to the Mae Tao clinic run by Dr Cynthia Maung.

Tawisa Amphong, a staff member at Mae Sot Hospital, said the hospital treats about 100,000 Burmese workers and ethnic minorities a year, but only 20,000 have a work permit.

The hospital had to meet expenditure itself of about 50 million baht a year treating this group, as the state did not want to pay medical expenses for illegal workers, said Ms Tawisa. Many women did not want to claim for them anyway, as their identity would be exposed.

The most common diseases found in Burmese patients were malaria, tuberculosis, elephantiasis, and Aids.

About 1000 pregnant Burmese women turned up seeking treatment every year, including those who suffered complications of unsafe abortions.

Patthini Suanprasert, a coordinator with the Mae Tao clinic, said 5,000 Burmese mothers registered for pregnancy care at the clinic every year.

Some returned with complications associated with substandard or illegal abortions such as internal bleeding and womb infections, said Ms Patthani.