Ja Htoi Lu was pregnant with her second child. She felt fine, and didn’t see much point in taking the time out from her chores to go for antenatal visits. In 2011, she had fled her home when armed conflict in Myanmar’s Kachin State reached her village. She had been through the trauma of escaping the terrors of war, and the hardship of living seven long years in a camp for internally displaced people. Compared to this, an apparently healthy pregnancy didn’t seem like much to worry about.
What Ja Htoi didn’t know, was that she was having a high-risk pregnancy, and that her life was at stake.
In Myanmar, only 59 per cent of pregnant women complete the four antenatal visits recommended by the World Health Organization. In rural areas, one in six women receive no antenatal care at all. This is partly due to lack of access to health services. But an important compounding factor is that many expectant mothers do not realize the importance of antenatal visits to their health. As a consequence, complications are not identified until it is too late. In Myanmar, over 2,800 women die each year from preventable causes related to pregnancy, childbirth and care in the early weeks after birth. The country’s maternal morality ratio of 282 is the second-highest in ASEAN.
Integrating care and outreach
Based on both experience and data, UNFPA and its partners know that it is not enough to make medical services available to pregnant women. To genuinely combat maternal death and to help pregnant women plan for a safe birth, the medical teams must also make outreach, information and incentives an integrated part of their work.
Ja Htoi might never have gone to her first antenatal visit had it not been for the efforts to reach women like her. One of their strategies is to give each pregnant woman who sees the doctor ten baby blankets. When Ja Htoi heard about this, she reconsidered. Ten squeaky clean blankets for her baby. She liked the idea. The next time the mobile clinic arrived, she decided to go.
The doctor immediately diagnosed her with high blood pressure, also called hypertension. Hypertension in pregnancy has few immediate symptoms and tends to go unnoticed by mothers. But it can lead to a dangerous condition called pre-eclampsia with a risk of serious complications, including permanent disability or death for both the mother and baby.
“The doctor treated me with respect”
Thanks to the timely diagnosis, these risk dropped for Ja Htoi and her unborn baby. The doctor gave her the drugs she needed and explained to her the importance of monitoring the condition closely. After that, Ja Htoi went for antenatal visits every time the clinic came to her camp. She stayed healthy throughout her pregnancy. Thanks to the information she received, she could, for the first time in her life, make an informed decision about her health and about how to deliver her baby safely.
“I gave birth to my first baby in the camp, and I had planned to do the same with my second”, says Ja Htoi, now 25. “But the doctor advised me that it would be much safer for me to deliver in the hospital this time. He really didn’t have to do much convincing. I trusted the doctor and the nurse from the first moment. They treated me with respect and they listened to me. Being a displaced person, I hadn’t expected that.”
Mobile teams give 50,000 people access to care
UNFPA funds two mobile clinic teams in Kachin. Over time, UNFPA has built the capacity of the teams to provide quality sexual and reproductive health and rights services that focuses on the needs of each individual. Operated by the Myanmar Medical Association, the clinic teams regularly visit 50 camps and 17 villages. They ensure access to sexual and reproductive health services, including antenatal and postnatal care, for over 50,000 people. Most of these live in protracted displacement from armed conflict, but the mobile clinics also serve host communities who are absorbing the shockwaves of conflict and displacement.
Ja Htoi is one of nearly a quarter million people who have been displaced by several different conflicts in Myanmar. She lives in the Pa La Na (Padauk Myaing) camp on the outskirts of the Kachin State’s capital Myitkyina. She shares in a single room in a long house with ten family members and relatives. There’s no running water. Toilets and areas for personal hygiene, washing and cooking are a considerable distance away, in the centre of the camp, and are shared by camp residents.
Reaching women, deep into the camps
For families that have so little, the blankets make a real difference to newborn and maternal hygiene and health in the crucial first weeks after birth. The white colour of the blankets also helps clinic staff identify jaundice in newborns, something that can be difficult to spot when babies are wrapped in worn-out longyis, and rooms are poorly lit. But more importantly, the small incentive motivates clinic visits by mothers who do not realize that they are at risk.
The baby blanket is just one of the many different ways that the mobile clinic manages to reach pregnant and vulnerable displaced women. UNFPA also provides training and funding for community health volunteers that are able to reach deep into the camps.
After keeping her condition in check with the right medicines and regular antenatal visit, the planned hospital delivery was without complications. Ja Htoi has been going to the mobile clinic for post-natal check-ups. She is now healthy again. So is her 3-month old baby, who she can’t stop hugging and cuddling. As she sits on the doorstep of the long house she says:
“Imagine that it was the gift of baby blankets that kept us both healthy. Without that incentive, I would not have gone to the clinic in the first place. But once I saw the doctor and the nurses, I realized that they were there to make sure I stay healthy, and to help me plan for a safe birth.”
UNFPA supports 8 Mobile clinics in Myanmar’s conflict affected areas of Kachin, Kayin, Rakhine and Shan. They are funded through UNFPA’s Women and Girls First Programme with support from Australia, Finland, Italy and Sweden, and the Myanmar Humanitarian Fund and are operated by Marie Stopes International, Myanmar Medical Association, and Relief International. In 2018, over 45,000 people received care from these clinics.
