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Access To Essential Maternal Health Interventions and Human Rights Violations among Vulnerable Communities in Eastern Burma

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...

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Autores principales: Mullany, Luke C, Lee, Catherine I, Yone, Lin, Paw, Palae, Oo, Eh Kalu Shwe, Maung, Cynthia, Lee, Thomas J, Beyrer, Chris
Formato: Texto
Lenguaje:English
Publicado: Public Library of Science 2008
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2605890/
https://www.ncbi.nlm.nih.gov/pubmed/19108601
http://dx.doi.org/10.1371/journal.pmed.0050242
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author Mullany, Luke C
Lee, Catherine I
Yone, Lin
Paw, Palae
Oo, Eh Kalu Shwe
Maung, Cynthia
Lee, Thomas J
Beyrer, Chris
author_facet Mullany, Luke C
Lee, Catherine I
Yone, Lin
Paw, Palae
Oo, Eh Kalu Shwe
Maung, Cynthia
Lee, Thomas J
Beyrer, Chris
author_sort Mullany, Luke C
collection PubMed
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 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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spelling pubmed-26058902008-12-22 Access To Essential Maternal Health Interventions and Human Rights Violations among Vulnerable Communities in Eastern Burma Mullany, Luke C Lee, Catherine I Yone, Lin Paw, Palae Oo, Eh Kalu Shwe Maung, Cynthia Lee, Thomas J Beyrer, Chris PLoS Med Research Article 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. Public Library of Science 2008-12 2008-12-23 /pmc/articles/PMC2605890/ /pubmed/19108601 http://dx.doi.org/10.1371/journal.pmed.0050242 Text en : © 2008 Mullany et al. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Mullany, Luke C
Lee, Catherine I
Yone, Lin
Paw, Palae
Oo, Eh Kalu Shwe
Maung, Cynthia
Lee, Thomas J
Beyrer, Chris
Access To Essential Maternal Health Interventions and Human Rights Violations among Vulnerable Communities in Eastern Burma
title Access To Essential Maternal Health Interventions and Human Rights Violations among Vulnerable Communities in Eastern Burma
title_full Access To Essential Maternal Health Interventions and Human Rights Violations among Vulnerable Communities in Eastern Burma
title_fullStr Access To Essential Maternal Health Interventions and Human Rights Violations among Vulnerable Communities in Eastern Burma
title_full_unstemmed Access To Essential Maternal Health Interventions and Human Rights Violations among Vulnerable Communities in Eastern Burma
title_short Access To Essential Maternal Health Interventions and Human Rights Violations among Vulnerable Communities in Eastern Burma
title_sort access to essential maternal health interventions and human rights violations among vulnerable communities in eastern burma
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2605890/
https://www.ncbi.nlm.nih.gov/pubmed/19108601
http://dx.doi.org/10.1371/journal.pmed.0050242
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