February 8, 2017

Reproductive Health

The Reproductive Health team deliver between 3 – 15 babies every day! They also provide comprehensive reproductive health care including family planning, neonatal and post-abortion care, as well as prevention of mother to child transmission of HIV.

 

The Reproductive Health Programme’s goals are to keep mothers strong and give all children a healthy start. The MTC Reproductive Health Department’s inpatient and outpatient sections provide comprehensive women’s services including family planning, gynaecology, normal and complicated labour and delivery, neonatal care, and post-abortion care. Its antenatal care programme offers screening for malaria, HIV, sexually transmitted infections and anaemia.

We now have between 3 – 15 births per day, with the average usually being 7.

Most Common Treatments / Services

Antenatal visits / Postnatal visits /Family planning visits / Delivery / Neonatal care / Post-abortion care / STI treatment

Reproductive Health Stats 2016

Antenatal 10,040 Deliveries 2,522
Family Planning 4,527 Neonatal 589
Post Natal 3,634 Post Abortion Care 355

History

The need for reproductive health services at the clinic was identified in late 1989, when expectant mothers began coming to the clinic to deliver their babies at all hours of the day and night, and to receive care from Dr Cynthia and another medic who now leads the Reproductive Health Outpatient Department. She started out with no medical training, recalls feeling fascinated, sympathetic and scared the first time she watched Dr Cynthia deliver a baby. Since she was the only other woman on the clinic’s small staff, she realised she had to watch and learn, so that she could be of use if a woman went into labour when Dr Cynthia was not available.

Back then, the facilities for expectant mothers were basic and women in labour had to climb a ladder to get to the delivery room, where they gave birth and then recovered as Dr Cynthia and others cleaned up around them.  In 1995, the clinic set up a maternal child health programme with a separate ground-floor delivery room.  It offered a Saturday morning vaccination clinic, family planning, reproductive health care, gynaecological services and antenatal care. Pregnant women went home from their antenatal visit carrying small bundles of chicken eggs – a high iron food to help prevent anaemia. The following year, 156 babies were born at the clinic. As the number of deliveries increased, the clinic added a second delivery room. The current head of the inpatient department recalls that the delivery rooms in those days were narrow, dark and they stank, suffering as they did from their proximity to nearby toilets. In 2001, the clinic built a new, bright and airy building for reproductive health with support from the Women’s Commission for Refugee Women and Children, as part of the Averting Maternal Death and Disability Programme. The clinic added programmes for safe motherhood, sexually transmitted infections and HIV/AIDs, adolescent health care and gender-based violence prevention.

Today, the Reproductive Health Inpatient Department is located in a recently renovated, breezy, light-filled concrete building with a shaded porch where mothers often cuddle swaddled newborns while staff members sit in a circle, assembling safe birth kits and rolling cotton hanks into swabs. The Reproductive Health Department’s inpatient and outpatient sections provide comprehensive women’s services including family planning, gynaecology, normal and complicated labour and delivery, neonatal care, and post-abortion care.  Its antenatal care programme offers screening for malaria, HIV, sexually transmitted infections and anaemia.
 
Training

The Reproductive Health Programme has come a long way since those early days when Dr Cynthia and one other medic were the only ones at the clinic who could deliver babies. Thanks to in-depth obstetric training, medics in the department can now manage prolonged labour, obstetric emergencies, perform vacuum extractions and prevent most post-partum haemorrhages.

The clinic provides in-depth training in obstetrics and obstetric emergencies to medics and midwives; it has also trained hundreds of Back Pack health workers and traditional birth attendants in safe birth techniques and provided them with life-saving birth kits and supplies for use in remote villages and ethnic conflict areas. In the jungle, something as simple as cutting an umbilical cord can be a matter of life and death, and doing so with a traditional sliver of bamboo risks neonatal tetanus, a terrible disease that can be prevented by using a sterilized razor blade instead.
 
Challenges

Maternal mortality rates are over 1,000 per 100,000 live births in the Eastern Burma conflict zones. This compares to 360 in the rest of Burma and 44 per 100,000 live births in Thailand. This demonstrates the huge need for the safe, free services provided by the MTC reproductive health department.

An ongoing challenge is managing pregnant women and mothers with HIV. MTC provides milk powder, but HIV peer counsellors need to explain how to prepare and use the milk powder. This might seem like a simple task, but when the mother’s living environment may be transient, without electricity, clean water, and clean cooking vessels, it becomes a massive challenge. Thanks to the perseverance of the HIV peer counsellors though, there has been measureable success counted with each HIV negative baby born.

Another huge challenge comes in the form of small swaddled bundles – the 10 or so newborns orphaned and abandoned at the clinic every year. Some mothers die in childbirth; other mothers leave their infants because poverty or other circumstances prevent them from providing a good home. In the case of abandoned children, medics care for the infants in the in-patient department for several months in case family members return to claim them. After that, the clinic works with community-based organisations to find safe local homes for these children.

Even though the clinic has expanded its capacity for reproductive health significantly, there is never enough room for all the women that come for the critical services provided. In addition, the need for quality reproductive health care continues to grow as more and more patients come to the clinic for obstetric and gynaecologic care.

Collaboration with Partners

Mae Tao Clinic coordinates care with Mae Sot Hospital for referral of complicated delivery and Preventing Mother to Child transmission of HIV (PMTCT). Back Pack Health Worker Team (BPHWT) works with MTC to improve health service delivery in Eastern Burma through its 80 Back Pack teams. This is done by organising Traditional Birth Attendant (TBA) training and workshops and providing TBA supplies and maternity kits. In Eastern Burma, MTC also works in collaboration with Burma Medical Association (BMA) to provide clinician training and high quality reproductive health care to displaced people and migrant workers from Burma.

MTC works actively on prevention and health education. For example, the Adolescent Reproductive Health Network (ARHN) is a group of nine community-based organisations on the Thai/Burma border. ARHN promotes sexual and reproductive health and rights of young people from Burma aged 12 – 24, many of whom are either living in conflict zones in Burma or as illegal migrants in Thailand.

Adolescent Reproductive Health

 

The Adolescent Reproductive Health Network Team is a community-based group that empowers teenagers to responsibly address adolescent reproductive health issues.

 

During the months of January to June 2011 ARHN team organised four workshops for students from migrant schools and students living at boarding houses. A total of 88 (46 female and 42 male) were trained in adolescent reproductive health issue.

ARHN is also a reflection of the strong collaboration among community-based organisations along the border. The first collaboration began in 2000 with Social Action for Women (SAW), Karen Women’s Organization (KWO) and MTC.  ARHN is now a network of organisations including, but not limited to Karen Women’s Organisation (KWO), Social Action for Women (SAW), Palaung Women’s Organisation, Karen Youth Organisation (KYO), Burmese Women’s Union, and NLD Women.

Usually the health organisations develop maternal and child services which are clinic based.   Unfortunately, this approach doesn’t integrate with youth, men or other members of society.  Therefore, the ARHN has developed effective outreach to all parts of society.   Cultural and reproductive rights information is provided to a broad population base in a culturally appropriate manner.  In the past, accessing reproductive information for young people was, at best stigmatised or at worst, not possible.  By working both within the schools and outside schools, the outreach is available for students and non-students alike. This approach provides the opportunity to discuss gender equity, youth participation, peer support networks, self-esteem, and raising awareness on issues such as unsafe abortion.

The ARHN conducted a survey of adolescents in migrant, internally displaced and refugee populations.[1]  They developed training curriculum together and conduct trainings with adolescents in these target populations. Topics include gender based violence, sexually transmitted infections, family planning, and leadership skills.


[1] “Protecting our Future:  A report on adolescents’ knowledge, attitudes, and practices related to reproductive health & rights on the Thai/Burma Border”  Released June 16, 2009.