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Reproductive Health Departments: Inpatient and Outpatient Department
The Reproductive Health team delivers around 6 babies every day. They also provide comprehensive reproductive health services including family planning, neonatal and post-abortion care, as well as prevention of mother to child transmission of HIV (PMTCT)
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, anaemia, blood group typing, HIV and syphilis. We safely deliver about 6 babies per day.
History
The need for reproductive health services at the clinic was identified after the establishment of Mae Tao Clinic in 1989, when expectant mothers began coming to the clinic to deliver their babies at all hours of the day and night.
In 1995, the clinic set up a maternal and child health programme with a separate delivery room. It offered tetanus vaccination, family planning, gynaecological services and antenatal care. The following year, 156 babies were born at the clinic. As the number of deliveries increased annually, the clinic added a second delivery room. In 2001, 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 the new Mae Tao Clinic compound, having 52 beds that are enough to accommodate all patients. The Reproductive Health Department’s inpatient and outpatient sections provide comprehensive women’s services.
Collaboration with Partners
Mae Tao Clinic refers patients in need of advanced emergency obstetric care to Mae Sot Hospital, women in need of PMTCT are referred to Mae Sot hospital or Myawaddy hospital.
Mae Tao Clinic is a key partner in the Ethnic Health Systems Strengthening Eastern Burma network, a network that aims to ensure access to maternal and child health services in ethnic areas of Eastern Burma. This is done by providing Traditional Birth Attendant (TBA) training, Maternal and Child Health (MCH) training and workshops, and providing TBAs with safe delivery kits. Health staff from our partner organisations are trained at MTC and deployed to clinics in remote areas to provide high quality reproductive health care to their respective communities.
Challenges
Maternal mortality rates are as high as 721 per 100,000 live births in conflict zones of Eastern Burma (EBRMS, 2013). This compares to a rate of 282 in the rest of Burma, which is the second highest in ASEAN in 2016. This demonstrates the huge need for the safe, free services provided our reproductive health department.
An ongoing challenge is managing pregnant women and mothers with HIV. We provide HIV screening during the first visit of antenatal care (ANC) and every pregnant woman who comes for delivery but did not attend ANC. The prevention of mother to child transmission of HIV (PMTCT) is a comprehensive programme, which includes ARV treatment, prophylaxis against infections, free laboratory investigations, delivery in a safe environment, milk formula and follow-up after birth. MTC referred more patients to Myanmar’s government programme to ensure continuity of ARV after delivery. For early diagnosis of whether PMTCT babies are HIV-positive, we register the babies in the Thai government hospital where they can get regular PCR tests. Of 8 babies tested in 2018, only 1 turned out to be HIV-positive.
Another huge challenge comes in the form of small swaddled bundles – some newborns orphaned and abandoned at the clinic every year, although not many. 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 for several months in case family members return to claim them. Meanwhile, the clinic works with community-based organisations to find safe local homes for these children.
Reproductive Health Outpatient Department (RHOPD)
Our reproductive health team provides care to women of reproductive age through multiple services:
- Antenatal care – WHO recommends eight antenatal visits with health providers throughout pregnancy. Women are assessed following our regularly reviewed protocol. Pregnant women receive counselling, pre-natal laboratory screening (blood group, haemoglobin, malaria, HIV, VDRL, urine), ultrasound investigation, immunisation, prophylactic antihelminth treatment and dietary supplements (iron, folic acid and vitamin B).
- Family Planning – Mae Tao Clinic offers emergency, short, and long acting reversible contraception family planning options. Most women prefer injections, which require a visit to the clinic every three months. However, our reproductive health team is advocating for increased use of LARC (long acting reversible contraception), such as implants or intrauterine devices (IUDs). MTC’s target is to provide LARC to 10% of our family planning clients.
- Delivery – Our commitment to specialized training for our midwives, enhanced clinical supervision, and improved infection control allows us to provide women access to a safe delivery. Our referrals are regularly reviewed and their outcomes are closely monitored.
- Neonatal – Managing premature and low birth weight babies continues to be a challenge due to our limited resources. We hope that through improved staff training and the education of parents on monitoring newborns we will be able to achieve better outcomes.
Challenges
According to our annual client survey, many women indicated they find it hard to regularly attend antenatal care services. This is mainly due to the distance between their residence and the clinic, i.e. transportation cost and risks of traveling without documentation in Thailand.
Over the years, our funding has been decreasing and we had to assess and scale down some of our existing programmes. Although we closely work together with our partner organisations to provide our clients with quality health service, we cannot fully cover costs of maternal and child health care.
Staff
9 medics including 1 in-charge and 2 supervisor are providing reproductive health services at our RH-OPD.
(Last update: 21 August 2019)
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