Building capacity for maternal health services in Karen refugee camps along the Thailand-Burma border: The role of Traditional Birth Attendants

In one of the most protracted refugee settings in the world, displaced Burmese populations have found shelter along the Thailand/Burma border for several decades. Nearly 200,000 refugees, of which over 60% are ethnic Karen, reside in camps along the border. Although refugee women have access to health services through local and international NGOs, there exist gaps in utilization and providers have found that requiring an institutional delivery alone is ineffective. While Karen women have relied on Traditional Birth Attendants (TBAs) prior to being displaced, the role of TBAs in the camp health system remains ambiguous. Moreover, recent resettlement initiatives to the U.S and Europe have complicated the Burmese diaspora, precipitating the need for a prompt, effective replacement of health workers in such emergency settings.

In order to implement a systematic training program for TBAs, this project used a community-based, mixed methods approach to conduct formative research and examine data from: 1) six focus group discussions (n=60) with TBAs 2) key-informant interviews with community leaders and health staff 3) existing studies on Karen women's choice of delivery sites, and 4) quantitative surveys with women of reproductive age using stratified random sampling (n=310).

Results indicate the need for a TBA training curriculum emphasizing discussions, repetition, and practice specific to illiterate subpopulations. The data informed a coordinated response to implementing a training program for TBAs, increasing their capacity to link women with the full scope of available services. The program also established a clear referral system and trained TBAs to provide Basic Emergency Obstetric Care. These findings have implications for participatory models of maternal health provision concordant with existing structures of care inherent to the displaced population.