Safe Motherhood in Eastern Burma: The MOM Project

Background: Access to essential maternal and reproductive health care is poor throughout Burma, but is particularly lacking among internally displaced communities in the eastern border conflict regions. Innovative strategies for accessing vulnerable populations and delivering basic public health interventions are urgently needed.

Methods: Four ethnic health organizations from the Shan, Mon, Karen, and Karenni regions collaborated between 2005 and 2008 to examine the feasibility of an innovative three-tiered network of community-based providers for promotion of maternal health interventions in unstable settings of eastern Burma. Two-stage cluster sampling surveys among ever-married women of reproductive age (15-45 yrs) conducted before and after program implementation enable evaluation of changes in coverage of essential antenatal care interventions, skilled attendance at birth, postnatal care, and family planning service.

Among 2,889 and 2,442 women of reproductive age in 2006 and 2008, respectively, population characteristics (age, marital status, ethnic distribution, literacy) were similar. Compared to baseline, women whose most recent pregnancy occurred during the implementation period were substantially more likely to receive antenatal care and focused interventions such as urine testing, malaria screening, and deworming. Postnatal care visits within 7 days doubled. Attendance at birth by those trained to deliver elements of emergency obstetric care increased almost ten-fold.

Conclusions: Community-based providers substantially improved coverage of maternal health interventions in eastern Burma. The MOM Project's focus on task-shifting, capacity building, and empowerment at the community level may serve as a model approach for similarly constrained settings.