Separated by borders, united in need: Emergency contraception access on the Thailand-Burma border

Introduction: The sixty-year civil conflict in Burma and the consequent population dislocation, disruption of services, and shortage of health service personnel have significantly impacted reproductive health. Women on both sides of the Thailand-Burma border are at increased risk of sexual violence, unintended pregnancy, and maternal death. In 2010-2011, we undertook a multi-methods reproductive health assessment to identify unmet needs of cross border populations, refugees, and migrants. Methods: Our assessment included: 1) A review of documents and institutional statistics related to reproductive health projects, services, and outcomes; 2) Key informant interviews with representatives from 28 organizations working on both sides of the border; 3) A service mapping exercise; and 4) Eighteen focus group discussions with 87 migrant adolescents, 60 migrant adults, and 30 healthcare workers. We used standard qualitative analytic techniques. Results: Structural barriers and the lack of evidence-based reproductive health protocols, education, and information restrict access to the limited family planning resources available along the border. This dynamic contributes to high rates of unintended pregnancy, particularly among adolescents. Misinformation among health workers about emergency contraception (EC) is widespread and organizational policies are often non-evidenced based. Discussion: EC has long been considered a core component of reproductive health service delivery in conflict, crisis, refugee, and emergency settings. However, EC access along the Thailand-Burma border is spotty. Avenues for expanding EC access include integrating evidence-based practices into community-based efforts, expanding training opportunities for health workers, and improving communication and coordination among organizations serving populations on both sides of the border.