267448 Separated by borders, united in need: Emergency contraception access on the Thailand-Burma border

Monday, October 29, 2012 : 3:15 PM - 3:30 PM

Angel M. Foster, DPhil, MD, AM , Faculty of Health Sciences, University of Ottawa & Ibis Reproductive Health, Cambridge, MA
Margaret Hobstetter, JD, MPH , Ibis Reproductive Health, Cambridge, MA
Meredith Walsh, MPH, RN , Graduate Entry Pathway, UMass Graduate School of Nursing, Worcester, MA
Jennifer Leigh, MPH , Field Director, Global Health Access Program, San Francisco, CA
Catherine Lee, MPH , Community Partners International, Global Health Access Program, San Francisco, CA
Cari Sietstra, JD , Ibis Reproductive Health, Cambridge, MA
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.

Learning Areas:
Conduct evaluation related to programs, research, and other areas of practice
Implementation of health education strategies, interventions and programs
Public health or related research

Learning Objectives:
1) Describe challenges to expanding access to contraceptive services on the Thailand-Burma border 2) Identify avenues for improving service delivery of emergency contraception in this longstanding conflict area

Keywords: Contraception, Access and Services

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the principal investigator or co-principal investigator of multiple studies in conflict and refugee settings. I was the senior investigator on this study and have been involved with all phases of the project, including design, implementation, analysis, and dissemination.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.