Addressing barriers to adoption of iuds among post-abortion clients on the Thailand-burma border

The sixty-year civil conflict, continued human rights violations, and lack of development in Burma have led to the displacement of more than 1.5 million people from Burma into Thailand. In 1989 the Mae Tao Clinic (MTC) was founded by Dr. Cynthia Maung to address the health needs of these especially vulnerable populations. As women from Burma on the Thailand-Burma border face structural, physical, service delivery, and logistical barriers that impede consistent access to hormonal contraceptives, increased utilization of intrauterine devices (IUDs), a highly effective long-acting reversible contraceptive (LARC), has the potential to make a significant contribution to improving reproductive health.

This pilot project aimed to identify and address the service delivery barriers to IUD use and seed a larger initiative to increase access to LARCs along the border.

The study team comprised of international and local researchers conducted 24 key informant interviews with health workers in the reproductive health departments and 24 in-depth interviews with post-abortion (PAC) clients upon discharge from the clinic.

Results indicated a lack of health worker knowledge and experience, and a range of misconceptions and attitudes about IUDs. The majority of PAC clients were not offered an IUD during contraceptive counseling. Data analysis informed the development of a clinic-based intervention to train 20 health workers from the reproductive health departments in IUD counseling, insertion, and removal.

Measurable outcomes include an exponential increase in IUD insertions and a dedicated space for the provision of LARCs at MTC. Future areas of research include expanding border-wide access to IUDs.