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Community-based delivery of maternal care in conflict-affected areas of eastern Burma: Perspectives from lay maternal health workers

Author

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  • Teela, Katherine C.
  • Mullany, Luke C.
  • Lee, Catherine I.
  • Poh, Eh
  • Paw, Palae
  • Masenior, Nicole
  • Maung, Cynthia
  • Beyrer, Chris
  • Lee, Thomas J.

Abstract

In settings where active conflict, resource scarcity, and logistical constraints prevail, provision of maternal health services within health centers and hospitals is unfeasible and alternative community-based strategies are needed. In eastern Burma, such conditions necessitated implementation of the "Mobile Obstetric Maternal Health Worker" (MOM) project, which has employed a community-based approach to increase access to essential maternal health services including emergency obstetric care. Lay Maternal Health Workers (MHWs) are central to the MOM service delivery model and, because they are accessible to both the communities inside Burma and to outside project managers, they serve as key informants for the project. Their insights can facilitate program and policy efforts to overcome critical delays and insufficient management of maternal complications linked to maternal mortality. Focus group discussions (n = 9), in-depth interviews (n = 18), and detailed case studies (n = 14) were collected from MHWs during centralized project management meetings in February and October of 2007. Five case studies are presented to characterize and interpret the realities of reproductive health work in a conflict-affected setting. Findings highlight the process of building supportive networks and staff ownership of the MOM project, accessing and gaining community trust and participation to achieve timely delivery of care, and overcoming challenges to manage and appropriately deliver essential health services. They suggest that some emergency obstetric care services that are conventionally delivered only within healthcare settings might be feasible in community or home-based settings when alternatives are not available. This paper provides an opportunity to hear directly from community-based workers in a conflict setting, perspectives seldom documented in the scientific literature. A rights-based approach to service delivery and its suitability in settings where human rights violations are widespread is highlighted.

Suggested Citation

  • Teela, Katherine C. & Mullany, Luke C. & Lee, Catherine I. & Poh, Eh & Paw, Palae & Masenior, Nicole & Maung, Cynthia & Beyrer, Chris & Lee, Thomas J., 2009. "Community-based delivery of maternal care in conflict-affected areas of eastern Burma: Perspectives from lay maternal health workers," Social Science & Medicine, Elsevier, vol. 68(7), pages 1332-1340, April.
    • Handle: RePEc:eee:socmed:v:68:y:2009:i:7:p:1332-1340
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    References listed on IDEAS

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    Cited by:

    1. Footer, Katherine H.A. & Meyer, Sarah & Sherman, Susan G. & Rubenstein, Leonard, 2014. "On the frontline of eastern Burma's chronic conflict – Listening to the voices of local health workers," Social Science & Medicine, Elsevier, vol. 120(C), pages 378-386.
    2. Hosler, Jennifer J.F. & Abrams, Jasmine A. & Godsay, Surbhi, 2018. "Combining task shifting and community-based care to improve maternal health: Practical approaches and patient perceptions," Social Science & Medicine, Elsevier, vol. 216(C), pages 26-32.
    3. Grundy, John & Annear, Peter & Ahmed, Shakil & Biggs, Beverley-Ann, 2014. "Adapting to social and political transitions – The influence of history on health policy formation in the Republic of the Union of Myanmar (Burma)," Social Science & Medicine, Elsevier, vol. 107(C), pages 179-188.
    4. Anne Schuster & Sabu S. Padmadas & Andrew Hinde, 2019. "The geography of changing fertility in Myanmar," Demographic Research, Max Planck Institute for Demographic Research, Rostock, Germany, vol. 41(2), pages 37-52.

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