UCI-led study shows link between a woman’s residence and pregnancy outcomes along the Thailand-Myanmar border

Daniel Parker, PhD

Clinics on the Thailand-Myanmar border serve large populations of refugee and migrant women, who struggle to access the prenatal care needed to support a healthy pregnancy

Public health researchers from the University of California, Irvine, led a study that showed clinics in the Thailand-Myanmar border region see low rates of post-partum follow-up care – approximately 17.4% – among the women they serve.

The findings are published in the journal BMC Pregnancy and Childbirth.

Previous studies have shown that the distance a patient must travel to healthcare facilities determines whether they seek care, how quickly they visit the facility and how often they return. This barrier affects many women seeking reproductive care, especially in active- and post-conflict regions like the Thailand-Myanmar border.

Prenatal care and skilled childbirth services are critical interventions to support maternal health and lower the risk of complications during pregnancy. For years, pregnant patients arriving at clinics along the Thailand-Myanmar border, oftentimes suffering severe complications in their pregnancy, reported having to travel long distances by foot to reach the clinic. Since this country has not had censuses or geographic surveys since World War II, accurate geographic data of these women is lacking for eastern Myanmar.

To help fill this reporting gap, Daniel Parker, PhD, corresponding author and assistant professor of population health and disease prevention at the UCI Program in Public Health, co-led a team of local villagers and community-based organizations to map out the location of home villages of patients and the distance to prenatal clinics on the Thailand-Myanmar border.

Using a geographic information system, the research team analyzed patient records, dated from 2007 to 2017, of these clinics. The system, which was created by lead author and a current medical student at the University of Michigan, Eric Steinbrook, allowed the team to quantify the distances that patients have been travelling and to look at pregnancy outcomes, treatment-seeking behavior and the relation to the distances they travel.

The study showed that distance travelled strongly predicts loss to follow-up care, miscarriage and even malaria infections in pregnancy for women residing in the Thailand-Myanmar border region. They also found that people lost to follow-up care traveled 50% farther than people who had a normal singleton childbirth, and that people who delayed prenatal care until the third trimester traveled 50% farther compared to people who attended in the first trimester.

“It seems obvious that we need to make healthcare more accessible, but unfortunately many pregnant people in Eastern Myanmar have extremely poor access to medical care outside of basic community-based malaria clinics that we set up beginning in 2014,” Parker said. “Here in the U.S., we tend to focus on high-tech solutions to global health problems, but many people across the world don’t have access to the basic health services that are already available to us in wealthier regions. New healthcare technologies can be great, but we need to remember that many people don’t have the basic healthcare technologies that are already available.”

In this study, the team was able to clearly document the extent of the problem and formulate what steps should be taken to help solve barriers to care.

“We are now working on taking reproductive healthcare to the communities. We really need to decrease the distances that they must travel,” Steinbrook said. “There is tremendous need for prenatal services in turbulent areas around the world. Our study speaks to that need.”

In March of 2021 there was a coup d’tat in Myanmar and the overall situation in the nation has drastically deteriorated. “Our work is even more pressing and important given the current dire situation in Myanmar,” Parker concluded.


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