High rates of maternal death are common among internally displaced persons (IDP) areas, where knowledge of and access to safe delivery procedures are limited. Worldwide, roughly 75% of maternal deaths result from direct obstetric complications, such as hemorrhaging, unsafe abortions, eclampsia, obstructed labor or infection. The other 25% of maternal deaths are the result of preexisting conditions such as malaria, anemia, hepatitis or HIV/AIDS. The good news is that access to emergency obstetric care can significantly lower the risk of maternal death, and that well-trained medics can handle most complications at basic facilities such as the Mobile Health Clinics.
The MOM Project
The Mobile Obstetric Maternal Health Worker (MOM) Project began as a pilot project in 2005 with the goal of increasing access to emergency obstetric care (EmOC) for IDP areas in Eastern Burma. Jointly implemented by Mae Tao Clinic, Burma Medical Association, Johns Hopkins University Center for Public Health and Human Rights, Global Health Access Program, and the health departments of four ethnic states (Mon, Shan, Karenni, and Karen), the MOM Project aimed to lower the rates of maternal and infant death and stressed the need to have a trained attendant at every birth.
In 2009 the pilot stage of the project ended and the activities continued as the Reproductive and Child Health Program (RCHP) under the direction of the Burma Medical Association. The Karen Reproductive and Child Health Program (kRCHP) grew out of the MOM project but did not replace it in Karen state.
The kRCHP currently has 25 maternal health workers (MHWs) working in twelve mobile health clinic areas with a target population of 36,853. Nineteen MHWs of the RCHP, directed by BMA, are working in eight other areas in Karen state with a population of 36,569. Ten RCHP MHWs also work in Karenni, Mon, and Shan States, serving a population of 17,198.
For seven months during 2005 and 2006, 43 trainees enrolled in emergency obstetric care (EmOC) training at the Mae Tao Clinic. Three months were dedicated to theory and four to practical training, with weekly reviews and case studies to reinforce the material. Supplemental workshops were held related to family planning, sexually transmitted diseases, training of trainers, blood screening and transfusion, as well as monitoring and evaluation.
Following the training, the Maternal Health Workers returned to their areas and conducted workshops to train other health workers and traditional birth attendants. These groups received two months and seven days of training, respectively. Both levels of workers receive follow-up training twice a year from the Maternal Health Workers, who themselves return every six months for a month-long refresher course (the first of which was in February 2007).
The components of emergency obstetric care provided in the field during the first year include IV/IM antibiotics, anticonvulsants, non-parental oxytocics, manual removal of the placenta, removal of retained products, and blood transfusions where proper screening tests are available. Maternal Health Workers have received extensive training for vacuum delivery. At this time, however, due to the low rate of indication for its use, it has yet to be implemented in the field.
At the end of 2008, due to security and logistical problems, the program was discontinued at six clinics at the same time as it was begun at three more clinics. Also because of these difficulties there was a decline in provision of ante-natal care during 2009. In 2010 the program was restored in three of the six clinics at which it had been discontinued. A summary of the services provided through 2010 is shown below.
RHFP Services 2007-2010
In 2007, ten KDHW survey team members were trained to conduct a baseline assessment of reproductive health in the projected future KRCHP implementation areas. The survey team conducted a total of 900 interviews with women of reproductive age in a population of nearly 20,000. A follow-up survey with the same methodology was conducted in 2010. The principal results of the surveys are shown below.
Results of the Baseline and Follow-up RHFP Assessments