Cultural and contextual challenges of childbirth in conflict

Background
The people of Myanmar face challenges from natural hazards such as cyclones and floods in addition to instability caused by human factors, such as the ongoing political instability. Those in need of maternal and neonatal care are especially vulnerable due to these risks, which are reflected in high mortality rates.
Aim
The aim was to gain insight into the challenges faced by women from ethnic minorities during pregnancy and infant care. We set out to identify cultural beliefs, practices, and barriers to accessing care with a particular interest in those living in remote areas.

Method
Following ethical approval, two face-to-face focus group interviews were conducted within two local communities of Karen State, Myanmar. Framework analysis was applied to the data and key themes were identified and then analysed based upon a recently developed Model of Maternal Risk that encompasses “Context, Maternal Healthcare, Infant Care and Culture”. The focus groups were implicitly addressing PPI

Findings
Data suggested that insufficient transport availability as well as reduced access to medical staff and facilities lead to poor outcomes in maternal and neonatal care. In addition, communities faced significant threats associated with ethnic conflict and inadequate response to intrapartum emergencies.

Conclusion and impact
Political instability, conflict, and poor infrastructure all affect the maternal and infant mortality due to decreased medical resources, a lack of antenatal education and reduced access to midwifery services. We suggest that impact may be achieved through community engagement, ensuring sustainability with education on antenatal and postnatal care.